Bone tumours I

Bone Tumours

Classification
Benign
Malignant : primary and 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 and 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 tumour
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

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