2. Introduction
A bone tumor is a neoplastic growth of tissue
in bone.
Abnormal growths found in the bone can be
either benign (noncancerous) or malignant
(cancerous
3. CLASSIFICATION
Bone tumors can be classified into
o PRIMARY BONE TUMORS
oSECONDRY BONE TUMORS
Primary bone tumors further classified into
Benign tumors
malignant tumors
10. CLASSIFICATION(cont….)
Bone tumours can be classified according to the
tissue of origin.
These include:
1. • metastases–may show histological features of
their tissue of origin;
2. • haemopoietic tumors – e.g. myeloma;
3. • osteogenic tumors – e.g. osteosarcoma;
4. • chondrogenic tumors –
e.g.chondrosarcoma;
5. •others– e.g. Ewing’s sarcoma
11. 1.metastasis
The vast majority of tumours spreading to the skeleton
are carcinomas
•Metastases are rare in children, but can occur from
neuroblastoma, rhabdomyosarcoma and clear cell
carcinoma of the kidney
Most common bone metastases (93 per cent)
1. Breast
2. Prostate
3. Lung
4. Renal
5. Thyroid
12. Most common sites of
bone metastases
1. Spine
2. Proximal femur
3. Proximal humerus
13. 2. Haemopoietic tumors
There are no benign neoplasms of the
haemopoietic system.
Malignant tumours can be divided into
two groups:
1 solitary plasmacytoma/multiple myeloma
2 lymphomas
(malignant neoplasm of the lymphoid cells)
14. Radiological
findings of
mutilple myeloma
The skull contains
innumerable
small lytic lesions
of more-or-less
uniform size. This
has been likened
to an "oil-droplet"
appearance. Meta
stases are
generally fewer in
number and of
different sizes and
shapes.
15. Radiological
findings of
mutilple myeloma
The pelvis contains
numerous lytic
lesions without
reactive sclerosis
which have an
almost "soap-
bubbly“
appearance in the
ischia. There are
also lytic lesions in
both proximal
femoral
16. 2.OSTEOGENIC TUMOURS
•These tumours produce osteoid or bony matrix
Osteoid osteoma
•is a benign bone forming lesion
•small but very painful
•Usually, symptoms occur at night and are typically
•relieved by anti-inflammatories.
•Children and adolescents are frequently affected.
•They can occur in any bone
•but are common in the proximal femur.
•usually diaphyseal in location
•give rise to a dense cortical reaction
17. Osteoid osteoma
Axial (CT) scan showing an
osteoid osteoma nidus in the
distal tibia.
CT-guided radiofrequency
thermocoagulation of an osteoid
osteoma
of the distal femur.(electrode)
19. Osteoblasto
ma
a lytic lesion
that involves the
posterior
elements of the
C3 vertebra.
Cortical
expansion of the
spinous process
and an ossified
matrix are noted
20. Osteosarcoma
it is malignant tumor of bone
Types
primary osteosarcoma
Secondory osteosarcoma
Primary osteosarcoma
It arises in the appearent abscenc of underlying
Bone disesase predisposing influences
Occurs mostly in 2nd decade of life
Most common in distal femur followed by proximal
tibia and proximal humerus
21. Osteosarcoma
Secondary osteosarcoma
it occurs on a background of some predisposing
influences
Usually occurs in later in life
Predisposing factors
1. Paget,s disease of bone
2. Irradiation
3. Fibrous dysplasia
Spread
maily via blood stream to lungs
23. 3.CHONDROGENIC TUMOURS
These tumours produce chondroid matrix.
The biological spectrum of these tumours ranges
from very benign to highly malignant
24. Osteochondromas
is a benign cartilage capped bony projection.
It is thought to originate from
the physis.
The bony projection is always growing away from
the joint; towards the diaphyseal region of the bone.
Osteochondromas can be pedunculated
or sessile.
The stalk or base is always continuous with the
intramedullary cavity of the bone.
They are usually solitary,
but can be multiple
26. Enchondroma
is a benign cartilaginous neoplasm
within the intramedullary cavity of bone
50 per cent are in the hands and feet.
most common bone tumour in the hand.
They can present with pain, swelling or pathological
fracture.
Often symptomless
Diagnosis is often incidental
Associated with Ollier’s disease and Maffucci syndrome.
Patchy calcification, expansion and scalloping can be
visible on the x-rays.
some are only diagnosed on (MR) scan.
28. Enchondroma
Ollier’s disease
is a developmental condition characterised
by multiple enchondromas.
Maffucci syndrome
the multiple enchondromas are associated
with multiple angiomas.
Malignant transformation to chondrosarcoma can
occur inapproximately
20 per cent of patients with Ollier’s disease and is
almost inevitable in patients with Maffucci syndrome
29. Chondroblastoma
is a benign cartilage producing tumour
occurs in the epiphysis of children.
It is most common around the knee.
Pain is often severe with associated
inflammation and possibly joint effusion.
bone scan is often helpful in diagnosis
30. Chondroblastoma
Lateral x-ray with barely visible
chondroblastoma in the epiphysis
of the proximal tibia
Sagittal CT reconstruction
showing calcification within a
chondroblastoma
of the proximal tibial epiphysis.
31. Chondrosarcoma
is a malignant tumour with cartilage differentiation.
The biological spectrum is very wide
ranges from very low grade lesions to highly
aggressive dedifferentiated tumours.
symptom is pain and/or swelling.
Symptoms are often longstanding.
Clear cell chondrosarcoma is a rare form of chondrosarcoma
that occurs in the epiphysis
34. 1.unicameral bone
cyst
is a
membrane-lined
cavity filled with
serous fluid.
It usually
occurs in
proximal long
bones of
children Fig.Pathological fracture through a simple bone cyst
with the pathognomic fallen leaf sign.
35. 2.Aneurysmal bone cyst
is a benign cystic lesion
of bone consisting of
blood-filled spaces
separated by fibrous septa.
much more aggressive
than a simple bone cyst
often presents with pain
and swelling.
Fig.Abc with pathological
fracture of the proximal tibia
36. 3.Giant cell tumour
is a benign aggressive
tumour with large
osteoclast-like giant cells.
It usually occurs between
The ages of 20 and 45,
when the physes have closed.
affects the epiphysis of long
bones,especially around the
knee,proximal humerus and
distal radius Fig.Giant cell tumour of the
distal radius.
37. 4.Eosinophilic granuloma
A rare neoplasm of Langerhans
Cells.
It can be unifocal or
Multifocal
In the spine it can present with
Collapse known as vertebra plana.
X-rays can appear aggressive
And similar to Ewing’s sarcoma.
Fig.Eosinophilic granuloma of the
scapula
38. 5.Fibrous dysplasia
it is a benign fibro-osseous
lesion.
It usually affects the long bones,
ribs and skull.
present with pain swelling or
fracture.
Hip fractures can produce a
shepherd’s crook deformity.
Cysts may well be present.
There is expansion of the bone
with a ground glass appearance.
39. 6.Ewing’s sarcoma
is a round cell sarcoma of bone.
It tends to arise in the diaphyses
of long bones or the pelvis.
usually present with a
painful mass.
may have general symptoms
with fever, anaemia
and increased (ESR).
may show an ‘onion-skin’
periosteal reaction
often significant inflammation with oedema on the M
40. Daignosing bone tumors
•A detailed history
•Examination
•General
•Systemic
•Local
Blood tests
Urine Dr
Imaging
•X-rays
•Ct scan
•Mri
•Pet scan
•Biopsy
Needle biopsy
Incisional biopsy
41. Staging of bone tumors
Bone tumours are usually staged using the
Enneking staging system.
Benign tumours are staged as:
• latent (i.e. osteochondroma);
• active (i.e. osteoid osteoma);
• aggressive (i.e. giant cell tumour).
42. Staging of bone tumors
•Latent
lesions are usually asymptomatic
and often discovered incidentally.
•Active lesions
Do present with mild symptoms
and continue to grow.
•aggressive lesion
Aggressive lesions tend to grow rapidly
A giant cell tumouris an example of an
aggressive lesion
43. Staging of bone tumors
For malignant tumours
•the Enneking system combines stage
and grade of a tumour
44. Staging of bone tumors
Low grade Intra compartmental 1A
Extra compartmental 1B
High grade Intra compartmental 1A
Extra compartmental 1B
Any grade metastasis 3
The Enneking staging system for bone tumours
•Compartment
is the bone that is involved with the
tumour.
•extracompartmental
when the tumour has breached the cortex of the bone
45. TREATMENT
Benign tumors
Mostly benign tumors are treated by intralesional
curettage.
Packing of the cavity wth bone graft is not required
Osteoid osteoma are treated by CT-guided thermo-
Coagulation
Large benign tumors might require extensive surgical
Excision and reconstruction
46. TREATMENT(cont,,,,)
Malignant tumors
Osteosarcoma and ewing,s sarcoma require surgical
Excision and neoadjuvent chemotherapy.
Chondrosarcoma require surgical excision and are
Insensitive to radiotherapy and chemotherapy
Most malignant tumors can be treated with salvage
There is no difference in survival between amputation
And limb salvage