Overview of Musculoskeletal Tumors

8/17/2019 Overview of Musculoskeletal Tumors

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Overview of musculo-skeletal

tumors

Musculoskeletal Education Program

RCSI Professorial Unit

Cappagh ational Orthopaedic !ospital


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"earning O#$ectives

Recognise s%mptoms &'Red (lags)* associated with+umours

,ifferentiate #etween lesions that resem#le

neoplasms #enign neoplasm and malignant

neoplasms

,escri#e common #enign tumours

,escri#e common malignant tumours

Recognise what tumours commonl% metastasi.e to

/one


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Musculo-skeletal tumours & some lesions that resemble

tumors, present exceptionally difficult diagnostic and

treatment problems.

- an% region of the musculoskeletal s%stem involve an% tissue

- great variet% in tissue origin composition response to treatment 0 natural h1

- man% have similar clinical presentations and appearances & imaging *

"esions that resem#le neoplasms

/enign neoplasms

Malignant neoplasms


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Clinical Presentation

Pain - often the first s%mptom

- wide range in intensit%

- not all tumors cause pain metastasi.e #efore

2 often associated with an enlarging mass

2 dull ache

2Often referred pain & 33 *2 night pain & keeps them awake * interferes with dail% activities

2 often does not relieve with rest


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Swelling or ‘a mass - diffuse or firm discrete

- wide range in si.e 4 growth rate

2 ma% #e er%thema increase in temp5 could ulcerate through the skin

2 could #e mistaken for a#scesses & 333 *

2 if deep & thigh hip * not alwa%s palpa#le & detecta#le *

!ack of a palpable mass or a measurable swelling does not exclude the

possibility of msk neoplasm and the presence of a well defined mass does

not necessarily indicate the presence of a neoplasm


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!oss of function - occasional presentation

2 neurological deficit 6 ma% #e su#tle ma% de sudden

2 pathological fracture after minor trauma & 73 *

2 restriction of ROM

"ook carefull% at 8-Ra% for su#tle changes 9: if an% suspicion

ask someone who knows


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"ncidental disco#ery

2 routine clinical e1amination

2 incidental 8-Ra%s 4 C+ 4 MRI


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Initial Evaluation

$etailed %istory and linical 'xamination

Plain (-)ays

*one scan

+ Scan #est for #one tissue

M)" - #est method of evaluating soft tissue tumors

$ecide if biopsy needed by experts in treatment

surgery of needed


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Classification

/. !esions that resemble bone & soft tissue neoplasms

- occur more fre;uentl% than neoplasms

- presentation 6 ma% #e similar to neoplasms

Stress fractures

Osteom%elitis

Simple #one c%sts


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Classification

0. *enign bone and soft tissue neoplasms- occur more commonl% than malignant neoplasms

- varia#le #ehavior

Osteoid osteoma

Osteoma

Osteo#lastoma

Osteochondroma

Enchondroma

Periosteal chondroma

Chondro#lastoma

!emangioma

=iant cell tumor of #one

"ipoma

!emangioma

"%mphangioma

eurofi#roma

Intramuscular m%1oma

Elastofi#roma

=iant cell tumor of tendon sheath


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Classification

/. Malignant bone and soft-tissue neoplasms

1. Primary

- fre;uentl% cause disseminated disease and death

- sometimes near pre-e1isting #enign processes & chronic osteom%elitis *

/one - m%eloma

- osteosarcoma

- chondrosarcoma

- Ewing>s sarcoma

Soft tissue - "iposarcoma

- (i#rosarcoma

- Malignant fi#rous histioc%toma


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Classification

/. Malignant bone and soft-tissue neoplasms

*. Metastatic disease

- occurs : ?@ times more fre;uentl% than primar%

- nearl% all malignant tumors metastases to #one

/reast

"ung

Prostate

2 Can cause pain 0 pathological fractures

2 Most fre;uentl% A verte#rae pelvis ri#s and pro1imal lim#s

2 "ook for primar% disease & !istor% 0 Clinical E1am *

2 Investigations A 8-Ra%s C+ MRI /one Scan PE+ scan

: B@


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Summar%

- can involve all parts of musculo-skeletal s%stem

- various clinical #ehavior & #enign highl% malignant *

- occur rarel% 9: often missed #% ph%sicians 4 non-specialists

- when suspicious alwa%s consider malignant until proven otherwise

- tr% to confirm suspicion #efore making the final diagnosis

- refer to specialist for #iops% 4 further treatment 4 multidisciplinar%

Current treatment offers the possibility of cure for many patientswith primary malignancies of bone and soft-tissue, and improved

quality of life for others and for patients with metastatic disease.

Documents

Overview of Musculoskeletal Tumors