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- Skeletally immature!
- L: diaphyseal, eccentric arising from cortex with central lucent nidus
- A: Lytic,
- R: Narrow zone, no periosteal reaction
- M: Heterogenous, blastic
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- < 2cm OO; > 2cm OB
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- Increased local concentration of prostaglandin E2 --> Pain!
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- Nidus - central nodule of woven bone [radioluscent with central radiodensity]
- Reactive zone - area of thickened bone and fibrovascular tissue
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- No
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- Lower extremity 50% (proximal femur > tibia diaphysis), talar neck
- Spine in 10-15%! (OB more than OO) - posterior elements! (Like ABC)
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- Painful!
- Painful scoliosis!
- Acute pain crisis precipitated by vasodilation (e.g. alcohol)
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- CT is preferred over MRI
- Bone scan - hot area at nidus, low update at reactive zone "double density sign"
- Histology - distinct demarcation of nidus and reactive bone
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- NSAIDs + clinical observation
- Successful in 50% (they will burn out)
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- Percutaneous CT Guided RFA - 90/6/1
- “Probe at 80-90° , 6min for 1cm of necrosis)”
- Successful in 90% after 1-2 sessions
- 10-15% recurrence rate
- Contraindicated in spine/near NV structures
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- Marginal excision and curettage
- 94% successful
- In spine, associated scoliosis does not need treatment ➔ will recover when pain removed
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- Standard of care is surgery! (as it is not self limiting - aggressive)
- Intralesional curretage biopsy and bone grafting
- Standard of care
- Recurrence 10-20%
- If large - en bloc resection
- Conservative management not advisable as lesion will grow - aggressive but benign tumour