Bone Tumors PDF

BONE TUMORS  Bone tumors Bone tumors are classified into:  Benign bone tumors  Malignant bone tumors  Haematological malignancies  Metastases to bone  Hamartomas(cysts)  Origin: 1-known -1ry bone cells -bone m...

BONE TUMORS  Bone tumors Bone tumors are classified into:  Benign bone tumors  Malignant bone tumors  Haematological malignancies  Metastases to bone  Hamartomas(cysts)  Origin: 1-known -1ry bone cells -bone marrow cells -periosteom 2-unknown -GCT -Ewing's 3-Secondaries 4- Tumors of included tissues: (fat,, vascular& neurogenic elements)  Bone tumors 1. Hamartomas : Fibrous cortical defect Fibrous dysplasia Simple bone cyst  2. Benign bone tumours : Aneurysmal bone cyst Enchondroma Chondroblastoma Chondromyxoid fibroma Osteochondroma Osteoid osteoma/osteoblastoma locally malignant:\Giant cell tumour  3. Malignant bone tumours : Osteosarcoma Ewing’ s sarcoma Chondrosarcoma Spindle cell sarcomas (including fibrosarcoma., leiomyosarcoma, Malignant Fibrous Histiocytoma)  4. Haematological malignancies: Plasmacytoma/myeloma lymphoma (Non - Hodgkin’s )  5. Metastases to bone: mostly from epithelial cancers, the commonest being breast, bronchus, prostate, thyroid and kidney.  Presentation Most bone tumors present with a history of increasing bone in the affected limb, sometimes accompanied by a swelling and sometimes followed by a pathological fracture. The key investigation for any patient with non - specific pain, particularly non - mechanical pain (i.e. not related to movement) is a plain X - ray of the affected part.  DIAGNOSIS Presentation of 1ry trs. : PAIN MASS  The presence of any of these should lead to further investigation of the patient to identify the cause. Potential causes apart from bone tumours include: developmental abnormalities, infection and metabolic deficiencies. Assessment of a suspected case. History Examination Simple tests: X - ray, bloods Scan: bone or CT MRI Biopsy Diff. Diagnosis 1- Sequels of trauma: -- -Traumatic fractures. -Stress - Myositis ossificanse 2- Sequels of infection: -- -subacute & chronic 3- Endocrinal disorders.— -brown tr. Of bone 4- Blood dyscrasias. 5- Developmental. Paget's D. / Fibrous dysplasia. 6- Granulomatosis Histocytosis 7- Cysts.  BIOLOGY Growth: Local extension. compartments. Natural barriers. Distant spread: - blood -lymphatic -other  Dissemination ≠ Metastasis Primary Tumor Transportation Tumor cell to another Disseminated cells Invasion organ Microscopic metastases Tumorigenesis Metastasis Development of overt metastases Classification. (Of 1ry tumors) Benign:--- Latent. Active. Aggressive. Malignant --- Low grade High grade With or without metastasis INVESTIGATION (AIM=STAGING) IMAGING: --Plain x-rays. --Tomography --CT scanning --Angiography --Arthrography. Radio isotope scanning, PET SCANNING. M.R.I. CHEST imaging (plain&C.T) SEROLOGICAL exam. ESR, CBC, Hb% , Ca , P. Alk. & Acid phosphates PSA , Protein electrophoresis Hormonal assay ( Parathormone , T3, T4) Bone marrow exam. Biopsy& Histopathology. Tumor markers Bone Scan of Prostate Caner Metastases Biopsy Benign Malignant TREATMENT Fracture prophylaxis #- OSSEOUS. 1- OSTEOOBLAST EXAMPLES BENIGN -Osteoma - Ost. osteoma -Osteochondroma MALIGNANT -Osteosarcoma. 2- CHONDROBLAST. # BONE MARROW: BENIGN -Lymphoma -Enchondroma -Myelomatosis -Chondroblastoma -Ewing's MALIGNANT -Chondrosarcoma # PERIOSTEAL: 3-FIBROBLAST. BENIGN -Chondrosarcoma -Non ossifying fibroma -Osteosarcoma MALIGNANT -M.F.H. -Fibrosarcoma. Benign bone tumors  Unicameral Bone Cyst Also referred to as a simple bone cyst A non-neoplastic, serous fluid-filled bone lesion thought to result from temporary failure of medullary bone formation near the physis  Age : usually found in patients