Pediatric Bone and Soft Tissue Tumor

The Pediatric Bone and Soft Tissue Tumor Program, led by affiliated physician, Ernest “Chappie” Conrad III, MD, offers an experienced team of specifically trained physicians and nurses to treat all types of bone and soft tissue tumors, both benign (non-cancerous) and malignant (cancerous).

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Timely diagnosis is key to the management of bone and soft tissue tumors. Families benefit from the coordinated care provided by a specialized team, including orthopedic surgeons, radiologists, nurses, pathologists, physical therapists and Child Life specialists, who strive to provide quality care to every patient. Children’s Memorial Hermann Hospital offers limb salvage surgery for malignant tumors. This is an advanced surgical approach, aimed to protect the child’s leg or arm and preserve normal growth, while also achieving an adequate resection of the bone or soft tissue tumor.

What Are Tumors?

Tumors are growths that typically form when a group of abnormal cells multiply in one specific area of the body, resulting from injury or disease. Bone and soft tissue tumors can either be benign or malignant. Malignant tumors of the musculoskeletal system are commonly referred to as sarcomas. They have an aggressive growth rate and the ability to spread to more distant locations in the body. Benign tumors generally are limited to a small area and are usually less harmful to the patient.

Bone Tumors   Soft Tissue Tumors   Diagnostic Imaging

Treatment Options   Limb Sparing Surgery   Why Choose Us?

Conditions We Treat

• Aneurysmal bone
• Baker’s cysts/Ganglion cysts
• Chondroblastoma
• Chondrosarcoma
• Ewings sarcoma
• Fibrosarcoma
• Fibrous dysplasia (osteofibrous dysplasia, other skeletal dysplasia)
• Lipomas or fibromas
• Non-ossifying fibromas (fibrous cortical defect)
• Osteoblastoma
• Osteochondromas (exotosis, enchondroma)
• Osteoid osteomas
• Osteosarcoma
• Other malignant tumors
• Rhabdomyosarcoma
• Synovial cell sarcoma
• Unicameral bone cysts
• Vascular malformations

Bone Tumors

A bone tumor is a mass of cells that develops inside of the skeletal system, specifically on the bone. Most bone tumors are not cancerous and are not life-threatening. All tumors are classified as benign or malignant.

Benign bone tumors are much more common than malignant bone tumors. They almost never advance to become cancerous. The three most common benign bone tumors found in children are:

• Exostosis or osteochondromas – A tumor made up of bone and cartilage. This type of tumor is commonly found in small bones like the ribs and also found adjacent to major growth plates (area of growing tissue that determines future length and shape of the bone) next to a child’s joints. Sometimes larger growths can grow in areas where two bones connect like the ankles, knees, shoulders, elbows and hips.
• Nonossifying fibroma – The most common benign bone tumor in children. It is a collection of abnormal cells mainly formed from scar tissue. This type of tumor usually occurs in long bones like the femur (thighbone) or tibia (shin bone).
• Unicameral bone cysts (UBC) – These are holes in the bone that fill up with fluid or tissue. These types of tumors are most likely to occur in the bones of the upper arm or upper leg but can occur in the pelvis, rib cage and heel bone. It usually affects children between 5 and 15 years old, but can affect older children.

Malignant bone tumors (bone cancers) can occur in any bone in the body. They can be aggressive and spread cancer cells to other parts of the body. A malignant bone tumor can threaten limb or life.

• Ewing Sarcoma – The second more common malignant bone tumor in kids. It represents 10% to 15% of childhood bone cancers¹ and is most common in teenagers and young adults. Ewing Sarcoma typically begins in the long bones of the pelvis, legs or arms, but it can occur in any bone. Less often, Ewing Sarcoma begins in the soft tissues of the arms, legs, and abdomen.
• Osteosarcoma – The most common malignant bone tumor in children and young adults between the ages of 10 and 20. It often occurs during a growth spurt and is more common in young males.

What are common symptoms of bone tumors?

Symptoms of a bone tumor vary based on the specific tumor type, where it is located and if it has grown or spread. The most common symptoms associated with bone tumors include:

• Pain in the bone or joint. Pain can present as a dull ache, which begins sporadically and then becomes persistent with more severe pain.
• Swelling at the site of the tumor.

If your child is experiencing persistent pain and/or swelling in his/her bones and/or joint lasting for more than one to two weeks, he/she should be evaluated by their pediatrician, primary care physician or an orthopedic specialist.

Soft Tissue Tumors

Soft tissue tumors typically form in connective tissues of the musculoskeletal system such as muscles, tendons, fat and skin. All soft tissue tumors are classified as benign or malignant.

The most common benign soft tissue tumors found in children include:

• Fibromas – A painless soft tissue tumor that usually enlarges slowly over several years and can be monitored without any additional treatment. This tumor is mainly found in the hands and feet.
• Lipomas – Comprised of mainly fat cells and usually located in arms and legs.

Malignant soft tissue tumors are not common in children but can occur at any age and in any musculoskeletal location. They are typically a challenging diagnosis to make. These cancers begin in soft tissues that connect or support other areas of the body including muscles, tendons, fat, blood vessels, nerves and the soft tissues in and around joints. The most common malignant soft tissue tumor in children is:

• Rhabdomyosarcoma – This cancer begins in muscles that are attached to the bone. It can start in nearly any muscle of the body.
• Most malignant soft tissue tumors occur much later in life and are not common in kids.

What are common symptoms of soft tissue tumors?

Soft tissue tumors are commonly diagnosed when the mass becomes visible under the skin. MRI imaging is required for soft tissue tumors larger than 3 centimeters. Soft tumors usually cause little to no pain and grow slowly over several years.

Children’s Memorial Hermann Hospital offers several diagnostic imaging options when determining the best treatment plan for every patient. The following tests and procedures may be used:

• CT (computed tomography) scan
• MRI (magnetic resonance imaging) if the X-ray is not conclusive
• Physical exam and medical history
• Ultrasound
• X-ray

Benign bone tumors, in general, are best imaged with regular X-ray. Malignant bone tumors require both X-ray and MRI. For benign or malignant soft tissue tumors larger than 3 centimeters, MRI is required, especially if those tumors are showing signs of growth. If imaging tests show there may be a bone or soft tissue tumor, a biopsy should be done prior to tumor resection or removal. Biopsy of the tumor involves withdrawal of a small sample of the abnormal tissue to confirm findings based on imaging results.

The multidisciplinary team of affiliated physicians provides both operative and non-operative treatment options for children with bone and soft tissue tumors. Whether the tumor is benign or malignant, all tumors require proper treatment upon diagnosis. Timely diagnosis is key to the management of bone and soft tissue tumors.

If your child is experiencing persistent pain and/or swelling in their bones and/or joint lasting for more than one to two weeks, they should be evaluated by their pediatrician, primary care physician or a pediatric orthopedic specialist.

Non-surgical Management

Benign bone and soft tissue tumors can be periodically monitored for approximately 6-12 weeks with repeat X-ray to determine the extent of pain, make decisions about treatment, obtain additional imaging ( e.g. MRI), or biopsy.

Surgical Treatment

Large painful benign tumors are usually surgically removed and require a bone graft to fill the tumor bony defect.

Certain types of benign bone tumors can effectively be treated through less invasive surgical treatments. These include radiofrequency ablation, used to reduce pain, or cyst injections, to treat the tumor. Currettage, the removal of tissue, and bone grafting are required for large and/or painful benign bone tumors. This may require two to three months of recovery. Surgery to remove the tumor will eliminate pain, prevent fractures and deformities.

Malignant bone and soft tissue tumors are less common and require timely diagnosis with an MRI and biopsy. Your team of specialists will determine the best treatment options available depending on the type of tumor, its location and if the cancer has spread to other parts of the body. For children with malignant tumors, treatment may include radiation therapy, the use of high energy waves to kill or shirk cancer cells, surgery to remove the tumor or chemotherapy, medicines used to fight cancer cells given orally or through an IV. Surgical treatment for malignant tumors is frequently referred to as limb salvage or limb sparing surgery because it is can preserve a child’s leg with good function and the risk of tumor recurrence is very small (10%).

What Is Limb-Sparing Surgery for Malignant Tumors?

Limb-sparing surgery, also referred to as limb-salvage surgery, is a treatment option for malignant (cancerous) bone or soft tissue tumors. This approach removes the malignant tumor while reconstructing the resulting bony defect in the affected limb. Surgical options for treating malignant tumors include amputation of the extremity to minimize the risk of tumor recurrence if the tumor is very large. Limb salvage focuses on removing the involved bone and affected soft tissues and keeping the limb intact. After removal of the tumor and surrounding soft tissue, a bone graft transplant or total knee or total hip implant is used to reconstruct the defect. Patients are usually given chemotherapy before and after surgical tumor resection.

For young children under 12 years of age who undergo limb sparing surgery, it is especially important to preserve the growth plate. At Children’s Memorial Hermann Hospital, the affiliated surgeons use devices called growing prostheses, implants, so the growth plate is separated from the tumor and saved. This technique can make it possible for young kids to have limb-sparing surgery even if a tumor is removed in or near the growth plate in their extremity.

The Pediatric Bone and Soft Tissue Tumor Program, affiliated with Children’s Memorial Hermann Hospital and the affiliated physicians at McGovern Medical School at UTHealth, offers a multidisciplinary team working together to optimize treatments for each patient’s unique case. Children’s Memorial Hermann Hospital is a comprehensive academic medical center capable of providing services to children of all ages.

The affiliated orthopedic surgeons and multidisciplinary team offer a continuum of care and are ready to care for any orthopedic condition children may face.

• The affiliated orthopedic surgeons have been focused on treating bone and soft tissue tumors in kids for more than 30 years
• Extensive experience in bone and soft tissue tumors and limb salvage surgery²
• Children’s Memorial Hermann Hospital has been providing high-quality, safe and effective care to kids for more than three decades.

¹https://www.acco.org/bone-cancer/

²https://www.ncbi.nlm.nih.gov/pubmed/?term=ernest+conrad

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Children's Memorial Hermann Hospital
6411 Fannin
Houston, TX 77030

Phone: (713) 486-4880