Bone Tumor

Karuniawan Purwantono
Head of Surgery Dept
Christian University of
Indonesia

Approach to Bone Tumor diagnosis - Back to Basics

a. General considerations
b. Relevant clinical information
1.Table-Age Groups
c. Radiological correlation
1.Table-Skeletal Site
2.Table-Long Bone Site
3.Table-Growth Patterns
4.Table-Types of Periosteal Reaction
5.Table-Types of Tumor Matrix
d. General histologic assessment of the lesion.

General considerations
Bone Tumors can be divided into

Primary Tumor

Secondary Tumor

Secondary Tumor
subdivided
Metastatic tumors
Tumors resulting from contiguous spread
of adjacent soft tissue neoplasms
Tumors representing malignant
transformation of the pre-existing
benign lesions.
most frequent malignant tumors
found in bone

Secondary Tumor
Most common malignancies producing
skeletal metastases
Adult
> 40
years
Chilfren
< 10
years

carcinomas of the prostate,

breast, kidney, lung and
melanoma
Neuroblastoma,
rhabdomyosarcoma, and
retinoblastoma

Secondary Tumor
Radiographic appearance of the
metastatic tumors
Purely lytic (kidney, lung, colon, and
melanoma)
Purely blastic (prostate and breast
carcinoma)
Mixed lytic and blastic (most
common appearance)

Primary bone
Primary bone tumors are characterized
by
Predominant occurrence in the first 3
decades of life, The commonest sites
for many primary tumors, both
benign and malignant, are in the
distal femur and proximal tibia
specific radiographic
presentations.

Primary bone
Benign tumors > malignant
(osteochondroma, non-ossifying fibroma,
and
enchondroma)
difficult to classify as benign or
malignant
highest incidence : osteosarcoma and
multiple myeloma , followed by
chondrosarcoma and Ewing's sarcoma.

Approach to Bone Tumor Diagnosis

Relevant clinical information
AGE
PAIN

MULTIPLE LESIONS

SKELETAL
LOCATION

SITE OF LONG BONE

INVOLVEMENT
TYPES OF PERIOSTEAL
REACTION
TYPES OF PERIOSTEAL
REACTION
PATTERNS OF MATRIX
MINERALIZATION

Primary bone
Two important features of bone tumors:
The ability of some to dedifferentiate
(eg., enchondroma or a low-grade
chondrosarcoma transforming into a highgrade sarcoma)
Tendency of high-grade sarcomas to arise
in damaged bone, at the sites of bone
infarcts, radiation osteitis and Paget's
disease

Primary bone
Relevant clinical information

Age
most important
clinical clue

Primary bone
Relevant clinical information

pain
Growing lesions. This category includes
locally aggressive lesions (eg., aggressive
osteoblastoma and GCT), and malignant
tumors
Pathologic fracture complicating either
benign or malignant tumor
Significant local tissue reaction to the
tumor

Primary bone
Relevant clinical information
MULTIPLE LESIONS
Radiological
Correlation

PLAIN RADIOGRAPH
COMPUTER
TOMOGRAPHY
MRI is a method of
choice for local
staging.
BONE SCINTIGRAPHY
is a highly sensitive
but relatively nonspecific technique

Primary bone
Relevant clinical information

SKELETAL
LOCATION

Primary bone
Relevant clinical information
SITE OF
LONG
BONE
INVOLVEME
NT

PATTERNS OF GROWTH and BONE

DESTRUCTION
geographic pattern

Cortical expansion.

PATTERNS OF GROWTH and BONE

DESTRUCTION
Permeative
"Moth-eaten"
pattern
pattern

TYPES OF PERIOSTEAL
REACTION
Focal cortical thickening

Codman's triangle

TYPES OF PERIOSTEAL
REACTION
"onion-skinning" and
spiculated "hair-onend" types

PATTERNS OF MATRIX
MINERALIZATION

Osteoid
Malignant osteoid
cloudlike
Or
ill-defined amorphous
densities with
haphazard
mineralization.

PATTERNS OF MATRIX
MINERALIZATION

Osteoid

Chondroid

Contoh kasus
Solitary Bone Cyst
(SBC)

Eosinophilic Granuloma (EG)

Non-Ossifying Fibroma (NOF)

Fibrous Dysplasia

Chondroblastoma

Giant Cell Tumor of Bone

Surgical staging

Surgical staging

treatment
Non surgical

Surgical

Radioterapy
brachytherapy
Chemotherapy
Adjunavt Chemoth/
Neo adjuvant
chemoth/

Cryosurgery

Excisional
Curetage
Amputation
Resection + bone
replacement /graft
Resection +
arthroplasty

Surgical procedure

Bone excision

Curetage

Treatment
Non surgical

Surgical

Excisional

And soft tissue