kuliah s1 uniba bone.ppt
TRANSCRIPT
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
1/69
Diagnosis of Bone Tumours
1. Age of patient
2. Location of tumour
3. Radiological appearance
4. Histological features
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
2/69
Age group Most common benign lesions Most common malignant tumors
0-20
non-ossifying fibroma
fibrous dysplasiasimple bone cystaneurysmal bone cystosteochondroma (exostosis)osteoid osteomaosteoblastomachondroblastomachondromyxoid fibromaeosinophilic granuloma
Ewing's sarcomaleukemic involvementmetastatic neuroblastomaosteosarcomaEwing's sarcoma
2!-"0enchondromagiant cell tumor chondrosarcoma
#"0 osteoma
metastatic tumorsmyelomaleukemic involvementchondrosarcomaosteosarcoma ($aget's associated)%&
chordoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
3/69
SITE OF LONG BONE INVOLVEMENT (most primary bone tumors have favored sites within long bones this may provide a clue todiagnosis)
Diaphyseal intramedullary lesions:Ewing's sarcoma, lymphoma, myeloma. *ommon for i!ro"s #ysplasia andenchon#roma
Metaphyseal lesions centered in thecortex:$lassic loca%ion or a non&ossi ying
i!roma NOF(. +lso a common site forosteoid osteoma
Epiphyseal lesions:$hon#ro!las%oma $h( an# Gian%$ell T"mor G$T( are almost
invariably centered in the epiphysis*hondroblastoma is a rare tumorseen in children and adolescents withopen growth plates ,* is the mostcommon tumor of epiphyses inskeletally mature individuals withclosed growth plates ,* oftenshows metaphyseal extension
Metaphyseal exostosis:Os%eochon#roma
Metaphyseal intramedullary lesions:Os%eosarcoma is usually centered in themetaphysis *hondrosarcoma and
fibrosarcoma often present as metaphyseallesions .steoblastoma enchondromafibrous dysplasia simple bone cyst andaneurysmal bone cyst are common in thislocation
Diaphyseal lesions centered inthe cortex:Os%eoi# os%eoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
4/69
Radiological Features
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
5/69
PRIMARY !M"R# "F $"%&
' Bone-producing tumors ( "steoma) osteoid osteoma) osteo*lastoma ( "steosarcoma+
' Cartilage-producing tumors ( "steoc,ondroma) c,ondroma -enc,ondroma ( c,ondrom/0oid fi*roma ( c,ondro*lastoma
( ,ondrosarcoma+
' Miscellaneous tumors ( & ing s sarcoma +
( iant cell tumor of *one
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
6/69
umour5li6e conditions of *one
' $one c/sts ( #imple *one c/st ( Aneur/smal *one c/st
' Fi*rous5osseous lesions ( Fi*rous d/splasia
' &osinop,ilic granuloma -Langer,ans ,istioc/tosis
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
7/69
Benign TumoursOsteochondroma
Also 6no n as an e0ostosis) is a cartilage (cappedout gro t,.
Men are affected t,ree times more oftent,an omen
7e8elop in *ones of endoc,ondral origin and arise fromt,e metap,/sis near t,e gro t, plate of long *onesespeciall/ a*out t,e 6nee
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
8/69
7e8elopment o8er time of an osteoc,ondroma*eginning it, an outgro t, from t,e epip,/sealcartilage
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
9/69
linicall/ present as slo gro ing masses
an *e painful if t,e/ impinge on a ner8eor if stal6 is fractured.
In man/ cases) t,e/ are detected as anincidental finding.
Rarel/ t,e/ gi8e rise to c,ondrosarcoma
Osteochondroma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
10/69
Osteochondromaof femur
The white arrows point to a mushroom-shaped, peduculatedbony excresence arising from the anteromedial aspect of thedistal femoral metaphysis, attached to the parent bone andpointing away from the metaphyisis
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
11/69
Osteochondroma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
12/69
Chondroma$enign tumours of ,/aline cartilage
Ma/ arise it,in t,e medullar/ ca8it/5enc,ondroma
Ma/ arise on t,e surface of *one ( su*periosteal c,ondroma
&nc,ondromas are t,e most common
Located in t,e metap,/seal region of tu*ular *ones
Most enc,ondromas are as/mptomatic and detectedas incidental finding
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
13/69
Enchondroma of the phalanx witha pathological fracture
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
14/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
15/69
&nc,ondroma it, a nodule of ,/aline cartilage encased*/ a t,in la/er of reacti8e *one.
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
16/69
"llier s 7isease9 Multipleenc,ondroma.
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
17/69
Chondroblastoma' Rare *enign tumor ' Most common primar/ epip,/seal tumor in
c,ildren
' #igns:#/mptoms9' Local pain and s elling; tumors 1.< to =.< cm' Age9
' 2 nd decade of life
' #e09' M > F' Anatomic 7istri*ution9
' &pip,/sis of long *ones' 4
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
18/69
L/tic lesion of epip,/sis it,t,in sclerotic rim; t,inningit,out destruction of corte0
Chondroblastoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
19/69
ellular lesion it,pol/,edral c,ondro*lasts;
giant cells and areas ofcalcification ma/ *e seen;
mitoses common
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
20/69
Osteoid osteoma and Osteoblastoma
Ha8e identical ,istolog/
"steo*lastoma larger t,an osteoidosteoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
21/69
Osteoid osteoma
@ 2 cm in greatest dimension
Affects teenagers and adolescents
= ? of patients @ 2 /ears
Affects corte0 of femur or ti*ia
Painful lesion
Relie8ed */ salic/late
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
22/69
"steoid osteoma of Femoral nec6
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
23/69
Osteoid osteoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
24/69
"# &"$LA# "MA
' linicall/ similar to osteoid osteoma -large' Also 6no n as giant osteoid osteoma.' ommon location 55 8erte*ral column
' Histolog/ similar ( *ut rare nidus.' an *e locall/ aggressi8e' ,erap/ 5 curettage:resection it, *one graft.
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
25/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
26/69
Osteosarcoma O!"
Most common primar/ malignanttumor of t,e *one
Mesenc,/mal tumor
ancerous cells produce *one matri0
= ? occur in patients /ounger t,an 2</ears of age
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
27/69
Primar/ osteosarcoma arise in t,e
metap,/sis of long *ones of t,ee0tremities
#econdar/ osteosarcomas occur in olderpatients it, Paget s disease
More common in men t,an omen
ommon sites are distal end of femur or pro0imal ti*ia
Osteosarcoma O!"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
28/69
Patients it, Mutation of R* gene arepredisposed to osteosarcoma
oncurrent trauma to *ones and Boints
In t,e elderl/ "# often arises from pree0isting *one diseases eg9 Paget s
disease of *one
Osteosarcoma O!"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
29/69
Clinical #resentation
Painful and progressi8el/ enlarging masses
#pread t,roug, *lood stream
,e tumour *rea6s t,roug, t,e corte0and lifts t,e periosteum
"ften metastasiCes to t,e lungs
Osteosarcoma O!"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
30/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
31/69
Osteosarcomaon distal end offemur
Cortex isdestroyed
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
32/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
33/69
$eoplastic osteoblasts forming osteoid
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
34/69
$eoplastic osteoblasts forming osteoid
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
35/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
36/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
37/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
38/69
Chondrosarcoma
FreDuenc/ is a*out ,alf ofosteosarcoma
#econd most common malignant matri0producing tumor
Mean age for c,ondrosarcoma is 43/ears
Men are affected more t,an omen
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
39/69
Chondrosarcomas
ommonl/ arise in t,e centralportions of t,e s6eletonincluding Pel8is) pro0imal femur) ri*s)sternum and s,oulder girdle
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
40/69
Present as painful progressi8el/enlarging masses
Prognosis depends on siCe of tumor
#preads to lungs and s6eleton
Chondrosarcoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
41/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
42/69
Chondrosarcoma
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
43/69
umor ,as de8eloped in t,e pro0imalfemur
%ot destro/ed t,e corte0
Has a *luis,) glass/ appearance )reminiscent of cartilage
Chondrosarcoma
Malignant neoplastic cells produce a chondroid matrix
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
44/69
g p p
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
45/69
The aggressi)eness o chon#rosarcomas can !e pre#ic%e# ! %heir his%ologic gra#e rading system is based on three parameters/ cellularity
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
46/69
The aggressi)eness o chon#rosarcomas can !e pre#ic%e# !y %heir his%ologic gra#e. ,rading system is based on three parameters/ cellularitydegree of nuclear atypia and mitotic activity
Gra#e * low&gra#e(ery similar to enchondroma owever the cellularity is
higher and there is mild cellular pleomorphism he nuclei aresmall but often show open chromatin pattern and smallnucleoli 1inucleated cells are fre uent %itoses are very rare,rade ! chondrosarcomas are locally aggressive and prone torecurrences but usually do not metastasi3e
Gra#e + low&gra#e(he cellularity is higher than in ,rade ! tumors *haracteristic
findings are moderate cellular pleomorphism plump nucleifre uent bi-nucleated cells and occasional bi3arre cells %itosesare rare &oci of myxoid change may be seen 4nlike ,rade !tumors about !05 to !65 of ,rade 2 chondrosarcomas
produce metastases
Gra#e high&gra#e(*haracteristic findings are high cellularitymarked cellular pleomorphism high 78*ratio many bi3arre cells and fre uentmitoses (more than ! per hpf) hese arehigh grade tumors with significantmetastatic potential
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
47/69
O!TEO!%&COM% C'&O$D&O!%&COM%
' 1
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
48/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
49/69
In8ol8e *ot, epip,/sis and metap,/sis
In adolescents limited to metap,/sis
ommon sites are distal femur andpro0imal ti*ia
(iant cell tumour of bone (CT"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
50/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
51/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
52/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
53/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
54/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
55/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
56/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
57/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
58/69
Ewing sarcoma E!"
Primar/ malignant small round cell tumour
& ing sarcoma ,as t,e /oungest
a8erage age at presentations -1
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
59/69
Pel8is is t,e most common siteusuall/ arises in t,e diap,/sis of
long *ones especiall/ femurfollo ed */ ti*ia and ,umerus
Ewing sarcoma E!"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
60/69
Ewing sarcoma
of tibia from achild
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
61/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
62/69
The ollowing s%"#ies are re-"ire# %o s"ppor% %he #iagnosis o ES an# NET /
Demonstration of t(11;22) or EWS- !"-1 fusion transcript (present in both E9 and $7E ) "mmunostains (both E9 and $7E are positive for *:;;8.!< =n addition $7E shows positive stainingwith neural markers)
EM (E9 cells are undifferentiated and show prominent glycogen deposits $7E shows neuraldifferentiation)
Ewing sarcoma E!"
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
63/69
,e pat, a/s of spread include
7irect e0tension
L/mp,atic or 8ascular dissemination
Intraspinal seeding
Ewing sarcoma E!
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
64/69
!econdary tumours of bone
Metastatic cancer to *one ismore common t,an primar/
cancer of *one
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
65/69
)*+ of bone metastasis originate from
ancers of prostate *reast 6idne/ lung
t,/roid
Metastatic lesions are multifocal
Produce a l/tic and or *lastic reaction
Bone metastasis
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
66/69
Bone metastasis
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
67/69
#rostatic carcinoma metastatic to bone
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
68/69
-
8/18/2019 kuliah s1 UNIBA BONE.ppt
69/69