Bone Tumours

Classification
Bone Cysts, Fibrous dysplasias
Benign & Malignant
Primary
ABCDE HN SUX
Bone forming Osteoma, Osteoblastoma, Osteosarcoma
Cartilage forming Chondroma, Chondroblastoma, Chondrosarcoma
Giant Cell Tumour Benign & Malignant
Marrow Tumours Ewing, Myeloma
Connective Tissue Lipoma, fibro sarcoma
Others Chordoma, adamantinoma, meurofibroma
Secondary
Breast, Thyroid, Kidney, Bronchus, prostate, GIT.
Incidence
Age Young age Osteo 10-20; Chondro 20-30; Old age - Secondaries
Sex
Males
Site Epiphysis Giant cell tumours, chondroblastoma.
Metaphysis - Osteoma, Osteosarcoma, Aneurysmal bone cysts etc.
Diaphysis Osteoid osteoma, Ewing, Osteoblastoma, Secondaries
Clinical Presentation
Symptoms
Pain night pain
Mass
Pathological fractures
Abnormal X-rays
Constitutional symptoms - Anorexia, weight loss
Signs Mass - Site, Size, shape, consistency, mobility, tenderness, local temperature and
change with position. Atrophy & circulation
Local lymph nodes.
Diagnosis
a.
Radiology
1.
Roentgenograms in two planes Lytic lesions, osteoblastic, erosion of
cortex, penetration, sun ray appearance, onion skinning.
2.
Computed tomography Bone & lungs.
3.
MRI- Extent, soft tissue & staging.
4.
Bone scans- Metastases; multiple lesions in such entities as Osteo
Chondroma, enchondroma, and eosinophilic granuloma.
5.
Ultrasonography- Cystic lesions.
6.
Angiography.
b.
Biopsy Needle or open; intralesional or excisional.
c.
Biochemistry - ESR, Serum Calcium, alkaline phosphatase, acid phosphatase,
PSA, serum and protein electrophoresis
D/D Hyper parathyroidism, benign cysts, infections.
Staging
Enneking classification - Clinical features, radiology, biopsy; concept of
compartment & lesion
I A - Low grade intra compartmental
I B - Low grade extra compartmental
II A - High grade intra compartmental
II B - High grade extra compartmental
III - Any grade with local or distant metastasis
Management
1.
Diagnosis
2.
Exclude biochemical and other abnormalities.
3.
Staging
4.
Orthopaedic management
5.
Adjuvant therapy

Orthopaedic Management
1.
Stabilization
Load bearing implants are better than load sharing implants I/L I/M nails better
than DCP.
Replacement arthroplasty
Implantation with bone cement
2.
Excision and limb salvage
Excision
Wide / Radical excision
Salvage
1.
Custom Designed prosthesis
2.
Bone grafting
3.
Rotation arthrodesis
4.
Rotationplasty
5.
Bone transport
3.
Amputation
Wide. Radical amputation
4.
Adjuvant therapy
Radiotherapy
Chemotherapy
Prognosis
Osteoid Osteoma
Pathology:
Osteoid in vascular granulation tissue encased in dense bone < 1 cm.
Incidence:
Age 10-25; Male
Site:
Femur or tibia.
Presentation: Pain esp. at night relieved by aspirin
X-rays:
Small radiolucent area nidus with surrounding sclerosis
Treatment:
Excision
Giant Cell Tumor
One third benign, one third locally malignant and one third metastasize
Stroma of spindle cells with large number of giant cells in vascular frame
work. Asymmetrically placed at the epiphysis
Incidence:
Age 20-40; Females
Presentation: Vague discomfort, swelling, joint irritation
X-rays:
At the very end of bone; trabeculations, soap bubble appearance; cortex
thinned out.
Treatment:
Excision in an expendable bone
Curettage and grafting
Curettage and cementing
Excision and reconstruction
Amputation
Pathology:

Osteosarcoma
Pathology:
Spindle shaped cells with matrix of bone, cartilage or mucoid cells.
Metaphysis; osteoclastic and osteoblastic activity; Metastasis to lungs via
blood stream.
Incidence:
Age 10-20 years; Males; Site: knee
Presentation: Pain, lump, pathological fracture
X-rays:
Osteolysis and osteoblastic, Metaphysis, cortex penetration, soft tissue
mass, sun ray appearance, Codmans triangle.
Treatment:
Diagnosis
Staging
Neo adjuvant Chemotherapy
Surgery
Limb Salvage
Amputation
Isolated Secondaries
Radiotherapy
Immunotherapy

Bone Tumours
(ABCDEF- HN SUX)
Benign
Angioma
Osteoma
Osteoblastoma
Osteoid osteoma
Chondroma
Osteochondroma
Chondroblastoma
Odontogenic Cyst

AB-

Tissue type
Angioid
Bone forming

C-

Cartilage forming

D-

Dental

EF-

Embryonic
Fibrous Tissue

H-

Heterotopic

N-

Non osseous

Lipoma
Neurofibroma
Neurolemmoma

SUX-

Synovium
Undifferentiated
Un diagnosable

Synovioma
Giant Cell

Fibroma
Myxoma
Dermoid

Malignant
Angiosarcoma
Osteosarcoma
Juxtacortical
Chondrosarcoma
Amelobalstoma
Cemetnoblastoma
Chordoma
Fibrosarcoma
Adamantinoma
Maxillary Ca
Liposarcoma
Reticulum cell sarcoma
Myeloma
Ewing
Leukemia
Leiomyo sarcoma
Synovial sarcoma
Giant Cell

Slides
1. Region of bone and predilection for tumours
2. Sunray appearance; Onion skinning
3. Load bearing devices vs. load sharing device IM Nail vs. DCP; Replacement
arthroplasty
4. Limb salvage Arthrodesis; Resection arthroplasty; Rotationplasty; Bone
transport; Custom designed prosthesis
5. Osteoid Osteoma
6. Giant cell tumour X-ray
7. Giant cell tumour excision fibular head; curettage and cementing; Reconstruction
8. Osteogenic Sarcoma X-ray
9. Osteogenic sarcoma -