Tumors of bone

tumors of bone

1. TUMORS OF BONE ANKIT KUMAR BRIT 2 nd Year

2. Introduction Classification of tumors Etiology/ Cause Staging of bone tumor Diagnosis: radiology lab diagnosis Treatment Complication References CONTENT

3. INTRODUCTION TUMOR : When cells divides abnormally and uncontrollably, they can form a mass or lump of tissue . Bone tumors grow when cells in the bone divide without control, forming a mass of tissue . Tumors can either be BENIGN( non cancerous ) or MALIGNANT ( cancerous ) .

4. According to WHO

5. Bone tumours may be primary or metastatic. Since histogenesis of some bone tumours is obscure, the WHO has recommended a widely accepted classification of primary bone tumours based on both histogenesis and histologic criteria . The various types of bone tumours arising from different tissue components— osseous and nonosseous , indigenous to the bone . Anatomic locations of common primary bone tumours

6. BONE FORMING TUMOR

7. CARTILAGE – FORMING TUMORS

8. MISCELLANEOUS TUMORS

9. BONE –FORMING TUMORS

10. Tumor Type Locations Age BENIGN Osteoma Facial bones, skull 40-50 Osteoid osteoma Metaphysis of femur and tibia 10-20 Osteoblastoma Vertebral column 10-20 MALIGNANT Primary osteosarcoma Metaphysis of distal femur, proximal tibia, and humerus 10-20 Secondary osteosarcoma Femur, humerus , pelvis >40

11. OSTEOMA Osteoma are benign lesions of bone that in many cases represent developmental aberrations or reactive growths rather than true neoplasms . SITE- facial bone , skull

12. OSTEOSARCOMA Osteosarcoma is a bone-producing malignant mesenchymal tumor . SITE – Metaphysis of distal femur, proximal tibia and humerus . Radiograph

13. Gross feature Distribution of osteosarcoma

14. OSTEOID OSTEOMA Osteoid ostoma is benign bone forming tumor typically occur in children. They cause night pain. SITE- Metaphysis of femur an tibia .

15. CARTILAGE- FORMING TUMORS

16. Tumor Type Locations Age BENIGN Osteochondroma Metaphysis of long tubular bones 10-30 Chondroma Small bones of hands and feet 30-50 MALIGNANT Chondrosarcoma Bones of shoulder, pelvis, proximal femur, and ribs 40-60

17. OSTEOCHONDROMA Osteochondromas are mushroom shaped and range in size from 1 to 20 cm . The outer layer of the head of the osteochondroma is composed of benign hyaline cartilage varying in thickness Newly formed bone forms the inner portion of the head and stalk, with the stalk cortex merging with the cortex of the host bone.

18. CHONDROSARCOMA Chondrosarcomas comprise a variety of tumors sharing the ability to produce neoplastic cartilage. SITE- Pelvis Shoulders Ribs Rarely invole in distal part of extremitis . Chondrosarcoma radiograph

19. GIANT CELL TUMOR This is a neoplasm that contains large numbers of osteoclast like giant cells admixed with mononuclear cells. These tumors are slightly more common in females

20. EWINGS SARCOMA May be confused with osteomyelitis Commonly affects diaphysis with onion skin appearance

21. ETIOLOGY Few possible causes are genetics, radiation treatment and injuries to the bone . osteosarcoma has been linked to radiation treatment and other anticancer drug , espically in children. The tumor often occur when parts of the body are growing rapidely . Those people who have bone fractures repaired with metal implants are more likely to develop osteosarcoma later.

22. Benign tumors ( Enneking staging of benign tumors) Stage 1 – latent Stage 2 – active Stage 3 - aggressive Malignant tumors AJCC ( American joint committee on cancer) staging system TNM ( Tumor, Noes , Metastasis ) staging Musculoskeletal tumor society staging system( enneking ) Surgical staging Note: Benign tumors - classified using Arabic numerals(1,2,3) Malignant tumors - classified using roman numerals(I,II,III ) STAGING OF BONE TUMOR

23. SIGN A tumour when looking at an X-ray of another problem ,such as a Sprain . symptoms may include pain that: Is in the area of the tumor Is dull or achy May get worse with activity Wakes you at night Trauma does not cause a bone tumor, but a bone that is weakened by a tumor may break more easily. This can cause severe pain.

24. Fever Night sweats Swelling around a bone Limping Note :- if you think you have a bone tumor , you may need blood and imaging test(such as x-ray). To confirm a diagnosis, your doctor may remove body tissue with a needle or through a cut from suspected area and have it examine under a microscope for sign of tumor /cancer. This is called a biopsy. SYMPTOM

25. RADIO IMAGING Plain radiograph : -( knee –AP/Lat) - ( pelvics – AP/ Judet view CT scan MRI Radionuclide scanning PET SCAN

26. Information yielded by radiography includes : Site of the Lesion Borders of the lesion/zone of transition Type of bone destruction Periosteal reaction Matrix of the lesion Nature and extent of soft tissue involvement RADIOGRAPHY

27. TREATMENT Benign tumor are watched or may be treated with medication. Medication : Bisphosphonate drug dose : once a week Strontium-89( i.v . ) dose : once in 3 months 2. SURGERY : Limb salvage surgery removes the part of the bone with cancer. Nearby muscles, tendons, and other tissues are not removed. A metallic implant replaces the portion of the bone that was removed. Amputation may be done if a tumor is large or extends to nerves and blood vessels.

28. Cont. 3. Radiation therapy kills cancer cells and shrinks tumors with high-dose x-ray (such as chondrosarcoma ) . It is used in combination with surgery and may be used before or after surgery. 4.Chemotherapy kills tumor cell with cancer drug. It may given before surgery, after surgery ,or for metastic disease. Complication of chemotherapy include: Nausea and vomiting caused by intestinal problem Loss of hair Anemia or low blood count Infection Loss of apetite and weight loss soreness of mouth, gums and throat

29. COMPLICATION Tumor-related bone: Bone loss Bone pain Hypercalcemia ( increase blood calcium) Osteomylitis Metastasis

30. REFERENCES Text book of pathology;sixth edition;harsh mohan https://www.webmd.com/cancer/bonetumor https://www.healthline.com/health/bone- tumors#outlook https://www.texasoncology.com/types-of-cancer/bone-cancer/bone-complication-and-cancer

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