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Tumor

1. tumour Lt col (Dr.) md mahbub ali MBBS,ms ( ortho surg ) Head of the department Dept. of orthopaedic surgery Cmh bogura & AMCB

2. Abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change. ( willis ) Definition

3. Primary Bone tumour Benign Intermediate Malignant Secondary bone tumour (Most common) Breast Bronchus (Lung) Thyroid gland Prostate Kidney classification

4. classification

5. Classification according to site

6. Most common bone tumour according to age

7. Commonest site of bone metastasis

8. Definition: Grading defines as degree of differentiation of the tumours cell and the number of mitoses within the tumours . Grading procedure: Grade-I: More than 75% cell differentiated Grade-II: 75-50% cell differentiated Grade-III : 50-25% cell differentiated Grade-I: Less than 25 % cell differentiated grading

9. Definition: Staging is the process of assessing the extent of spread of malignant lesion both locally and distantly. staging

10. Enneking staging of malignant tumors: staging Low grade lesions are well-differentiated, have few mitoses, and exhibit only moderate cytological atypia . The risk for metastases is low. (25%) High grade lesions are poorly differentiated with a high mitotic rate and a high cell-to-matrix ratio.

11. Tumor excision Limb salvage Amputation Multi agent chemotherapy Radiotherapy Methods of treatment

12. a. Intracapsular / intralesional excision and curettage: For benign lesion with very low risk of recurrence Incurable tumor‚ needs debulking to relieve local symptoms. b. Marginal excision: Tumor tissue + Pseudocapsule Suitable for benign lesion Chemical cauterization: 70% Methyl alcohol+ 5% phenol Cryosurgery: Liquid Nitrogen Resulting cavity filled with bone graft or bone cement. Treatment: Tumor excision

13. c. Wide excision: Tumor tissue + Pseudocapsule + compressed tissue+ portion of normal tissue 5 cm d. Radical resection: Whole of anatomical compartment where tumor lies Enbloc removal of compartment where tumor lies without exposing the tumor. Treatment: Tumor excision

14. Wide excision of tumor with preservation of neurovascular structures. ↓ Resulting defects dealt with several ways Short diaphyseal segments replaced by – vascularized/ non- vascularized bone graft Large gap- replaced by : Custom made implants Osteo -articular segments replaced by Large allograft Endoprosthesis – custom made / modular system Treatment: limb salvage

15. Definition: It is an osteolytic tumor of uncertain origin appears in the epiphysis of mature bone (after closure of epiphysis ) characterized by the presence of oval or spindle shaped mononuclear cells and uniformly distributed multinucleated giant cells. Synonyms of GCT: - Osteoclastoma - Giant cell sarcoma - Benign giant cell tumor Giant cell tumour (GCT)

16. Incidence and predisposing factor: 5 % of all primary bone tumors Age : 20-40 years of age Peak incidence- 3rd decade Extremely rare- before closure of epiphysis and after 50 years. G ender: Female> male Site : Distal femur Proximal tibia Proximal humerous Distal radius – 3rd most common site Giant cell tumour (GCT)

17. History : H/O trauma may be present Chronic few months to several years Sequelae : Trauma →Pain → tumor → pathological fracture (10-15%) How you will diagnose a case of GCT of bone?

18. Clinical features : 1. Pain: Chronic ‚ constant pain around the joint. Dull and aching. Progressively more severe Worse at night Increases with activity 2. Swelling: a. Towards one side of the bone b. Skin over the bone is shiny but no dilated vessels. c. Eggshell crackling sound may be there on applying pressure. How you will diagnose a case of GCT of bone?

19. Clinical features: 3 . Tenderness: Mild or absent. 4. Joint movement: - No change at the beginning. - Later on joint movement is diminished - There may be fracture of articular cartilage. - The joint is not involved, there is no effusion. 5. Pathological fractures occur in 10-15% of cases. How you will diagnose a case of GCT of bone?

20. Clinical features: 3 . Tenderness: Mild or absent. 4. Joint movement: - No change at the beginning. - Later on joint movement is diminished - There may be fracture of articular cartilage. - The joint is not involved, there is no effusion. 5. Pathological fractures occur in 10-15% of cases. How you will diagnose a case of GCT of bone?

21. Investigation: 1. X-rays 2. Blood test 3 . CT scan and MRI 4. Biopsy Macroscopic Microscopic How you will diagnose a case of GCT of bone?

22. Investigation: 1. X-rays 2. Blood test 3 . CT scan and MRI 4. Biopsy Macroscopic Microscopic Treatment of gct

23. Thank you