Bone tumoursBone tumours

Dr.Surya prakash sharma

MBBS D’ortho (PG Student)

MMC Chennai

Bone tumours

Commonest bone tumour is secondaries from other sites

Commonest primary bone tumour is multiple myeloma, second osteosarcoma.

Classification (W.H.O.) Bone-forming tumours Cartilage forming tumours Giant-cell tumour Marrow tumours Vascular tumours Other connective tissue tumours Other tumours Secondary malignant tumours of bone

Bone forming tumours

Cartilage forming tumours

Giant cell tumour

Osteoclastoma

Marrow tumours

Ewing’s sarcoma Neuroectodermal tumour Malignant lymphoma of bone

(Primary/secondary) Myeloma

Vascular tumoursBenign Haemangioma Lymphangioma Glomus tumourIntermediate Haemangio endothelioma Haemangio pericytomaMalignant Angiosarcoma Malignant haemangio pericytoma

Other connective tissue tumours

Benign Benign fibrous

histiocytoma LipomaIntermediate Desmoplastic fibroma

Malignant Fibrosarcoma Malignant fibrous

histiocytoma Liposarcoma Malignant

mesenchymoma Leiomyosarcoma Undifferentiated sarcoma

Other tumours

Benign Neurilemmoma Neurofibroma

Malignant Chordoma Adamantinoma

Secondary malignant tumours of bone

From primary in: Thyroid Breast Bronchus Kidney Prostate

Diagnosis

Clinical examination Imaging Laboratory investigations Biopsy

Imaging

Radiographs CT scan MRI Radio nuclide bone scan Arteriogram

Radiographs

Exact location of the tumour Borders of the tumour Pattern of bone destruction Matrix formation Periosteal reaction

CT Scan

Very useful in early diagnosis Extra osseous extension Early detection of pulmonary secondaries Exact measurement for limb salvage

procecures (Prosthesis/allograft)

MRI

Intra medullary extension Soft tissue extension Defines the relationship to the nearby

major blood vessels

Radio nuclide bone scanning For pre biopsy

staging Dissemination of

tumour Silent secondaries

and skip lesions

Arteriogram Planning limb sparing

surgery Therapeutic

embolization To assess vascularity

of tumour

Laboratory investigations Hb % ESR Alkaline Phosphatase Serum electrophoretic pattern Bence-Jones protein Acid Phosphatase

Biopsy

Closed biopsy

FNAC

Needle biopsy

Open biopsy

Incisional biopsy

Excisional biopsy

Principles of biopsy

From boundary or edge of tumor Take several samples Incision strategically placed Ideally done by the treating surgeon Wound closed without drain

Staging of the tumor

By Enneking (1986) Based on aggressiveness of the tumor

and Spread

Intra compartmental Extra compartmental

Low grade I-A I-B

High grade II-A II-B

Low/High grade with metastasis

III-A III-B

Staging (Enneking)

Correlation of staging and management

I-A - Wide excision I-B - Wide excision with larger clearance II-A - Wide excision/amputation II-B - Radical resection or disarticulation III - Palliative treatment Low grade intra compartmental lesions – wide

resection and management of metastases

Principles of management

Benign, asymptomatic lesions

Excisional biopsy or curettage

Benign, symptomatic or enlarging lesions

Biopsy confirmation followed by marginal resection or curettage (cystic lesions)

Principles of management Suspected malignant lesions Laboratory and imaging investigations Chest x-ray or CT scan of the chest Biopsy confirmation

Surgical options Ablative surgeries (amputation/disarticulation) Limb sparing surgeries

Chemotherapy Adjuvant/Neo-adjuvantRadiotherapy