The benign fibrous histiocytoma is a rare tumor with only a few descriptions. In order to better define the optimal therapeutic procedure and the necessity of surgery we retrospectively analyzed the patients of the orthopedic department. Benign fibrous histiocytoma occurred in the femur (n = 3), pelvis (n = 2), humerus, tibia, fibula, rib and spine. Pain as the cardinal symptom and a median age of 28 years are factors that differentiate benign fibrous histiocytoma from other metaphyseal fibrous lesions such as the nonossifying fibroma. Radiographic investigation of this entity showed osteolytic lesions with eccentric thinning of the cortex and small fissures. To a variable extent, sclerosis was found in the margin of the lesions. Computer tomography revealed dense soft tissue in the lesions, but one lesion was filled with fluid. The tumor was restricted to bone, with no periosteal or soft tissue reaction. Magnetic resonance imaging showed enhancement of the tumor after administration of contrast medium. All lesions had uniform histological findings. Although no pathologic fracture occurred in any case, local expansion of the tumor was indicated by cortical thinning, small fissures and pain. This implied that the patients needed prophylactic curettage and bone grafting. Surgery restricted to the osteolytic area was sufficient to prevent recurrence.