Management of bone tumours
Neoplasms of bone
Osteoblast origin
Benign
Osteoma
Osteoid osteoma
Osteoblastoma
Malignant
Osteosarcoma
Chondroblast origin
Benign
Chondroma
Osteochondroma*
Chondroblastoma
Malignant
Chondrosarcoma
Unknown cell of origin
Giant cell tumour (Osteoclastoma)
Ewing’s tumour
Connective tissue tumours :
(Vascular , Neural, etc)
Metastases
Tumour – like conditions• Fibrosseous lesions
– Fibrous dysplasia– Osteofibrous dysplasia ( Ossifying fibroma)– Metaphyseal fibrous defect (non ossifying
fibroma)• Cysts
– Solitary bone cyst (unicameral bone cyst)– Aneurysmal bone cyst– Ganglion cyst
Modes of presentation
• Lump• Pathological fracture• Pain• Pressure effects• Incidental finding• Secondaries
Exostosis
• Osteochondroma (actually a hamartoma)• Growing end of long bones• Problems – lump. Malignant change rare• Multiple (diaphyseal aclasis) – can interfere
with growth
• Excise if single, causing problems – tumour is larger than it appears on X-ray
Exostosis
Exostosis
Chondromata
Others
Fibrous cortical defect
Aneurysmal bone cyst
Fibrous dysplasia
Osteoclastoma• Giant cell tumour• Expands the bone• Classically asymmetrical• Occurs at the site of epiphysis• Lytic. Septate• ‘Egg shell crackling’
Osteoclastoma
Osteoclastoma - treatment
• Curettage and bone grafting• Pamidronate• Allograft / autograft bone• Bone cement• Prostheses
• NO radiotherapy
Ewing’s tumour
Classically mid shaft
Onion peel appearance
Respond to RT
Osteosarcoma• Common at growing end of long bones• Occur in the second decade (2nd peak –due
to Paget’s disease)• Warm swelling• X-ray – Codman’s triangle, sunray spicules,
bone destruction, cortex breached• CT-scan for extent. Also CT chest• Biopsy – incision or true-cut
Osteosarcoma
Osteosarcoma -treatment
• Excision, DXRT, Chemo
• Excision – amputation, limb conserving
• Custom made prostheses, allograft
Chondrosarcoma
• Occur in older patients• Affect the axial skeleton
• Treatment – Surgical (not responsive to Chemo, DXRT)
Chondrosarcoma
Secondaries in bone• Commonly lytic• Common primaries – lung, thyroid, breast,
kidney, prostate• Multiple myeloma• Sclerotic – prostate, breast, colon• 50% of bone must be destroyed to be seen
on X-ray• CT, Bone scan – seen as hot spots.
Myeloma is cold
Ca- Breast
Multiple myeloma
Secondaries -treatment
• Wherever possible –fix.• Use bone cement.• Aim is to get early mobilization
Soft tissue sarcomas
• Can occur anywhere• Limbs, abdominal
wall, retro-peritoneum• Radical excision + RT
+ CT