Bone tumor

Nassr Saif AL-Barhi

Bone tumor

• refers to a neoplastic abnormal growth of tissue in bone. It can be either benign or malignant.

•Most bone tumors are noncancerous(benign).

•Bone tumors may be classified as:▫"primary tumors <3rd decade.▫secondary tumors >3rd decade.

Clinical presentation

•Clinically, bone tumors present in various ways.

•The more common benign lesions are:

frequently asymptomatic and are detected as incidental findings.

Many tumors, however, produce localized pain or are noticed as a slow-growing mass.

Sometimes, the first hint of a tumor's presence is a sudden pathologic fracture.

Diagnosis

•Radiographic analysis plays an important role in diagnosing bone tumors. ▫Help limit the differential diagnosis▫Give clues to the aggressiveness of the tumor.

•Ultimately, in most instances, biopsy and histologic study are necessary, sometimes we need radionuclide scanning in small tumors e.g. osteoid osteoma.

Benign bone tumor

Classification of bone tumor according to cell type

Bone:Osteoid osteoma

Cartilage:Chondroma, Osteochondroma.

Fibrous tissue:Fibroma

Uncertain:Giant bone cyst

Osteoid Osteoma

•Peak incidence in 2nd and 3rd decades, M:F= 3:1

• It has a center of growing cells, called a nidus(less than 1 cm) surrounded by a hard shell of thickened bone.

•Most common in femur and tibia.

•Symptoms:▫An osteoid osteoma causes a dull aching pain.▫The pain is moderately intensity, but can be

severe, especially at night.

•The tumor is not related to previous injury or activity.

•Over-the-counter pain medicines such as aspirin, ibuprofen are helpful in decreasing pain.

Small nidus <1 cm round oval in shape in diaphysis

• Treatment:

• is surgically cutting out of the entire tumor, particularly the central core, for a good outcome

Osteochondroma •One of the commonest tumor of bone (45% of all

benign)

• It is developmental lesion which is an outgrowth of the growth plate and is made up of both bone and cartilage (cartilage-capped bone).

• the commonest site are the fast growing end of long bone and the crest of ilium.

•Can be simple or multiple

Well defined bony exostosis emerging from metaphysis

•The most common symptom of an osteochondroma is a painless mass near the joints

•An osteochondroma ordinarily stops growing when a person reaches full normal growth any further enlargment is suggestive of malignant change.

•Treatment:▫Usually no treatment is required.▫Surgical Excision, if causes pain or put

pressure in the nerve or blood vessels.

Enchondroma

• benign Cartilaginous islands growth In medullary cavity.

• It is very common and often occure in the small bone of the hand and feet. Others femur, humerus, ribs.

•Appear inside of the bone.

•Usually begin and grow in childhood, then stop growing but remain through adulthood.(10-20 age)

•Can be single or multiple

•Symptoms:▫Usually painless.▫But can causes enlarged fingers, pathologic

fracture or deformities.

•X-ray finding:▫Dark hole in bone, but usually they have

calcification or white spot in the hole.

•Treatment:▫ No treatment is required for asymptomatic

lesions.▫ If fracture occurs, it is usually treated with

scraping out and filling of the cavity with bone grafting.

• Risk of transformation:▫ < 2% will transform to chondrosarcoma.▫ pain without pathological fracture.

Chondroblastoma

• It is rare type of benign tumor.

• It is appear in epiphysis usually in proximal humrus, femur or tibia.

•Presenting with aching & tenderness adjacent joint.

• It have potential to metastasize to the lung.

Well demarcated radiolucent area in the epiphysis

Treatment:• It requires surgery by scraping out and filling of

the cavity with bone grafting.

Fibrous dysplasia

• replacement of the medullary bone with fibrous tissue and woven bone.

• It can affect one bone (monostotic) or many bones(polystotic).

• Fibrous dysplasia leads to bone weakness so it can cause angulation bent of the bone (shepherd's crook deformity)

Hazy appearance (ground glass)Shepherd’s crook deformity

Simple bone cyst

• A unicameral bone cyst is a cavity found within a bone that is filled with straw-colored fluid.

• Appears during childhood typically in the metaphysis.

• Not tumor tends to heal spontaneously

A large bubble inside the bone mostly in metaphysis

Giant Cell Tumor of Bone

• is a very rare, aggressive benign tumor. It generally occurs in between the ages of 20 and 40 years.

• very rarely seen in children or in adults older than 65 years of age.

• is formed by fusion of several individual giant cells into a single, larger complex cystic.

occurs in the end portion of long bones (epiphysis)

• Localized pain.

• Pain increase with movement, decrease with rest but it progressively increase with time

Treatment:Radiation therapy or curettage surgery

Summary Tumor location

Osteoid osteoma Diaphysis

Chondroma Intermedulary

Osteochondroma Bone ends of long bone

Chondroblastoma Epiphysis

Fibrous dysplasia Intermedulary

Simple bone cyst Metaphysis

Giant bone cyst Epiphysis

Summary

- Most of benign tumors are a symptomatic & an incidental diagnosed.

- No treatment required for benign tumor except when it cause pain or can damage epiphysis.

- Some of benign tumor can transform to malignant, the most important symptom for transforming is pain without pathological fracture.

Malignant Bone Tumors

Malignant Bone Tumors

•The following malignant tumors will be discussed:▫Osteosarcoma▫Chondrosarcoma▫Ewing’s Sarcoma▫Multiple Myeloma▫Metastatic Disease

OSTEOSARCOMA.•Highly malignant tumor.•Rapidly go to periosteum. •Most common primary malignant tumor of bone.•Males> females.

•Most occur in teenagers ages (10-25) •Clinical features: localized pain is the firstWorse at night and swelling

Major sites of origin of osteosarcomas. The numbers are approximate percentages .

Osteosarcoma

•Metaphysial tumor•Radiographic terms to know:▫Codman’s Triangle:

▫“Sunburst” periostial formation:

▫Bone destruction

OsteosarcomaBone destruction

CHONDROSARCOMA•Malignant tumor of cartilage.

•pelvic bones, spine, and shoulder girdle

•Males> females age 30-60.

•Slowly growing.

•Tumor may arise primarily or secondary to a pre-existing enchondroma,exostosis or Paget’s disease.

•Clinical presentation: dull ache and swelling

Chondrosarcoma

•Plain films show • large osteolytic lesions.•Central flecks of calcification

Treatment •Unresposive to chemotherapy

•Treat with aggressive surgial resection.

EWING SARCOMA

•Malignant neoplasm of undifferentiated cells arising within the marrow cavity.

•Males are affected slightly more often than females.

• most occur in teenagers ( 5-20)

•Clinical features: thrombing pain , swelling and tenderness

•Other symptoms including fever, anemia, leukocytosis,

X-ray: concentric onion skin layering of new periosteal bone.

EWING SARCOMA(cont.)•Gross: ▫often affects the diaphyses of long bones with most

common sites like femur, pelvis and tibia seen a white tan mass with necrosis and hemorrhage..

•Frequently the tumoral cells erode cortex and periosteum and invade surrounding tissues.

•Tx: ▫chemotherapy, surgery and/ or radiation.

•Prognosis: 5 year survival rate of 75%

Multiple myeloma

•Tumor made up of malignant monoclonal plasma cells ( B-cell).

• is the most common primary bone cancer.

•Usually affects patients Over 40 years of age.

•Patients often present with malaise, bone pain mild anemia, hypercalcaemia, or a pathologic fracture. It cause osteoporosis … How???

Multiple Myeloma•Classic radiographic appearance is multiple lytic “punched out” areas in bone.• Frequently involves the calvarium.

• Treatment consists of palliative chemotherapy or bone marrow transplant.

Multiple Myeloma

•Characteristic “punched-out” lesions

Multiple Myeloma

• “Punched-out” lesion

Imaging Where Growth present age Type

Godman Triangle sunburst

metaphyses

rapid Pain at nightLocal

tenderness

15-25

Osteosarcoma

Central flacks of

calcification

Cartilage and

metaphyses

slow Dull achePath-

fructure

30-60

Chondrosarcoma

Onion skin diaphysis - Throbbing pain

swelling . General

illnes

>40 Ewing’s Sarcoma

Punch out Bone marrow

- Weekness ,back pain

path-fructure

45-65

Multiple Myeloma

Metastatic Disease

•Most common malignancy in bone.•Must be considered in any differential diagnosis

of a bone lesion in a patient Over 50 years old.•May have virtually any appearance.•May be lytic or blastic.•Majority of metastases to bone originate in

Breast, Prostate, Lung, Kidney and Thyroid.

Metastatic Disease

•Most common sites for bony metastases include thoracic and lumbar spine, pelvis, femur, rib, proximal humerus and skull

•Pain •Sudden back pain

Metastatic Disease

•Bone mets from Lung CA

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