Bone tumours I

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 margins

This 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 yr

Pain > at night relieved by aspirin

In spine  painful scoliosis

No 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

thanx