Bone Tumors part 1

Bone Tumours

Dr. Wahby Ghalib FJMC, CABO, MRCS

Classification

Benign Malignant : primary secondary

Benign bone tumors

Bone : osteoid osteoma & osteoblastoma

Cartilage : enchondroma, chondroblastoma & osteochondroma Blood vessels : haemangioma Others : giant cell tumour

Benign tumour - like lesions

Bone cysts : simple & aneurysmal Fibrous cortical defect

Primary malignant bone tumours

Bone : osteosarcoma Cartilage : chondrosarcoma Bone marrow : Ewing sarcoma & myeloma Connective tissue : fibrosarcoma Others : chordoma & adamantinoma


Secondary malignant bone tumours
Prostate Breast Lung Colon Kidney Thyroid

Staging of malignant tumours (Enneking)

I : low grade II : high grade III : sarcoma with metastasis A : intra- compartmental B : extra-copartmental

Surgery for malignant tumours

Wide excision : safe marginsThis includes : amputation limb – salvage surgery

Chemotherapy

Preoperative : (neoadjuvant) 8-12 w After tumour resection : check tumour necrosis Postoperative : 6-12 m

Radiotherapy

Residual tumour Inaccessible tumour Painful metastasis

Benign bone tumours

Fibrous cortical defect
= non-ossifying fibroma Very common Child Accidentally on XR Pain or pathologic fracture


No malignant potential Rx : curettage + bone graft

Osteoid osteoma

Patient < 30 yrPain > at night relieved by aspirinIn spine  painful scoliosisNo malignant potential

XR : radioluscent nidus surrounded by sclerosis Any bone except the skull Rx : removal of nidus

osteoblastoma

= O.O. but nidus > 1.5 cm

Compact (ivory) osteoma

Rare Young adult Painless lump on outer or inner table of skull

Enchondroma

More in tubular bones of hand Accidentally or pain / pathologic # XR : lytic lesion + flecks of calcification Malignant risk : 2% Rx : curettage + bone graft


Picture 4. Frontal radiograph of the right thigh demonstrates coarse calcifications in the distal femur.

Osteochondroma

= exostosis Commonest benign bone tumour It is bone outgrowth covered by cartilage

Hereditary multiple exostosis : AD Malignant risk : 1% solitary 6% multiple If continues to grow > 18 yr suspect malignancy Rx : excision

Objectives :

Stressing the importance of the bone tumours as being a significant source of mortality and morbidity. Training the students to acquire the basic skills of XR interpretation in case of bone tumours.

Objectives :

Emphasizing the general outlines of treatment including the medical and surgical lines. Emphasizing the significance of classifying the bone tumours and the tumour-like conditions. Stressing the importance of the tumour-like conditions and the sequellae of misdiagnosis.