2. Definition
⢠10 bone neoplasm
⢠First described Cooper 1818
⢠Generally benign but locally aggressive
⢠Potential for :
â Recurrence
â Pulmonary metastasis
â Frank malignancy
3. ⢠Osteolytic tumour arising from
epiphysis
⢠Common in young adults
⢠Though it is benign it is locally
malignant
4. Epidemiology
⢠5-10% 10 bone tumors
⢠20% benign bone tumors
⢠F : M 1.5 : 1
⢠70-80% age 20-40yrs
5. SITES
⢠Most common location âdistal femur followed
closely by the proximal tibia
⢠In the distal radius(3rd most common location)
these are frequently more aggressive
6. Presentation
⢠Swelling with skin over the
swelling stretched
⢠Pain x wks. â mos(usually not a presenting
feature
⢠Mass
⢠Pathologic #
⢠Neuro deficit (spine / sacrum)
⢠Incidental
7. ⢠EGG SHELL CRACKING sensation may be
present
⢠Limitation of joint movement and pathological
fractures âusually a late feature
8. Radiology
⢠Lytic lesion near epiphysis
⢠Eccentric or central
⢠Narrow zone transition B/W
tmr and surrounding tissue
⢠Cortical thinning
⢠expansile
⢠No sclerotic margin
⢠No periosteal bone formation
9. ⢠Thin septa of bone traverse the interior
producing soap bubble appearance
⢠Joint extension usually not a feature
⢠Cortex disrupted in late stages
⢠Intra articular extension is rare as subchondral
bone usually remains intact
10.
11.
12.
13. Other modalities
⢠CT
â Integrity cortical rim
⢠MRI
_extent of lesion within the bone and soft tissue
â Assess subchondral breakthrough
â Lesion dark on T1 and bright on T2 wt
⢠Bone Scan
â Suspect multicentri loci
â Uses very low radioactive material
(disphosphonate) to see spread to other bone
14.
15. CAMPANACCIâS GRADING
⢠GRADE 1 :CYSTIC LESION
⢠GRADE 2:CORTEX THIN BUT NOT PERFORATED
⢠GRADE 3:CORTEX PERFORATED WITH
EXTENSION INTO SOFT TISSUE
16. ENEKINGâS STAGING
⢠STAGE 1: LATENT-NO CHARACTERISTIC
GROWTH OR PROGRESSIVE CHANGE,RESOLVE
SPONTANEOUSLY
⢠STAGE 2:ACTIVE-LESION DEFORM THE HOST
BONE BUT REMAINS INSIDE BONE
⢠STAGE3:AGGRESSIVE-TUMOUR EXTEND
BEYOND THE BONE
17. Histology
⢠Fibrohistiocytic origin
⢠Multinucleated giant cells
(40-60 nuclei per cell) in a sea
of mononuclear stroma
â Round / ovoid / spindle
⢠Indistinct cell membrane
⢠Mitoses
⢠Appearance of spindle cells-malignant
potential
18. ⢠GCT USUALLY ARE SOLITARY
LESIONS;HOWEVER 1%-2% MAY BE
SYNCHRONOUSLY OR METACHRONOUSLY
MULTICENTRIC
19.
20. PULMONARY METASTASIS
⢠OVERALL MORTALITY:15%
⢠PATIENT WITH RECURRENT LESIONS OR
PRIMARY LESIONS THAT APPEAR AGGRESSIVE
RADIOGRAPHICALLY ARE AT HIGHER RISK
⢠MALIGNANT GCT <5% CASES
22. ⢠HISTORICALLY TRT CONSISTED OF SIMPLE CURETTAGE
⢠BUT RECURRENCE RATES > 50%
⢠FOR DEFECTS AFTER RESECTION OR
CURETTAGE,EITHER ALLOGRAFT OR BONE CEMENT
USED AS FILLING AGENTS
EXTENDED CURETTAGE âUSE OF A POWER BURR TO
ENLARGE THE CAVITY 1-2 CM IN ALL DIRECTIONS IS
NOW CONSIDERED STANDARD
24. Adjuvant Tx
⢠PMMA, Liquid N2, Phenol, CO2 laser,
Electrocautery
â Local extension of margin
â Kill residual foci and remaining tumour cell
⢠ASSOCIATED WITH PATHOLOGIC
FRACTURES,WOUND HEALING PROBLEMS
25. BONE GRAFT
ADVANTAGE:
⢠RESTORING NORMAL BIOMECHANICS TO
JOINT SURFACE
⢠PREVENT FUTURE DEGENERATIVE JOINT
DISEASES
⢠RESTORING BONE STOCK
26. ⢠DISADVANTAGES
JOINT MUST BE PROTECTED FOR AN
EXTENDED PERIOD OF TIME TO PREVENT A
PATHOLOGICAL FRACTURES
TUMOUR RECURRENCE IS DIFFICULT TO
DISTINGUISH FROM GRAFT RESORPTION
27. ⢠THE ABOVE DISADVANTAGES OVERCOME BY
USE OF BONE CEMENT
⢠PROVIDES IMMEDIATE STABILITY-HENCE
QUICKER REHABILITATION
⢠EASIER DETECTION OF RECURRENCE SEEN AS
EXPANDING RADIOLUCENCY ADJ TO CEMENT
⢠KILLS RESIDUAL TMR CELLS
THRUPOLYMERISATION
29. ⢠INITIAL PROCEDURE OF CHOICE AND HERE
2CM OF NORMAL BONE IS ALSO EXCISED
⢠DEFECTS ARE FILLED WITH CANCELLOUS BONE
GRAFTS,FREEZE DRIED ALLOGRAFT OR
PROSTHESIS
30. ⢠AROUND THE KNEE,A HEMICONDYLAR
OSTEOARTICULAR ALLOGRAFT
RECONSTUCTION OR A ROTATING HINGE
ENDOPROSTHESIS MAY BE NECESSARY
⢠FOR AGGRESSIVE LESION OF DISTAL
RADIUS,PRIMARY RESECTION AND
RECONSTRUCTION WITH A PROXIMAL
FIBULAR AUTOGRAFT INDICATED
31. ⢠FOR LESIONS IN EXPENDABLE BONES(DISTAL
ULNA OR PROXIMAL FIBULA)PRIMARY
RESECTION WITHOUT RECONSTRUCTION
INDICATED
⢠FOR INOPERABLE LESIONS IN SPINE OR
PELVIS,RADIATION MAY BE USED
32.
33. EXCISION AND RECONSTRUCTION
⢠FOR GCT AFFECTING LOWER END OF
FEMUROR UPPER END OF TIBIA
⢠AFTER EN BLOCK EXCISION RECONSTRUCTION
CAN BE DONE BY
1.TURN-O-PLASTY TECHNIQUE
2.ARTHRODESIS
3.ARTHROPLASTY
34. RECURRENCE OF LESIONS
⢠MOST LOCAL RECURRENCES AND
PULMONARY METASTASES OCCUR WITHIN
3YRS OR EVEN UPTO 20 YRS
⢠PATIENT SHOULD HAVE RADIOGRAPH OF THE
PRIMARY TUMOUR SITE AND THE CHEST AT
3MONTHS INTERVAL FOR 1YR
6MONTHS INTERVAL FOR NEXT 2 YRS
AND ANNUALLY THEREAFTER
35. ⢠TREATMENT IS SAME AS FOR PRIMARY
LESIONS.
⢠AFTER BIOPSY SHOWS THAT TUMOUR IS STILL
BENIGN,REPEAT CURETTAGE OR RESECTION IS
PERFORMED