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Bone tumors are rare tumorsaccou nt ing for less th an .2% of al l cancers Occur more in young ages

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Classification of Bone tumors

Origin: - primary- secondary: 95%, breast, lung, prostate, kidney and

thyroid cell type:

Bone Osteoma, osteosarcomaCartilage Chondroma, ChondrosarcomaMarrow Hemangioma, angiosarcoma

Fibrous tissue Fibroma, fibrosarcoma

Tumor type:Benign: Osteoma, osteochondroma

Malignant :: Osteosarcoma, chondrosarcoma

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Symptoms and Signs

It may be asymptomatic and discoveredaccidentally.Pain : may worsen at night and awakes

patient, caused by tumor compression onsurrounding tissue, hemorrhage in thetumor, pathological fractures also causepain

Swelling .Local tenderness.Warmth

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Pathological fracture: may be the first sign.

General: fatigue, fever, wt. loss

A mass can be felt at the tumor site.

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Malignant vs. Benign TumorsRapid growth, warmth, tenderness,and ill defined edges are suggestiveof malignancy.

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INVESTIG TIONS

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History and examinationImagingBiopsyLabs

Calcium: Greater than normal levels may indicate metastasis.

Serum phosphorus: Greater than normal levels may indicatebone metastasis.

PTH: Lower than normal levels may indicate bonemetastasis.

ALP isoenzyme: Higher than normal ALP levels may indicatePaget's disease, osteoblastic bone cancers, osteomalacia andrickets.

LDH: High values indicate poor prognosis

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Plain x-rayMost usefulCould see:

A lump Bone destruction Cortical thickening + periosteal reaction Cysts

Important to notice: Where How many Cystic or not Margins destruction

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Periosteal reaction

Periosteal reactions: periosteal hypertrophywhich develops in response to periostealirritation. They are a non-specific sign:they have many causes:- Infections- Tumors ( both benign + malignant)- Healing fractures- Chronic stress

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Periosteal reactions with benigntumors are either thick and

smooth , or are completely absent ! Periosteal reactions are thinner

but irregular (wavy) withmalignant tumors.

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Periostealreactionsseen in thedistal tibiaand fibula.

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Periostealreaction at thedistal radius

with irregularedges:malignant.

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Osteosarcomaof the distal

femur: Codmanstriangle can beseen:periosteum isbeing liftedoff.

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Midshaftperiostealreaction with

smooth + thick edges: this is abenign osteoma.

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A tibia healing from a fracture showinga smooth and thick periosteal reaction.

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CT and MRI

Asses the extent of the tumorRelation to surrounding structures

Radionuclide scanning:

Helpful in revealing site of a smalltumorSkip lesionsSilent secondary deposits

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Multiple hot spots seen:lung cancerwhich hasmetastasized

to vertebrae.

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Biopsy*

Biopsy allows us to reach a diagnosis.* Biopsy allows us to plan for treatment.

Methods of biopsy :

Open biopsy: surgical procedure done under GA. Zonal biopsy: open biopsy from transition zone. Excisional biopsy: excision of the entire tumor. Largebore needle biopsy: aspirating cells .

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Be aware of biopsy complications:

1. Hemorrhage2. Wound break down

3. Infection4. Pathological fractures

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BENIGN TUMORSGeneral Considerations About

Benign Bone Tumors :Most bone tumors are benign, and unlikely tospread.They can occur in any bone, but they are usually

found in the biggest ones.It could affect the femur , tibia , humerus . Some types are more common in specific placessuch as near the growth plates of the largestbones

Appearance and location of mass on radiographsare keys to diagnosis.Benign bone tumors most often are asymptomatic

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Benign bone tumors:

Non ossifying fibromaOsteochondromaOsteoid osteomaEnchondromaGiant cell tumor of boneosteoblastoma

1 NON OSSIFYING

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1-NON-OSSIFYINGFIBROMAFibrous tissue within bone ossiffy in timeAsymptomatic, incidental findingsdevelopmental defect, seen in childrenMetaphysis of long bones, occasionally multiplelesionAs bone grows , defect becomes less obviousMay enlarge and cause pathological fracture

No need for treatment, unless there ispathological fracture

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2- Osteoid osteomaNeoplastic proliferation of osteoid and fibrous tissue

More common in male under age of 30 year , invertebra or long bones , less commonly in mandibleor other craniofacial bones.

Small in size (

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ON X-Ray :

Nidus : a tiny radiolucent areaIf in diaphysis surrounded by densebone and thickend cortex

Metaphysis less cortical thickening

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Male 23 years old, with a history ofincreasing pain in the knee, relieved byaspirin

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Plain radiograph in a25-year-old male withcortical osteoid

osteoma. shows aradiolucent nidussurrounded byfusiform corticalthickening

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3- Osteochondroma(exostosis)

Commonest benign tumor of boneMature bone with cartilaginous cap.Common sites are the fast growing sites of

long bones(lower end of femur and upper end oftibia) and crest of ileum and shoulder.It occurs most frequently in male under age of 25year.

Small risk of malignant transformation(

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Osteochondroma

Symptoms A hard, immobile, detectable mass that ispainlessLower-than-normal-height for ageSoreness of the adjacent musclesOne leg or arm may be longer than the otherPressure or irritation with exercise

X-Ray:Exostosis: well defined bony projectionCartilage maybe calcified if lesions are large

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Osteochondroma

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Treatment

Only if causing symptoms or;Ifbecoming bigger and more painfulBy excision

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Thank You

Done By Osama Nimri