Aneurysmal bone cyst

Pain

Swelling

Spine

Metaphysis of the long bones

Young adult

Aneurysmal bone cyst

Pathology Cyst contains clotted blood

The membrane contains giant cells

X-ray Metaphysis Cystic The boundary stops well short of the articular margin Expands the bone Marked thinning of the cortex

Treatment

Curettage + Bone graft ( Profuse bleeding)

Recurrence is common

Giant cell tumourPathologyUncertain origin

After the end of bone growth

At the rapid growing ends of the long bones

Reddish fleshy appearance

Abundant giant cells

●1/3 benign●1/3 locally invasive

●1/3 metastasize

Clinical features

Young adult

Pain at the end of a long bone

±Slight swelling

Pathological # in%15

Imaging

Eccentric radiolucent at the end of a long bone( soap bubble)

Always extends to the articular cartilage

CT + MRI = extent

Treatment●Well confined, benign histology

Curettage + stripping with burrs

+ hydrogen peroxide or liquid nitrogen + bone graft

●More aggressive and recurrent lesions Excision

+ bone graft or prosthetic replacement

Primary Malignant Bone Tumours

.

osteosarcomaPathology

Highly malignant tumor

Arises from inside the bone

Spreads rapidly to the periosteum, surrounding soft tissues Contains fibrous, cartilage, osteoid tissue in different amounts

Clinical features

Children and adolescents

Pain (1) Constant(2) ↑ at night(3) ↑ gradually(4)around the knee shoulder ( long bone metaph)

Lump

Local tenderness

The overlying skin looks inflamed

Blood exam

(1 )Anaemia

(2↑ )ESR

(3↑ )serum alkaline phosphatase

ImagingPlain X-rayAlternating osteolytic and osteoblastic areas

Margins are poorly defined

The cortex is breached

Codman’s triangle

Sunburst effect

Radioisotope study : skip lesions

CT and MRI : extent of the lesion

Chest X-ray and CT of the lung: lung metastasis

Diagnosis)1 (Imaging

)2 (Biopsy: Mandatory

TreatmentChemotherapy + Resection OR Amputation + Chemotherapy

Diagnosis)1 (Imaging

)2 (Biopsy: Mandatory

Treatment

Chemotherapy + Resection OR Amputation + Chemotherapy

Ewings sarcomaPathologyArises from endothelial cells in the bone marrow

Clinical features

10-20 years

Throbbing pain in tibia or fibula or clavicle

Swelling

Generalized illness

Pyrexia

Tenderness

↑ESR

Imaging

Middiaphysis

Bone destruction

Fusiform layers of bone ( onion-peel appearance)

Treatment

Radiotherapy and chemotherapy have dramatic effect

Amputation may be needed

Metastatic bone diseaseSourcesBreastProstateKidneyLungThyroidBladderGITIn 10% no primary is found

Commonest sites for bone metastasisVertebraePelvisProximal ½ of femur and humerus

Clinical presentations

Pain

Sudden backache in elderly

Incidentally on Xray

Pathological#

Sudden collapse of a vertebral body

Symptoms of hypercalcaemia( anorexia, nausea, thirst, polyuria, abdominal pain, general weakness)

Imaging

Rarefied areas

Osteoblastic deposits in late cases of prostatic Ca

Vertebral collapse

Radioscintigraphy using 99mTc-HDP is the most

sensitive in detecting silent metastatic deposits

Special investigations)1↑(ESR

)2↓ (Hb)3↑ (Serum alkaline phosphatase

)4↑ (Serum acid phosphatase in prostatic Ca

Special investigations

)1↑(ESR

)2↓ (Hb

)3↑ (Serum alkaline phosphatase

)4↑ (Serum acid phosphatase in prostatic Ca

Treatment

)1 (Primary tumor = Accordingly

)2 (Fracture of the shaft = internal fixation followed by radiotherapy

)3 (Fracture of femoral neck = replacement followed by radiotherapy

)4 (Large deposit may fracture = prophylactic internal fixation

)5 (Stable vertebral # = brace)6(Unstable vertebral # = spinal fusion

)7 (Signs of cord compression = urgent decompression + stabilization

)8 (Terminal stage of the disease = radiotherapy ± steroid ± narcotics