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BONE TUMORS

Learn about benign and malignant bone tumors, tumor-like lesions, and metastatic bone tumors. Understand the evaluation stages, radiological assessments, biopsy procedures, staging, and treatment options.

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BONE TUMORS

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  1. Assoc. Prof. Melih Güven Yeditepe University Hospital Department of Orthopaedics and Traumatology BONE TUMORS

  2. Learning Objectives • Classification of benign bone tumors • Charasteristic clinical and radiological features of most common benign bone tumors • Definition of tumor like lesions • Classification of malign bone tumors • Charasteristic clinical and radiological features of most common malign bone tumors • Charasteristic features of metastatic bone tumors • Surgical applications in benign and malign bone tumors

  3. Bone tumors • General knowledge • Benign tumors • Tumor like lesions • Malign tumors • Metastatic bone tumors

  4. General approaches • Initial referral • Pain • Deeply, sharp and increased over time • Localized sensitivity and rush • Pathologic fracture • Deformity • Incidental finding

  5. General approaches • First stage evaluation • Anamnesis • Duration and level of pain, number and duration of the lesions, age, loss in weight, fever, weakness • Physical examination • Site and size of the lesion, mobility, sensitivity,LAP • Radiological evaluation • Codman triangle, onion skin view, sunrise view • Laboratory findings • ALP, serum Ca level, ESR, LDH, protein electrophoresis

  6. General approaches • Second stage evaluation • CT • Bone scintigraphy – Tc 99m • Anjiography • MRI • PET – CT

  7. General approaches • Radiological evaluation • Definition of the radiographs • Where is the tumor? • Name of the bone, proximal-distal, metaphysis-diaphysis • What is the localisation of the tumor? • Central, medullary, cortical • How does the tumor effect the bone? • Lysis, sclerosis, destruction, deformity • Any surrounding abnormalities?

  8. General approaches • Second stage evaluation • Biopsy • Closed • Fine needle aspiration biopsy • Trochar biopsy • Needle biopsy under CT control • Open • Incisional biopsy • Excisional biopsy • Frozen section biopsy (intraoperative)

  9. Staging • Staging of benign bone tumors (Enneking) • Stage I: Latent • thick capsule, no reactive zone • can grow up in children and adolescents, no growing in adults, spontaneous healing can occur • Stage II: Active • thick capsule, adhesions between capsule and surrounding soft tissue, thick reactive zone • no spontaneous healing, rarely metastasis

  10. Grading • Staging of benign bone tumors (Enneking) • Stage III: Agressive • irregular border of the lesion, very thin capsule • thick and edematous reactive zone • Tumor grows up rapidly into the surrounding tissues, no restrictive tissues around the tumor

  11. Staging • Staging of malignant bone tumors (Enneking) • G (Grade) : G1 %10 > metastasis potency , G2 %20 < metastasis potency • T (Compartment) : intracompartmental (T1) or extracompartmental (T2) • M (Metastasis): Lymph nodule or far metastasis IA G1 T1 M0 IB G1 T2 M0 IIA G2 T1 M0 IIB G2 T2 M0 IIIA G1-G2 T1 M1 IIIB G1-G2 T2 M1

  12. General classification • Tumors with osseous origin a-Benign:  Osteoma, Osteoid osteoma, Osteoblastoma b-Malignant:   Osteosarcoma • Tumors with cartilaginous origins a- Benign : Chondroma, Osteochondroma, Chondroblastoma, Chondromixoid fibroma b- Malignant :  Chondrosarcoma

  13. General classification • Tumors with bone marrow origins Ewing sarcoma Reticulum cell carcinoma of the bone Lymphosarcoma of the bone Multiple or solitary myeloma • Gaint cell tumors Gaint cell bone tumors (osteoclastoma)

  14. General classification • Tumor like lesions (Fibrous, cystic) Solitary bone cyst (unicameral bone cyst) Aneurysmal bone cyst Non-ossifying fibroma (fibrous cortical defect) Eosinophilic granuloma Fibrous dysplasia Myositisossificans Brown tumor (hyperparathyreoidismus)

  15. Treatment • First of all, LIFE !! • Extremity preserving surgery • Usable extremity • Physical appearance of the body • Psychological compliance • Sociocultural compliance

  16. Surgical treatment 1.Intracapsular: - Benign, latent lesions 2.Marginal excision: - Excision of the lesion with reactive zone - Benign, active lesions

  17. Surgical treatment 3.Wide resection: - Resection of the tumor with surrounding healthy-normal tissues - Benign, aggressive lesions; malignant low grade lesions (with adjuvant therapies) 4.Radical resection: - Resection of the whole, entire compartment - Malignant high grade lesions 5. Amputation

  18. Adjuvanttherapies • Chemotherapy • Neoadjuvant (8-12 weeks) • Adjuvant (6-12 months) • Drugs: • metotrexate, cyclophosphamid, ifosfamide, doxorubicin, vincristine ve cis-platine • Radiotherapy • Local adjuvants: • Phenol, hydrogene peroxide, liquid nitrogen, bone cement, alcohol, coterisation, hot water (80°C)

  19. BENIGN BONE TUMORS

  20. Osteochondroma (Exostosis)

  21. Enchondroma

  22. Enchondroma • Ollier disease • Maffuci synd.

  23. Osteoid osteoma

  24. Osteoblastoma

  25. Gaint cell bone tumor (Osteoclastoma)

  26. Chondroblastoma

  27. Benign bone tumors • Osteochondroma • Multiple familial osteochondromatosis • Enchondroma • Osteoid osteoma • Osteoblastoma • Gaint cell bone tumor • Chondroblastoma

  28. TUMOR LIKE LESIONS

  29. Simple (solitary) bone cyst

  30. Aneurysmal bone cyst

  31. Eosinophilic granuloma

  32. Non-ossifying fibroma(Fibrous cortical defect)

  33. Fibrous dysplasia mlgn 5 years later

  34. Tumor like lesions • Simple (solitary) bone cyst • Aneurysmal bone cyst • Eosinophillic granuloma • Fibrous cortical defect • Fibrous dysplasia

  35. MALIGNANT BONE TUMORS

  36. Osteosarcoma Birkaç ay sonra

  37. Osteosarcoma • Classification: • Clasicosteosarcoma • Parostealosteosarcoma • Periostealosteosarcoma • Endostealosteosarcoma • Telengiectaticosteosarcoma • Small cell osteosarcoma • Intracorticalosteosarcoma • Secondary osteosarcoma • Paget, Rt, low grade Chondrosarcoma, fibrous dysplasia,bone infarct

  38. Chondrosarcoma

  39. Chondrosarcoma • Classification: • Primary • Low grade, borderline, high grade • Secondary • Multiple familial osteochondromatosis, Ollier disease, Mafucci syndrom

  40. Ewing’s sarcoma

  41. Multiple myeloma

  42. Chordoma

  43. Malignant bone tumors • Osteosarcoma • Chondrosarcoma • Ewing’s sarcoma • Multiple myeloma • Chordoma

  44. METASTATIC BONE TUMORS

  45. Metastatic bone tumors • Pain (most common), ROM limitation, pathologic fracture, cord compression, hypercalcemia • Most common; breast in females, prostate and lung in males • Breastcancer %73 • Ductal carcinoma • Prostate cancer%68 • Adeno ca • Thyroid cancer %42 • Papiller ca • Lung cancer %36 • Adeno ca • Renal carcinoma%35 • Clear cell ca • Rectum carcinoma%11

  46. Metastatic bone tumors • Metastasis; • Direct • Indirect • Lymphogenic • Hematogenic • Localisation of metastasis; - vertebra% 69 - pelvis %41 - femur % 25 - cranium %14 • Osteoblastic or osteolytic Batson vertebral venous plexus

  47. Breast metas. Renal met. Prostat met. Prostate met. ob ol Lung met.

  48. Metastatic bone tumors • Diagnosis; • Bone scintigraphy – Tc 99m • Radiography • CT • MRI • PET-CT • Biopsy Standard

  49. THANKS

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