BONE TUMORS

Pamela Gregory-Fernandez

RPA-C

Benign Primary Bone Tumors

• Definition = tumors that arise from cells of mesenchymal origin

– Bone; cartilage; fibrous tissue; round cells– Bone cyst; fibrous lesion; osteochondrome;

giant cell tumor; chondroma; osteoid osteoma

Diagnosis

• 1. H & P • 2. Three age groups: children; young adults;

older adults = > 40 yo• 3. How was the tumor discovered ?

• Incidental finding on x-ray• Mass• Pain• Pathological fracture

• 4. BEWARE masses in the KNEE, SHOULDER, BUTTOCK

• 5. Plain x-rays :• A. Location of the tumor in the bone• B. Reaction of the tumor/bone complex

• 6. MRI : • A. Anatomic location and extent of tumor• B. Soft tissue involvement• C. Bone marrow involvement

• 7. Bone Scan: • A. Multiple lesions

• 8. CAT Scan • 9. Special Imaging• 10. Blood testing: Multiple Myeloma• 11. Biopsy: open; needle

Problems

• 1. Pathological fracture

• 2. Deformity

• 3. Growth plate involvement

• 4. Pain

• 5. Tenderness

• 6. Neurovascular compromise

• 7. Joint motion restriction

Treatment

• 1. Excision

• 2. Curettge and bone grafting

Malignant Primary Bone Tumors

• Sarcoma: a malignant tumor arising from cells of mesenchymal origin

– 1. metastasizes by the blood stream– 2. very aggressive– 3. poor response to radio or chemotherapy

• Examples: osteosarcoma (most common)• Fibrosarcoma; Ewings sarcoma; multiple

myelome; chondrosarcoma

Clinical Features / Diagnosis

1. Younger age group1. Except myeloma

2. Pain1. Night

2. Progressive

3. Mass

4. Pathological fracture

5. Bone not deformed

• 1. Staging– A. CT; MRI;

arteriograms; scans; clinical

– B. Grade I; II; III = distant mets

– C. Intra vs. Extracompartmental

• 2. Biopsy

Treatment

• 1. Wide margin excision, may mean amputation, with adjunctive RT and/or chemotherapy

• 2. Limb salvage with adjunctive RT and/or chemotherapy

– Custom made total joints– Large bone allografts

Osteosarcoma

• 1. MOST COMMON• 2. males• 3. second decade• 4. metaphysis• 5. distal femur, proximal tibia, humerus• 6. Spindle cell sarcoma• 7. x-ray = CODMAN’S TRIANGLE• 8. pain• 9. soft tissue mass

Ewings Sarcoma

1. 5-30 years old

2. Second most common

3. Pain of involved extremity

4. May follow trauma

5. FEVER, FATIGUE, MALAISE, WEIGHT LOSS

6. Micromets at presentation

Nonossifying Fibroma

Pathologic fx curretage Bone graft

asymptomatic Found incidentally

children metaphyseal

X-ray = sclerotic riml Serial x-rays

Benign Tumors