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Paediatric Bone Tumours

William Aston. Paediatric Bone Tumours. DiagnosisStagingBenignMalignantTreatment. William Aston. Paediatric Bone Tumours. Diagnosis- History- Examination- ImagingAt any stage

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Paediatric Bone Tumours

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    1. Paediatric Bone Tumours William Aston Consultant Sarcoma and Joint Reconstruction Surgeon Royal National Orthopaedic Hospital Stanmore Paedriatric Revision Course 2009

    2. William Aston Paediatric Bone Tumours Diagnosis Staging Benign Malignant Treatment

    3. William Aston Paediatric Bone Tumours Diagnosis - History - Examination - Imaging At any stage – Tertiary referral to MDT

    4. William Aston Paediatric Bone Tumours Staging - Characterise the lesion - Examination - X ray - U/S +/- Angiogram - CT - MRI +/- Whole Body - Bone Scan - PET

    5. William Aston Paediatric Bone Tumours Staging - Characterise the lesion - If MDT not sure of diagnosis then Biopsy Benign Malignant - Image whole compartment - Distant Staging CT Chest, Bone Scan, PET, Whole body MRI

    6. Classification of Tumours Enneking W F. A system of staging musculoskeletal neoplasms. Clin Orthop. 1986; 204: 9-24. 1 Low grade 2 High grade 3 Any grade with metastases A Intracompartmental B Extracompartmental William Aston

    7. William Aston Considerations before biopsy Mankin H J, Lange T A, Spanier S S. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumours. J. Bone and Joint Surg. 1982; 64-A: 1121-27. Biopsy complication rate 3-5 times higher when performed by an inexperienced surgeon than by a member of the MSTS “If the surgeon or institution is not equipped to investigate the patient appropriately, perform definitive surgery and administer adjuvant therapy then the patient should be referred to a treatment centre before biopsy”

    8. William Aston Considerations before biopsy Open vs Needle Biopsy Always needle if possible In line of surgical incision Experienced Person Direct route Tract marking Don’t contaminate other compartments

    9. William Aston The ideal biopsy - Adequate volume of representative tissue - Carefully planned site - Minimal contamination - Appropriately prepared specimen - Examined by expert pathologist

    10. William Aston Paediatric Bone Tumours Benign - Bone forming - Cartilage forming - Fibrous and Cystic tumours - Others

    11. Classification by anatomy William Aston

    12. Classification by cell type William Aston

    13. William Aston Behaviour Benign/latent Slow growth during normal growth of individual, then stop. Never become malignant. (Non-ossifying fibroma) Benign/active Progressive growth (Aneurysmal bone cyst) Benign/aggressive Locally aggressive but do not metastasize. There is a pseudocapsule with tumour extension into the reactive zone. Local control can only be achieved by complete removal of the lesion. (Giant-cell tumour)

    14. William Aston Paediatric Bone Tumours Benign Bone Forming - Osteoid Osteoma - Osteoblastoma

    15. Osteoid Osteoma M>F Any bone- cortical Classic hx pain -Night pain -Relieved by salicylate Xray, bone scan, CT < 1cm Rx by -Radiofrequency ablation -(Excision) William Aston

    16. Radiofrequency ablation

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