Mateusz Gładysz FESSH prep

FESSH prep Hand tumours

Osteoid osteoma, giant cell tumour of bone and aneurysmal bone cyst

Last reviewed v1.0

FESSH-101Hand tumours●●○ intermediate

Regarding osteoid osteoma, giant cell tumour of bone and aneurysmal bone cyst:

  1. 1.In the carpus, worsening night pain that is relieved by non-steroidal anti-inflammatory drugs favours osteoid osteoma over osteoblastoma.

  2. 2.In the bones of the hand, giant cell tumour of bone recurs less often after curettage than after other surgical methods.

  3. 3.In a skeletally mature patient, a typical giant cell tumour of a long bone is an eccentric lytic lesion extending close to the articular surface.

  4. 4.Primary aneurysmal bone cysts of long bones are usually centred in the epiphysis rather than the metaphysis.

  5. 5.The presence of fluid–fluid levels on magnetic resonance imaging is enough on its own to distinguish an aneurysmal bone cyst from a telangiectatic osteosarcoma.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-101
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In the carpus, worsening night pain that is relieved by non-steroidal anti-inflammatory drugs favours osteoid osteoma over osteoblastoma.

    True

    In Zhao and colleagues' single-centre series of 20 surgically treated patients with carpal lesions (16 with osteoid osteoma and 4 with osteoblastoma), osteoid osteoma had higher night-pain worsening scores and lower pain scores after non-steroidal anti-inflammatory drugs. On computed tomography, osteoid osteomas were also much smaller (median diameter 5.8 mm against 18 mm) and more mineralised; the series is small and retrospective (level IV).

    • Zhao B, Zhang J, Yu D, Zheng Y, Yang Z, Xiong G. Distinguishing characteristics of carpal osteoid osteoma versus osteoblastoma: a comparative study. J Hand Surg Eur Vol. 2026:17531934261454029. PMID 42316854

  2. 2. In the bones of the hand, giant cell tumour of bone recurs less often after curettage than after other surgical methods.

    False

    A 2024 systematic review of 13 cohort and case–control studies (244 patients) found an overall recurrence rate of about 20% for giant cell tumour of bone in the hand, with curettage associated with higher recurrence than other surgical methods. In Peimer and colleagues' earlier series of multicentric giant cell tumour, every lesion in the hand treated by curettage recurred.

    • Berger O, Mendelson M, Goren D, Andrakhanov A, Talisman R. Recurrence and Risk Factors of Giant Cell Tumors in Hand Bones: A Systematic Review. Plast Reconstr Surg Glob Open. 2024;12(10):e6253. PMID 39421677
    • Peimer CA, Schiller AL, Mankin HJ, Smith RJ. Multicentric giant-cell tumor of bone. J Bone Joint Surg Am. 1980;62(4):652-6. PMID 7380862

  3. 3. In a skeletally mature patient, a typical giant cell tumour of a long bone is an eccentric lytic lesion extending close to the articular surface.

    True

    The typical giant cell tumour occurs after physeal closure and has an eccentric lytic appearance with a well-defined but non-sclerotic margin, extending close to the articular surface. This pattern guides the differential diagnosis; it is not proof of the diagnosis, and more aggressive lesions may expand or destroy the cortex.

    • Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013;33(1):197-211. PMID 23322837

  4. 4. Primary aneurysmal bone cysts of long bones are usually centred in the epiphysis rather than the metaphysis.

    False

    A primary aneurysmal bone cyst usually involves the metaphysis or metadiaphysis of a long bone and often appears as an eccentric expansile lytic lesion. A purely epiphyseal lesion should raise concern for an underlying tumour with secondary aneurysmal changes, such as giant cell tumour or chondroblastoma. Location guides the differential diagnosis rather than acting as an absolute exclusion rule.

    • Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol. 2022;52(9):1601-1614. PMID 35941207
    • Nasri E, Reith JD. Aneurysmal bone cyst: a review. Journal of pathology and translational medicine. 2023;57(2):81-87. PMID 36950810

  5. 5. The presence of fluid–fluid levels on magnetic resonance imaging is enough on its own to distinguish an aneurysmal bone cyst from a telangiectatic osteosarcoma.

    False

    Zishan and colleagues note that the two lesions share fluid–fluid levels on magnetic resonance imaging (MRI), as well as a young age at presentation and a lytic radiographic appearance. In their 183 patients, the MRI features favouring aneurysmal bone cyst were a smaller lesion, no soft-tissue mass, fluid levels filling more than two-thirds of the lesion and thin septal enhancement.

    • Zishan US, Pressney I, Khoo M, Saifuddin A. The differentiation between aneurysmal bone cyst and telangiectatic osteosarcoma: a clinical, radiographic and MRI study. Skeletal Radiol. 2020;49(9):1375-1386. PMID 32248448