BEST CERVICAL SPINE TREATMENT IN INDIA | SHISHIR SPINE CENTER

1. Diagnosis of Malignant Bone Tumours Dr Shishir Kumar PG Ortho

2. X Ray Evaluation • Other Imaging Techniques • Biopsy • Classification • Brief overview of important tumours

3. Algorithm of Evaluation Benign or Malignant Age Location Special features

4. Lodwig’s Classification • Patterns of Osteolysis • Matrix • Periosteal Reaction • Soft tissue extension

5. Geographic destruction • IA: geographic sclerotic margin • IB: geographic unsharp margin • IC: geographic no margin

6. II. Moth eaten like destruction • Moth eaten • Permeative

7. Patterns of bone destruction

8. Matrix • Osteoid • Chondroid

9. Periosteal reaction • Solid • Lamellated • Hair on end Sunburst

10. Periosteal reaction • Solid Osteoidosteoma

11. Periosteal Reaction • Lamellated Infection

12. Multilayered Ewing

13. Periosteal Reaction • Codman’s triangle Osteosarcoma

14. Soft tissue Involvement

15. Age Malignant tumours more common after 30 years Benign tumours more common before 30 years and most often before physis closure

16. Location

18. Special Investigations • Bone Scan • CT Scan • MRI • PET Scan

19. Biopsy • Single most important procedure • Should not be taken lightly • An inadequately performed biopsy -does not allow proper diagnosis -May end up in amputation/limb salvage - have a negative impact on survival

20. Clinically and radiologically benign-appearing lesions—no biopsy • Indicated in - benign aggressive tumours -malignant tumours -questionable lesions to confirm the clinical diagnosis -accurately classify

21. Timing of Biopsy • After all imaging studies have been completed • After Full staging completed • Can interfere with imaging if done earlier • Biopsy of all • Local • Skip • Metastatic lesion

22. Biopsy technique • Sarcomas grow heterogenously • Single biopsy not enough • Multiple representative biopsies • Thorough evaluation of radiology Main concern about biopsy---infiltration of biopsy tract with tumour----convert a limb salvage to amputation

23. Principles of Biopsy • Part of the lesion is most representative of the underlying disease • Extraosseous component is as representative as bony component • First biopsy the soft tissue component • Avoid violating the cortex as predisposes to pathological fractures • Done only if no extraosseous element present • Biopsy point along planned incision • Shortest way to lesion • must not violate more than one compartment • Must be remote from neurovascular bundles

24. Types of Biopsy • FNAC • Tru-cut • Incisional • Excision

28. Biopsy tibia

29. Biopsy shoulder

30. Sighting of incision

31. Sighting incision

32. Bone window

33. Insertion of drain

34. Ennekin staging

35. Excision • Intracapsular excision • Marginal excision • Wide excisions • Radical excision and amputation

36. WHO CLASSIFICATION • BONE FORMING – osteosarcoma; • CARTILAGE FORMING - chondrosarcomas • GIANT CELL TUMORS • MARROW TUMORS – Ewing’s ; lymphomas; multiple myeloma • VASCULAR & other connective tissue TUMORS – Angiosarcoma, ; Fibro sarcoma, Malignant Fibrous Histiocytoma • MISCELLANEOUS – Chordoma ; adamantinoma; neurosarcoma Radiation induced sarcoma

38. Osteosarcoma(Osteogenic sarcoma) • Mesenchymaltumor in which cancellous cell produce bone matrix. • Most common primary malignant tumor of bone • All age group but has bimodal age distribution • 75% in person younger than 20 years of age • Second peak occur in elderly who have predisposing condition – Paget disease, bone infarct, prior irradiation • Males> females

39. Usually arise from metaphysis of long bones of extremities, and almost 50% occur about the knee. • Beyond the age of 25 years incidence in flat bones and long bones is almost equal.

40. Osteosarcoma

41. Osteosarcoma

44. Classical

45. Codman’s triangle Sunrays appearance Osteosarcoma

46. Codman's triangle Osteosarcoma

47. Osteosarcoma

48. Imperceptable

49. Sclerosis

50. Telengectiatic