defination,classification,haemopoeitic tumors,osteogenic,chondrogenic,investigations of bone tumors,surgical management,etiology,

1. BONE TUMORS
PREPARED BY
DR BADAL KHAN PGR.2 ORTHO
UNIT 3 BMCH

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

4. CLASSIFICATION (cont….)
BENIGN TUMORS
Exostosis
Osteoid osteoma
Osteochondroma
Chondroma
Fibroma
Aneurysmal bone cysts

5. CLASSIFICATION(cont….)
Malignant Tumors
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Synovial sarcoma
Giant cell tumor
Ewing tumor

6. CLASSIFICATION(cont….)
Secondry bone tumors
Mostly from
Thyroid
Lungs
Breast
Kidney
prostate

7. CLASSIFICATION(cont….)
Radiological classification
Depend on their site within bone
Epiphyseal lesion
giant cell tumor
chondroblastoma
Metaphyseal lesion
osteochondroma
osteosarcoma
Diaphyseal lesions
ewing,s sarcoma
osteoid osteoma

8. CLASSIFICATION(cont….)

9. CLASSIFICATION(cont….)
X-ray showing an osteoid osteoma of the tibial diaphysis
with reactive bone formation

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)

18. 2.OSTEOGENIC TUMORS
Osteoblastoma
•Larger
•more aggressive
•counterpart of osteoid osteoma
•Commonly occurs in the spine
•Dull pain
•Not relieved by aspirin
•produces osteoid and bone.

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

22. Osteosarcoma
Sclerotic osteosarcoma of the
distal femur in a child.
Sclerotic osteosarcoma of the
distal femur in a child.

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

25. Osteochondromas
Pedunculated osteochondromas of
the proximal fibula with pseudarthrosis.
Excised pedunculated
osteochondroma showing cartilage
cap

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.

27. Enchondroma
Calcification and
pathological
fracture in a
benign
enchondroma of
the proximal
phalanx of the
ring finger.

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

32. Chondrosarcoma
Clear cell chondrosarcoma of the
medial Femoral condyle.
Computed tomography scan
reconstruction shows calcification
within the lesion

33. OTHERS
1.Unicamberal bone cyst
2.Aneurysmal bone cyst
3.Giant cell tumor of bone
4.Eosinophilic granuloma
5.Fibrous dysplasia
6.Ewing,s sarcoma

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