Management of bone tumours

Neoplasms of bone

Osteoblast origin

Benign

Osteoma

Osteoid osteoma

Osteoblastoma

Malignant

Osteosarcoma

Chondroblast origin

Benign

Chondroma

Osteochondroma*

Chondroblastoma

Malignant

Chondrosarcoma

Unknown cell of origin

Giant cell tumour (Osteoclastoma)

Ewing’s tumour

Connective tissue tumours :

(Vascular , Neural, etc)

Metastases

Tumour – like conditions• Fibrosseous lesions

– Fibrous dysplasia– Osteofibrous dysplasia ( Ossifying fibroma)– Metaphyseal fibrous defect (non ossifying

fibroma)• Cysts

– Solitary bone cyst (unicameral bone cyst)– Aneurysmal bone cyst– Ganglion cyst

Modes of presentation

• Lump• Pathological fracture• Pain• Pressure effects• Incidental finding• Secondaries

Exostosis

• Osteochondroma (actually a hamartoma)• Growing end of long bones• Problems – lump. Malignant change rare• Multiple (diaphyseal aclasis) – can interfere

with growth

• Excise if single, causing problems – tumour is larger than it appears on X-ray

Exostosis

Exostosis

Chondromata

Others

Fibrous cortical defect

Aneurysmal bone cyst

Fibrous dysplasia

Osteoclastoma• Giant cell tumour• Expands the bone• Classically asymmetrical• Occurs at the site of epiphysis• Lytic. Septate• ‘Egg shell crackling’

Osteoclastoma

Osteoclastoma - treatment

• Curettage and bone grafting• Pamidronate• Allograft / autograft bone• Bone cement• Prostheses

• NO radiotherapy

Ewing’s tumour

Classically mid shaft

Onion peel appearance

Respond to RT

Osteosarcoma• Common at growing end of long bones• Occur in the second decade (2nd peak –due

to Paget’s disease)• Warm swelling• X-ray – Codman’s triangle, sunray spicules,

bone destruction, cortex breached• CT-scan for extent. Also CT chest• Biopsy – incision or true-cut

Osteosarcoma

Osteosarcoma -treatment

• Excision, DXRT, Chemo

• Excision – amputation, limb conserving

• Custom made prostheses, allograft

Chondrosarcoma

• Occur in older patients• Affect the axial skeleton

• Treatment – Surgical (not responsive to Chemo, DXRT)

Chondrosarcoma

Secondaries in bone• Commonly lytic• Common primaries – lung, thyroid, breast,

kidney, prostate• Multiple myeloma• Sclerotic – prostate, breast, colon• 50% of bone must be destroyed to be seen

on X-ray• CT, Bone scan – seen as hot spots.

Myeloma is cold

Ca- Breast

Multiple myeloma

Secondaries -treatment

• Wherever possible –fix.• Use bone cement.• Aim is to get early mobilization

Soft tissue sarcomas

• Can occur anywhere• Limbs, abdominal

wall, retro-peritoneum• Radical excision + RT

+ CT