11. BONE NEOPLASMS in Medical Pathology.pptx

Bone neoplasms pathology

1. BONE NEOPLASMS DR KINGORI

2. A bone tumor is an abnormal growth of cells within a bone. refers to a neoplastic growth of tissue in bone .

3. Causes The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: -Genetic defects passed down through families -Radiation -Injury In most cases, no specific cause is found.

4. Symptoms Symptoms of bone tumor may include any of the following: -Bone fracture, especially fracture from slight injury (trauma)-pathological fractures - Bone pain , may be worse at night -Occasionally a mass and swelling can be felt at the tumor site Some benign tumors have no symptoms.

5. Diagnosis Blood -Full haemogram - Low HB level in malignant disease Alkaline phosphatase enzyme- levels are raised in bone tumours. This test is more reliable in adults who have stopped growing.

6. Imaging Tests This is to determine the size and exact location of the tumor . A plain xray Depending on the X-ray results, other imaging tests may be necessary. These includes: CT scan - computed tomography: It produces a series of detailed images taken from several angles. Good with bone tissues

7. imaging MRI , or magnetic resonance imaging: It takes detailed pictures of the area in question and is very good with soft tissues. Its more detailed than CT scan. PET scan , or positron emission tomography: Uses radioactive elements given intravenous and locates the tumour cells Angiogram : elaborates on blood vessels.

8. Others Chest xray – This is used to rule out matastasis to the lungs. Chest CT scan- Is more sensitive than the xray

9. Biopsies a sample of the tissue is removed and taken for histology. The main types of biopsies are: - a needle biopsy, - incisional biopsy and - excisional biopsy.

10. A needle biopsy This may be done under the guidance of Ultrasound, CT scan or MRI. An incisional biopsy- Part of the tumour is removed surgically for histology excisional biopsy – Is both diagnostic and curative . The whole extent of the tumour is removed. The bone biopsy is important to make a definite diagnosis

11. Staging of malignant musculoskeletal tumours- Enneking staging -Histology (Low grade, High grade stage-I,II), -Site ( Intracomparmental,extracomparmental -A,B), -Metastasis- Stage III

12. Principles of treatment -Leave alone- some benign tumours eg bone cyst 1.Surgical - Wide excicion eg Chondrosarcoma -Amputations -Limb salvage procedures (custom made prosthesis) 2.Chemotherapy - eg Osteosarcoma ( Surg+chemo ) Neo-adjuvant, adjuvant chemotherapy

13. 3.Radiotherapy (pain relief eg secondaries ), Ewings sarcoma Secondary bone tumours- Investigate and treat the primary

14. Classification 1. Primary bone tumours Benign: This arise from bone but do not metastasise. Malignant- This arise from bone and have the potential to metastasise. 2 -secondary tumours - These arise from other organs and matastasise to the bone

15. Benign bone tumours Benign tumors are more common than malignant ones. the most common type is osteochondroma . This type accounts for between 35 and 40 percent of all benign bone tumors .

16. Osteochondromas Osteochondromas develop in adolescents and teenagers. The tumors form on the metaphysiss of long bones. Most commonly at the knee. These tumors are formed of a combination of bone and cartilage. The osteochondroma has been considered to be an abnormality of growth. A child may develop a single osteochondroma or many.

17. Unicameral bone cyst unicameral cyst is a simple solitary bone cyst. It is the only true cyst of bone. occurs most often in children and adolescents.

18. Aneurysmal Bone Cyst An aneurysmal bone cyst is an abnormality of blood vessels that begins in the bone marrow. It can grow rapidly and can be particularly destructive because it affects growth plates.

19. Giant Cell Tumors Giant cell tumors grow aggressively. They occur in adults and begin on the epiphysis. These are rare. X-ray- bubblesoap appearance Majority of them are benign but there are a few that are malignant.

20. Enchondroma An enchondroma is a cartilage cyst that grows inside the bone marrow. When they occur, they begin in children and persist in adults. They tend to be part of syndromes called Ollier’s and Mafucci’s syndrome. Enchondromas occur in the hands and feet as well as the femur and humerous .

21. enchondroma

22. Fibrous Dysplasia Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to fracture .

23. Primary malignant bone tumours These are less common than secondary metastatic tumours. Osteosarcoma Begins in bone cells and is most common around the knee. It affects long bones and begins from the metaphysis . It is found in teenagers and young adults. X-ray features- Sunburst/ray appearance - Codman's triangle

24. Ewing's sarcoma -Affects young people between the ages of 10 and 20. -Ribs, pelvis, tibia, and humerous are the most common sites. It usually shows up in bone, but can also start in soft tissue around bones. X-ray features- Onion peel appearance 

25. Chondrosarcoma -occurs most often in people between 40 and 50. -The ribs, pelvis, tibia, humerous , and scapular (more on flat bones) are more common sites of this tumour, which begins in cartilage cells. - xray features- calcification is noted.

26. Chordoma - This is a tumour of the skull and bones of the spine. More common in adults over age 40 it tends to grow slowly and is less likely than other tumours to spread.

27. secondary tumours - Breast -Thyroid -Lungs -GIT -Prostate -Kidney Majority- Lytic Prostate- mixed picture – lytic , blastic

28. Multiple myeloma

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