1 / 84

Bone Tumors and Tumor-like Conditions

Bone Tumors and Tumor-like Conditions. Prof. Mamoun Kremli AlMaarefa College. Objectives. Bone tumors: Primary: Benign – Malignant Secondaries in bone Tumor-like conditions Bone cysts How to read x-ray of a bone lesion. Classification – predominant tissue.

bambi
Download Presentation

Bone Tumors and Tumor-like Conditions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Bone Tumors andTumor-like Conditions Prof. Mamoun Kremli AlMaarefa College

  2. Objectives • Bone tumors: • Primary: • Benign – Malignant • Secondaries in bone • Tumor-like conditions • Bone cysts • How to read x-ray of a bone lesion

  3. Classification – predominant tissue

  4. Clinical presentation - history • Prolonged history: • In most benign lesions • Some malignant: slow growing / in pelvis (expandable) • Age: • Childhood and adolescence • Most benign, and some malignant (e.g. Ewings sarcoma) • 4th – 5th decade: • Chondrosarcoma and fibrosarcoma • Sixth decade: • Myeloma (the commonest primary malignant bone tumor) • Over 70 yrs: • Metastatic lesions are the commonest

  5. Clinical presentation - history • Pain: • In both malignant and benign • May be caused by: • Rapid expansion – stretching of tissues • Central hemorrhage or degeneration • Insipient pathological fracture • Tense encapsulation in bone (e.g. osteoid osteoma) • Swelling • H/O Trauma • Neurological symptoms • Pressure on nerve / stretching the nerve • Pathological fracture

  6. Clinical examination • A mass (lump) • Location • Discrete or ill-defined • Tenderness • Warm • Pulsatile • Mobility • ….etc • Range of motion • LN, pelvis, abdomen, chest, spine

  7. Imaging – x-rays • Which bone, and which site in bone? • Solitary or multiple? • Bone forming or bone eating? • Margins: well-defined or ill-defined? • Calcifications in the lesion? • Is cortex eroded or destroyed? • Is there periosteal new bone formation? • Soft tissue extension?

  8. Location Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  9. Radiographic features Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  10. The Border Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  11. The Matrix Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  12. Type of Bone Destruction Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  13. Type of Periosteal Reaction Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  14. Soft Tissue Extension Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  15. Benign Vs. malignant Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  16. Other imaging • Bone scan (Tc99): • Shows the site of lesion / and skip lesions • CT: • Intraosseous and extraosseous structure and extension • Good in deep bones (pelvis, spine) • MRI: • Tumor spread • Within bone, into joints, into soft tissue • Relation to vessels • Soft tissue and cartilage tumors

  17. Lab, investigations • Look for infection • Look fro metabolic disease (brown tumor) • Anemia, raised ESR • S. Alkaline phosphatase • Bence Jones protein in urine: myeloma • S. Acid phosphatase: prostatic carcinoma • Raised s Calcium in metastasis

  18. Biopsy • Diagnostic • Needle biopsy: • CT- guided • Inthe line of further surgical incision • Representative sample • ? frozen section confirmation of a good sample • Open biopsy: • After all imaging techniques completed • More reliable – significant morbidity • Site considering further surgery • From boundaries • Excision biopsy for almost certainly benign tumors

  19. Differential diagnosis • Soft tissue hamartomas • Myositis ossificans • Stress fracture: • Histopath. may be confused with osteosarcoma? • Tendon avulsion injuries • Near hip and knee (e.g. Osgood-Schlatter) • Infection • Gout: • Large gouty typhus • Other bone lesions: • Cortical defects, bone infarcts, “bone islands”

  20. Staging • How does the tumor behave? • Aggressiveness • How far has it spread? • Extent

  21. Staging – benign tumors

  22. Staging – malignant tumors

  23. Tumor Excision • Intracpsular • Marginal • Wide local • Radical • Amputation Apley’s System of Orthop. And Fractures

  24. Benign bone lesions • Non-ossifying fibroma • Fibrous dysplasia • Osteoid osteoma / osteoblastoma • Chondroma / chondroblastoma • Osteochondroma • Simple bone Cyst • Aneurysmal bone cyst • Giant cell tumor

  25. Non-ossifying fibroma • Another name: • Fibrous cortical defect • The commonest benign lesion of bone • Asymptomatic • Incidentally discovered • Children: • Disappears later • Common site: • Metaphysis of long bones • Treatment: • Observation • Surgery if v large Apley’s System of Orthop. And Fractures Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  26. Non-ossifying fibroma Non-ossifying fibroma ……..………Fibrous cortical defect Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  27. Fibrous Dysplasia • Developmental disorder • Trabecular bone replaced by fibrous tissue • Types: • Monstatic • Monomelic • Polystatic • Site: • Prox. Femur: • Shepherd’s crook • Tibia, humerus. Ribs, cranio-facial • Deformity of bone Apley’s System of Orthop. And Fractures

  28. Polystotic Fibrous Dysplasia Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  29. Osteoid osteoma • Small tumor (<1 cm) • Young adults • Pain, pain, pain • Relieved by Salicylates • Sites: Femur, tibia, spine • X-ray: • Small radiolucent “nidus” • Surrounded by sclerotic bone • CT: Shows “nidus” better • Tc scan: hot • Treatment: surgical excision, or thermal ablation Apley’s System of Orthop. And Fractures

  30. Osteoid osteoma • Small tumor (<1 cm) • Young adults • Pain, pain, pain • Relieved by Salicylates • Sites: Femur, tibia, spine • X-ray: • Small radiolucent “nidus” • Surrounded by sclerotic bone • CT: Shows “nidus” better • Tc scan: hot • Treatment: surgical excision, or thermal ablation Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  31. Osteoid Osteoma • 7 year old boy

  32. Osteoid Osteoma Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  33. Osteoblastoma • A giant ostoid osteoma • Spine and flat bones Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  34. Chondroma (Enchondroma) • Incidentally discovered • Young age • Tubular bones of hands and feet • X-ray: • Well-defined, central lesion • At junction of metaphysis with diaphysis • Flake of calcification are characteristic • Malignant transformation • Rare in solitary • 30% in multiple (Ollier’s disease) Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  35. Chondroma (Enchondroma) • Incidentally discovered • Young age • Tubular bones of hands and feet • X-ray: • Well-defined, central lesion • At junction of metaphysis with diaphysis • Flake of calcification are characteristic • Malignant transformation • Rare in solitary • 30% in multiple (Ollier’s disease) Slide Atlas of Orthop Pathology, P Bullough. Gower Med P

  36. Chondroma (Enchondroma) Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  37. Enchondromatosis (Ollier’s) • Many lesions • Malignant transformation: 30% Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  38. Enchondromatosis (Ollier’s) • Many lesions • Malignant transformation: 30% Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  39. Chondroblastoma • In epiphysis • Proximal humerus, femur, tibia Apley’s System of Orthop. And Fractures Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  40. Osteochndroma (Exostosis) • A common lesion • Ends of long bone • Bony overgrowth • Away from epiph. Late • Covered by cartilage • Growth: • Stops when epiphysis close • If continues later: • ? Malignant transformation Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  41. Osteochndroma (Exostosis) Apley’s System of Orthop. And Fractures Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  42. Multiple Exostosis • Many lesions • Causes growth disturbance Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  43. Simple bone cyst • Solitary – unicameral • Children • Metaphysis • Prox. Humerus and Femur • Not a tumor • Not seen in adults • Heals spontaneously • Pathological fracture / incidental • Aspirate is clear straw-colored Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  44. Simple bone cyst • Solitary – unicameral • Children • Metaphysis • Prox. Humerus and Femur • Not a tumor • Not seen in adults • Heals spontaneously • Pathological fracture / incidental • Aspirate is clear straw-colored Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  45. Simple bone cyst • Treatment: • Small, reducing: leave alone • Increasing in size, active • Multiple bone marrow injections • Pathological fracture • Treat fracture • Cyst might heal • Recurrent / injection failed: • Surgical curettage and bone grafting Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  46. Aneurysmal bone cyst • Young adults • Metaph. of long bone • X-ray: • Well-defined cyst • Trabeculated • Eccentrically placed • Ballooning • Bloody content Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  47. Giant-Cell Tumor • Unknown origin • Giant cells abundant • Behavior: • One third benign • One third locally aggressive • One third (less) with distant metastasis • Young adults • Common sites: • Around knee • Proximal humerus • Distal radius Orthopedic Radiolgy. A Greenspan. Lippincott-Raven

  48. Giant-Cell Tumor • Unknown origin • Giant cells abundant • Behavior: • One third benign • One third locally aggressive • One third (less) with distant metastasis • Young adults • Common sites: • Around knee • Proximal humerus • Distal radius Apley’s System of Orthop. And Fractures

  49. Giant-Cell Tumor • Eccentric lesion • Radiolucent • Soap bubble • Abuts against the joint • Thin cortex • Margins may be clear / unclear • Depends on aggressiveness • Treatment • Curettage & bone grafting • More wide excision in recurrent and aggressive lesions Apley’s System of Orthop. And Fractures

  50. Giant-Cell Tumor Apley’s System of Orthop. And Fractures

More Related