Bone Tumor (Benign and malignant)
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Transcript of Bone Tumor (Benign and malignant)
Bone tumor
• refers to a neoplastic abnormal growth of tissue in bone. It can be either benign or malignant.
•Most bone tumors are noncancerous(benign).
•Bone tumors may be classified as:▫"primary tumors <3rd decade.▫secondary tumors >3rd decade.
Clinical presentation
•Clinically, bone tumors present in various ways.
•The more common benign lesions are:
frequently asymptomatic and are detected as incidental findings.
Many tumors, however, produce localized pain or are noticed as a slow-growing mass.
Sometimes, the first hint of a tumor's presence is a sudden pathologic fracture.
Diagnosis
•Radiographic analysis plays an important role in diagnosing bone tumors. ▫Help limit the differential diagnosis▫Give clues to the aggressiveness of the tumor.
•Ultimately, in most instances, biopsy and histologic study are necessary, sometimes we need radionuclide scanning in small tumors e.g. osteoid osteoma.
Classification of bone tumor according to cell type
Bone:Osteoid osteoma
Cartilage:Chondroma, Osteochondroma.
Fibrous tissue:Fibroma
Uncertain:Giant bone cyst
Osteoid Osteoma
•Peak incidence in 2nd and 3rd decades, M:F= 3:1
• It has a center of growing cells, called a nidus(less than 1 cm) surrounded by a hard shell of thickened bone.
•Most common in femur and tibia.
•Symptoms:▫An osteoid osteoma causes a dull aching pain.▫The pain is moderately intensity, but can be
severe, especially at night.
•The tumor is not related to previous injury or activity.
•Over-the-counter pain medicines such as aspirin, ibuprofen are helpful in decreasing pain.
Small nidus <1 cm round oval in shape in diaphysis
• Treatment:
• is surgically cutting out of the entire tumor, particularly the central core, for a good outcome
Osteochondroma •One of the commonest tumor of bone (45% of all
benign)
• It is developmental lesion which is an outgrowth of the growth plate and is made up of both bone and cartilage (cartilage-capped bone).
• the commonest site are the fast growing end of long bone and the crest of ilium.
•Can be simple or multiple
•The most common symptom of an osteochondroma is a painless mass near the joints
•An osteochondroma ordinarily stops growing when a person reaches full normal growth any further enlargment is suggestive of malignant change.
•Treatment:▫Usually no treatment is required.▫Surgical Excision, if causes pain or put
pressure in the nerve or blood vessels.
Enchondroma
• benign Cartilaginous islands growth In medullary cavity.
• It is very common and often occure in the small bone of the hand and feet. Others femur, humerus, ribs.
•Appear inside of the bone.
•Usually begin and grow in childhood, then stop growing but remain through adulthood.(10-20 age)
•Can be single or multiple
•Symptoms:▫Usually painless.▫But can causes enlarged fingers, pathologic
fracture or deformities.
•X-ray finding:▫Dark hole in bone, but usually they have
calcification or white spot in the hole.
•Treatment:▫ No treatment is required for asymptomatic
lesions.▫ If fracture occurs, it is usually treated with
scraping out and filling of the cavity with bone grafting.
• Risk of transformation:▫ < 2% will transform to chondrosarcoma.▫ pain without pathological fracture.
Chondroblastoma
• It is rare type of benign tumor.
• It is appear in epiphysis usually in proximal humrus, femur or tibia.
•Presenting with aching & tenderness adjacent joint.
• It have potential to metastasize to the lung.
Fibrous dysplasia
• replacement of the medullary bone with fibrous tissue and woven bone.
• It can affect one bone (monostotic) or many bones(polystotic).
• Fibrous dysplasia leads to bone weakness so it can cause angulation bent of the bone (shepherd's crook deformity)
Simple bone cyst
• A unicameral bone cyst is a cavity found within a bone that is filled with straw-colored fluid.
• Appears during childhood typically in the metaphysis.
• Not tumor tends to heal spontaneously
Giant Cell Tumor of Bone
• is a very rare, aggressive benign tumor. It generally occurs in between the ages of 20 and 40 years.
• very rarely seen in children or in adults older than 65 years of age.
• is formed by fusion of several individual giant cells into a single, larger complex cystic.
• Localized pain.
• Pain increase with movement, decrease with rest but it progressively increase with time
Treatment:Radiation therapy or curettage surgery
Summary Tumor location
Osteoid osteoma Diaphysis
Chondroma Intermedulary
Osteochondroma Bone ends of long bone
Chondroblastoma Epiphysis
Fibrous dysplasia Intermedulary
Simple bone cyst Metaphysis
Giant bone cyst Epiphysis
Summary
- Most of benign tumors are a symptomatic & an incidental diagnosed.
- No treatment required for benign tumor except when it cause pain or can damage epiphysis.
- Some of benign tumor can transform to malignant, the most important symptom for transforming is pain without pathological fracture.
Malignant Bone Tumors
•The following malignant tumors will be discussed:▫Osteosarcoma▫Chondrosarcoma▫Ewing’s Sarcoma▫Multiple Myeloma▫Metastatic Disease
OSTEOSARCOMA.•Highly malignant tumor.•Rapidly go to periosteum. •Most common primary malignant tumor of bone.•Males> females.
•Most occur in teenagers ages (10-25) •Clinical features: localized pain is the firstWorse at night and swelling
•Metaphysial tumor•Radiographic terms to know:▫Codman’s Triangle:
▫“Sunburst” periostial formation:
▫Bone destruction
CHONDROSARCOMA•Malignant tumor of cartilage.
•pelvic bones, spine, and shoulder girdle
•Males> females age 30-60.
•Slowly growing.
•Tumor may arise primarily or secondary to a pre-existing enchondroma,exostosis or Paget’s disease.
•Clinical presentation: dull ache and swelling
EWING SARCOMA
•Malignant neoplasm of undifferentiated cells arising within the marrow cavity.
•Males are affected slightly more often than females.
• most occur in teenagers ( 5-20)
•Clinical features: thrombing pain , swelling and tenderness
•Other symptoms including fever, anemia, leukocytosis,
EWING SARCOMA(cont.)•Gross: ▫often affects the diaphyses of long bones with most
common sites like femur, pelvis and tibia seen a white tan mass with necrosis and hemorrhage..
•Frequently the tumoral cells erode cortex and periosteum and invade surrounding tissues.
•Tx: ▫chemotherapy, surgery and/ or radiation.
•Prognosis: 5 year survival rate of 75%
Multiple myeloma
•Tumor made up of malignant monoclonal plasma cells ( B-cell).
• is the most common primary bone cancer.
•Usually affects patients Over 40 years of age.
•Patients often present with malaise, bone pain mild anemia, hypercalcaemia, or a pathologic fracture. It cause osteoporosis … How???
Multiple Myeloma•Classic radiographic appearance is multiple lytic “punched out” areas in bone.• Frequently involves the calvarium.
• Treatment consists of palliative chemotherapy or bone marrow transplant.
Imaging Where Growth present age Type
Godman Triangle sunburst
metaphyses
rapid Pain at nightLocal
tenderness
15-25
Osteosarcoma
Central flacks of
calcification
Cartilage and
metaphyses
slow Dull achePath-
fructure
30-60
Chondrosarcoma
Onion skin diaphysis - Throbbing pain
swelling . General
illnes
>40 Ewing’s Sarcoma
Punch out Bone marrow
- Weekness ,back pain
path-fructure
45-65
Multiple Myeloma
Metastatic Disease
•Most common malignancy in bone.•Must be considered in any differential diagnosis
of a bone lesion in a patient Over 50 years old.•May have virtually any appearance.•May be lytic or blastic.•Majority of metastases to bone originate in
Breast, Prostate, Lung, Kidney and Thyroid.
Metastatic Disease
•Most common sites for bony metastases include thoracic and lumbar spine, pelvis, femur, rib, proximal humerus and skull
•Pain •Sudden back pain