BONE TUMOURS

PRESENTED BY

MARYAM RASHEED

ROLL NO 82

FINAL YEAR MBBS

CLASSIFICATION

Metastases –may show histological

features of their tissue of origin

Haemopoietic tumours – e.g Myeloma

Osteogenic tumours e.g Osteosarcoma

Chondrogenic tumours e.g

Chondrosarcoma

Others e.g Ewings sarcoma

1) METASTASES

The most common malignant bone

tumours are metastases.

Most common tumours that metastasise

to bone are breast ,prostate , lung ,

kidney and thyroid carcinoma.

METASTASES

2) HAEMOPOIETIC

TUMOURS Two Types ( malignant )

1) Solitary Plasmacytoma / multiple

myeloma

2) Lymphomas; malignant neoplasm of

lymphoid cells

3) OSTEOGENIC

TUMOURS The most common of these is

osteosarcoma.

Osteosarcoma has two incidence

peaks, one in adolescense ,the other

later in life, arising in patients with

pagets disease and those who have had

previous radiotherapy.

4 )CHONDROGENIC

TUMOURS

These tumours produce chondroidmatrix.

Osteochondroma- cartilage capped,grows away from physis.

Enchondroma- inside bone,mostcommon in hands and feet.

Chondroblastoma-in epiphysis of adolescents.

Chondrosarcoma-of varying malignancy.

CHONDROSARCOMA

GIANT CELL TUMOUR

Giant cell tumour of bone is a benign

aggressive tumour with large osteoclast

like giant cells.

Occurs between ages 20 and 45.

EOSINOPHILIC

GRANULOMA It is a neoplasm of Langerhans cells.

It can be unifocal, multifocal or

disseminated.

There is a predilection for the skull and

diaphyses of long bones.

FIBROUS DYSPLASIA

It usually affects long bones, ribs and

skull.

Patients can present with pain, swelling

or fracture.

Hip fractures can produce a shepherd

crooks deformity.

Radiologically, there is often expansion

and a ground glass appearance.

Ewings sarcoma

It is a round cell sarcoma of bone.

Radiologically the bone appears moth-

eaten and may show an onion-skin

periosteal reaction.

It tends to arise in the diaphyses of long

bones or pelvis.

EWINGS SARCOMA

Assessement

The three phases of assessement of

lesions.

PHASE 1 (within 24 hours )

History and examination

Blood

X-ray whole bone

Chest X-ray

PHASE 2 ( Within first week )

Bone scan

Ultrasound scan abdomen

C.T scan chest

PHASE 3 (At tumour centre)

C.T scan lesion

MRI scan lesion

Biopsy

TREATMENT-BENIGN

TUMOURS

1) Benign lesions can be simply curetted

2) CT- guided thermocoagulation is used

for osteoid osteoma

3) Large benign tumours may require

reconstruction

Treatment-malignant bone

tumours

1 ) Osteosarcoma and ewings sarcoma

require neoadjuvant chemotherapy

2) Chondrosarcoma are insensitive to

radiotherapy or chemotherapy

3) Most malignant tumours can be treated

with limb salvage

4)There is no difference in survival

between amputation and limb salvage.

Complications

1)If surgery excision is undertaken it is important for the biopsy track to be excised EN BLOCK with the surgical specimen to avoid LOCAL RECCURRENCE THROUGH THE BIOPSY TRACK.

2)Renal metastases tend to be very vascular and MASSIVE BLOOD LOSS CAN BE ENCOUNTERED DURING SURGERY.

COMPLICATIONS

(Contd…)3) Epiphyseal and metaphyseal lesions

are best treated with prosthetic

replacement. In the shoulder a

PROSTHETIC REPLACEMENT HAVE A

POOR FUNCTION.

4) Preoperative radiotherapy can also

have good result but there is a RISK OF

WOUND HEALING PROBLEMS

FOLLOWING SURGERY