Bone tumor a lecture for orthopedicS.pdf

Bone tumor a lecture for orthopedic

1. Bone tumors
•Rare tumors (< 2%)
•More in young ages

2. Classification
•Origin
–Primary
–Secondary(95%): breast, lung, prostate, kidney and
thyroid
•cell type:
–BoneOsteoma, osteosarcoma
–CartilageChondroma, Chondrosarcoma
–MarrowHemangioma, angiosarcoma
–FibroustissueFibroma, fibrosarcoma
•Tumor type:
–Benign: Osteoma, osteochondroma
–Malignant:: Osteosarcoma, chondrosarcoma

3. Symptoms and Signs
•Asymptomaticand discovered accidentally.
•General: fatigue, fever, wt. loss
•Masscan be felt at the tumor site.
•Pain:
–May worsen at night and awakes patient, caused by
–Tumor compression on surrounding tissue
–Hemorrhage in the tumor
–Pathological fractures
•Swelling
•Local tenderness
•Warmth
•Pathological fracture: may be the first sign.

4. Malignant vs. Benign Tumors
•Rapidgrowth
•Warmth
•Tenderness
•Ill defined edges
All are suggestive of malignancy.

5. Investigations
•Historyand examination
•Imaging (x-ray, CT, MRI & radionuclide scanning)
•Biopsy
•Labs
•Ca& P: Greaterthan normal levels may indicate bone
metastasis.
•PTH: Lowerthan normal levels may indicate bone metastasis.
•ALPisoenzyme: Higherthan normal ALP levels may indicate
Paget's disease, osteoblasticbone cancers, osteomalaciaand
rickets.
•LDH: Highvalues indicate poor prognosis

6. •CT and MRI
•Asses the extentof the tumor
•Relation to surrounding structures
•Radionuclide scanning:
•Helpful in revealing site of a small tumor
•Skip lesions
•Silentsecondary deposits

8. Benign tumors

9. Benign bone tumors
•Non ossifying fibroma
•Osteochondroma(the Commonest)
•Osteoidosteoma
•Enchondroma
•Giant cell tumor of bone
•Osteoblastoma

10. Osteochondroma(exostosis)
•Commonestbenign tumor of bone
•More in male <25y.
•Solitary
•Mature bone with cartilaginous cap.
•Common sites are the fast growing sites of long bones (lower
end of femurand upper end of tibia), crest of ileum&
shoulder.
•Flattened (sessile) or stalk-like (exostosis)
•Most likely caused by Congenital defect or traumaof the
perichondrium, which results in the herniationof a fragment of the
epiphysealgrowth plate through the periostealbone cuff.
•OsteochondromasSmall risk of malignant
transformation(<1%)

11. Symptoms:
•A hard, immobile, detectable massthat is painless
•Lower-than-normal-height for age
•Musclesoreness
•One leg or arm may be longerthan other
•Pressure or irritationwith exercise
•X-Ray:
•Exostosis: well defined bony projection
•Calcified cartilage in large lesions
Treatment: excisionif becoming bigger and more painful.

12. •Solitary osteochondroma.
•Lateral radiograph of a
sessile osteochondromaof
the distal femur

13. Osteoidosteoma
•Neoplasticproliferation of osteoidand fibrous tissue
•More in male < 30 year
•more in vertebraor long bones
•Less in mandible or other craniofacial bones.
•Smallin size (<1.5 cm)
•Ovalor rounded shape
•Pain(severe) worse at night ,not relieved by rest but relieved
by aspirin.
•Types: Cortical, cancellous, subperiosteal.
•Treatment: Complete removal after careful localization by
CT.

14. X-Ray
•Nidus: tiny radiolucent area
•Diaphysissurrounded by dense bone and
thickendcortex
•Metaphysislesscortical thickening

15. •Male 23 years old
•History of increasing pain in the knee
& relieved by aspirin.

16. •Plain radiograph in a
25-year-old male with
corticalosteoid
osteoma. shows a
radiolucent nidus
surrounded by fusiform
cortical thickening

20. Malignant tumors
•Primary
•Secondary (metastasis)

21. Primary bone cancer
Risk factors:
1.Radiotherapy& chemotherapy
2.Paget'sdisease
3.Family Hx(hereditary retinoblastoma)
Signs & symptoms
•Fever, Night sweats, Fatigue& Unintended weight loss
•Bone painthat often is nocturnal
•Swelling& tendernessnear the affected area
•Pathological fractures

22. Osteosarcoma
•Most common primary bone malignancy
•Incidence: 2.8 per million
•M >F
•Age 10-25 years (the 8
th
most common childhood cancer)
Prognosis
•Aggressivetumor
•Metastasisto the lung
•5-year survival
–Without metsis 70%
–With metsis 25%

23. Where
Mainly affects metaphysis
of long bones
More in:
•Knee
–Distal femur
–Upper tibia
•Humerus(prox.end)
•Maxilla

24. Clinical features
•Pain:
–Dull aching
–Progressive
–Constant
–Worse at night
•Swelling
•Redness
•Hotness
•Tenderness
•Pathological fracture

25. X-ray findings
1.Lesion
2.Cortical destruction
3.Extensionto the marrow or soft tissue
4.Codman’s triangle a term used to describe the triangular area
of new subperiostealbone that is created when a lesion, often
a tumour, raises the periosteumaway from the bone.
5.Sunburst Effect
Osteosarcomascan be
•Predominantly osteolytic
•Predominantly osteoblastic
•Mixture

26. Sunburst Appearance

27. Ewing sarcoma
•A malignant round-cell tumor.
•Raredisease (incidence 0.6 per million
•2
nd
most common bone malignancy in pediatrics.
•M>F
•Age 10-20 years
•Usually the lesions are diaphyseal
•Mets(30%), most commonly in the lungs& other
bones& less commonly in the bone marrow.

28. Clinicalfeature:
•Pyrexia
•Pain:
–Constant
–Increase with movement
•Limping
•Swelling, warm, tender & red
Radiologicalstudies:
1.X-Ray
1.Lyticmedullarylesion
2.Onionskin appearance
2.CT-scan
3.Bone scan & MRI

29. •White arrow: onionskin apperance
•Red circle: sunburstperiostealreaction
•Blue circle: osteolyticlesion

30. Treatment:
1.Local radiotherapycombined with systemic
chemotherapy
2.In young children amputationmay be necessary
due to severe compromise of bone growth.
Prognosis, 5-year survival
•50% with the 1
st
approach
•75% with the 2
nd
approach

31. Metastatic bone tumor

32. •Most common malignant lesion of the bone.
•The most common sites of spread of cancers arelung, liver&
skeleton.
•Carcinomasare much more likely to metastasize to bone than
sarcomas
•Typically multifocalBUT renaland thyroidcarcinomas produce
only a solitarylesion.
•Common sites for metastasis:
–Vertebrae, pelvis, proximal parts of the femur, ribs, proximal
part of the humerus, and the skull.
–Batson venous plexus >> more metsto the axial skeleton
–Hands& feetare rare
–50% of them originate from lung neoplasms.
•Mets:
1.Directextension
2.Retrograde venousflow
3.Seedingwith tumor emboli via the bloodcirculation

33. Destructive expanded
osteolyticlesion in the
metacarpalof the thumb
in a 55-year-old man with
lung carcinoma.

34. Thank You
Good Luck