Bone tumors are rare tumors

accounting for less than .2% of all cancers

Occur more in young ages

Classification of Bone tumors

Origin: - primary - secondary: 95%, breast, lung, prostate, kidney and thyroid cell type: Bone Osteoma, osteosarcoma Cartilage Chondroma, Chondrosarcoma Marrow Hemangioma, angiosarcoma Fibrous tissue Fibroma, fibrosarcoma

Tumor type: Benign: Osteoma, osteochondroma Malignant:: Osteosarcoma, chondrosarcoma

Symptoms and Signs

It may be asymptomatic and discovered accidentally. Pain: may worsen at night and awakes patient, caused by tumor compression on surrounding tissue, hemorrhage in the tumor, pathological fractures also cause pain Swelling. Local tenderness. Warmth

Pathological fracture: may be the first sign. General: fatigue, fever, wt. loss

A mass can be felt at the tumor site.

Malignant vs. Benign Tumors

Rapid growth, warmth, tenderness, and ill defined edges are suggestive of malignancy.

INVESTIGATIONS

History and examination Imaging Biopsy Labs

bone metastasis. metastasis.

Calcium: Greater than normal levels may indicate metastasis. Serum phosphorus: Greater than normal levels may indicate PTH: Lower than normal levels may indicate bone ALP isoenzyme: Higher than normal ALP levels may indicate

Paget's disease, osteoblastic bone cancers, osteomalacia and rickets.

LDH: High values indicate poor prognosis

Plain x-ray
Most useful Could see:

A lump Bone destruction Cortical thickening+ periosteal reaction Cysts

Important to notice:

Where How many Cystic or not Margins destruction

Periosteal reaction
Periosteal reactions: periosteal hypertrophy which develops in response to periosteal irritation. They are a non-specific sign: they have many causes: - Infections - Tumors (both benign + malignant) - Healing fractures - Chronic stress

 Periosteal reactions with benign tumors are either thick and smooth, or are completely absent! Periosteal reactions are thinner but irregular (wavy) with malignant tumors.

 Periosteal reactions seen in the distal tibia and fibula.

 Periosteal reaction at the distal radius with irregular edges: malignant.

Osteosarcoma of the distal femur: Codmans triangle can be seen: periosteum is being lifted off.

 Midshaft periosteal reaction with smooth + thick edges: this is a benign osteoma.

 A tibia healing from a fracture showing a smooth and thick periosteal reaction.

CT and MRI
Asses the extent of the tumor Relation to surrounding structures

Radionuclide scanning:

Helpful in revealing site of a small

tumor Skip lesions Silent secondary deposits

Multiple hot spots seen: lung cancer which has metastasized to vertebrae.

Biopsy
* Biopsy allows us to reach a diagnosis. * Biopsy allows us to plan for treatment. Methods of biopsy:

Open biopsy: surgical procedure done under GA. Zonal biopsy: open biopsy from transition zone. Excisional biopsy: excision of the entire tumor. Largebore needle biopsy: aspirating cells.

 Be
1.

aware of biopsy complications:

Hemorrhage 2. Wound break down 3. Infection 4. Pathological fractures

BENIGN TUMORS General Considerations About Benign Bone Tumors:

Most bone tumors are benign, and unlikely to spread. They can occur in any bone, but they are usually found in the biggest ones. It could affect the femur , tibia , humerus . Some types are more common in specific places such as near the growth plates of the largest bones Appearance and location of mass on radiographs are keys to diagnosis. Benign bone tumors most often are asymptomatic

Benign bone tumors:

Non ossifying fibroma Osteochondroma Osteoid osteoma Enchondroma Giant cell tumor of bone osteoblastoma

1-NON-OSSIFYING FIBROMA

Fibrous tissue within bone ossiffy in time Asymptomatic, incidental findings developmental defect, seen in children Metaphysis of long bones, occasionally multiple lesion As bone grows , defect becomes less obvious May enlarge and cause pathological fracture No need for treatment, unless there is pathological fracture

Radiographically, the tumor presents as a well marginated radiolucent lesion, with a distinct multilocular appearance .

2- Osteoid osteoma

Neoplastic proliferation of osteoid and fibrous tissue

More common in male under age of 30 year , in vertebra or long bones , less commonly in mandible or other craniofacial bones. Small in size (<1.5 cm);oval or rounded shape
Pain(severe) worse at night ,not relieved by rest but relieved by aspirin. Types :Cortical;Cancellous ;Subperiosteal . Treatment: Complete removal after careful localization by CT.

ON X-Ray :
Nidus : a tiny radiolucent area If in diaphysis surrounded by dense bone and thickend cortex Metaphysisless cortical thickening

Male 23 years old, with a history of increasing pain in the knee, relieved by aspirin

Plain radiograph in a 25-year-old male with cortical osteoid osteoma. shows a radiolucent nidus surrounded by fusiform cortical thickening

3- Osteochondroma(exostosis)
Commonest benign tumor of bone Mature bone with cartilaginous cap. Common sites are the fast growing sites of long bones(lower end of femur and upper end of tibia) and crest of ileum and shoulder. It occurs most frequently in male under age of 25 year. Small risk of malignant transformation(<1%) solitary

Osteochondroma
Symptoms
A hard, immobile, detectable mass that is

painless Lower-than-normal-height for age Soreness of the adjacent muscles One leg or arm may be longer than the other Pressure or irritation with exercise

X-Ray:
Exostosis: well defined bony projection Cartilage maybe calcified if lesions are large

Osteochondroma

Treatment

Only if causing symptoms or;If becoming bigger and more painful By excision

Thank You
Done By : Osama Nimri