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BONE TUMORDr. Karuniawan P SpOTRSU UKIJAKARTA

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Introduction & Incidence:

Rare - 0.5% of cancer deaths.40% Malignant.Primary & Secondary/metastatic.Primary in Young. (Osteosarcoma)Secondary in the old. (Breast, Kidney,thyroid, lung, prostate)

Marrow neoplasms (hemopoietic)myeloma, leukemia, lymphoma etc.

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PRIMARY TUMORS OF BONE

Bone-producing tumorsOsteoma, osteoid osteoma, osteoblastomaOsteosarcoma*

Cartilage-producing tumorsOsteochondroma, chondroma (enchondroma)chondromyxoid fibromachondroblastomaChondrosarcoma*

Miscellaneous tumorsEwing

s sarcoma*Giant cell tumor of bone

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Tumour-like conditions of bone

Bone cystsSimple bone cystAneurysmal bone cyst

Fibrous-osseous lesionsFibrous dysplasia

Eosinophilic granuloma (Langerhans

histiocytosis)Osteochondroma - ?hamartoma

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Approach

ClinicalX ray

Bone scanningPatology : aspiration biopsy , open biopsy

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Bone scanning

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Clues by Appearance of

Lesion Patterns of Bone DestructionGeographicMoth-eatenPermeative

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Geographic Bone Destruction

Destructive lesion withsharply defined borderImplies a less-aggressive, more slow-growing, benignprocess

Narrow transition zone

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Geographic Bone Destruction

Examples: Non-ossifying fibroma

Chondromyxoid fibroma Eosinophilic granuloma

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Moth-eaten Bone Destruction

Areas of destruction withragged borders

Implies more rapid growth

Probably a malignancy

Examples:MyelomaMetastasesLymphomaEwing

s sarcoma

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Permeative Bone Destruction

Ill-defined lesion with multiple

worm-holes

Spreads through marrow space

Wide transition zoneImplies an aggressive malignancy

Round-cell lesions

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Patterns of Bone Destruction Permeative

Examples:Lymphoma,leukemiaEwing

s SarcomaMyelomaOsteomyelitisNeuroblastoma

Leukemia

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Patterns of Bone Destruction

Geographic Moth-eaten Permeative

Less malignant More malignant

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Periosteal Reactions Benign

None Solid

Aggressive/malignant onion-peel Sunburst Codman

s triangle

Non-ossifying fibroma

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Periosteal Reactions Benign

None Solid

Aggressive/malignant onion-peel Sunburst Codman

s triangle

Chronic osteomyelitis

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Periosteal Reactions Benign

None Solid

Aggressive/malignant onion-peel Sunburst Codman

s triangle

Ewing sarcoma

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Periosteal Reactions Benign

None Solid

Aggressive/malignant onion-peel Sunburst Codman

s triangle

Osteo-sarcoma

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Periosteal Reactions Benign

None Solid

Aggressive/malignant onion-peel Sunburst Codman

s triangle

Osteo-sarcoma

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Periosteal Reactions

Solid onion-peelSunburst Codman

striangle

Less malignant More malignant

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Tumor Matrix

OsteoblasticFluffy, cotton-like or cloud-like densitiesOsteosarcoma

CartilaginousComma-shaped, punctate, annular, popcorn-likeEnchondroma, chondrosarcoma, chondromyxoid fibroma

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Tumor Matrix

OsteoblasticCartilaginous

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Tumor Matrix

OsteoblasticCartilaginous

Chondrosarcoma

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Osteochondroma:

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Expansile Lesions of Bone

Multiple myeloma MetastasisBrown tumor

EnchondromaAneurysmal bone cystFibrous dysplasia

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Osteolytic Metastasis: Breast ca

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Multiple myeloma

MetsBrown tumorEnchondromaAneurysmal bone cystFibrous dysplasia

Expansile Lesions of Bone

Renal cell carcinoma

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Multiple myelomaMets

Brown tumorEnchondromaAneurysmal bone cystFibrous dysplasia

Expansile Lesions of Bone

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Multiple myelomaMetsBrown tumor

EnchondromaAneurysmal bone cystFibrous dysplasia

Expansile Lesions of Bone

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Multiple myelomaMetsBrown tumorEnchondroma

Aneurysmal bonecyst

Fibrous dysplasia

Expansile Lesions of Bone

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Multiple myelomaMetsBrown tumorEnchondromaAneurysmal bone cyst

Fibrous dysplasia

Expansile Lesions of Bone

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Clues by Location of Lesion In the Transverse Plane In the Longitudinal Plane

Characteristic Locations by tumors Characteristic Tumors by Body Site Pelvic Lesions

Expansile Rib Lesions Lesions of the Spine

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In the Transverse Plane

.

.

.

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In the longitudinal Plane

EpiphysealGCT, chondroblastoma

MetaphysealOsteomyelitis, osteo-and chondrosarcoma

DiaphysealRound cell lesions, ABC, enchondroma

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Characteristic Locations

Simple bone cystProximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphyses

AdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posterior

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Characteristic LocationsSimple bone cystProximal humerus

ChondroblastomaEpiphysesGiant Cell tumorEpiphyses

AdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posterior

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Simple bone cyst

Proximal humerusChondroblastomaEpiphyses

Giant Cell tumorEpiphysesAdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posterior

Characteristic Locations

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Simple bone cyst

Proximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphysesAdamantinomaTibia

ChordomaSacrum, clivusOsteoblastomaSpine, posterior

Characteristic Locations

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Clues by Density of Lesion

Sclerotic Cortical LesionsLytic Lesions in Children

Lytic Lesions in AdultsBlastic Lesions in ChildrenBlastic Lesions in Adults

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Sclerotic CorticalLesions

Osteoid osteomaBrodie

s abscess

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Sclerotic CorticalLesions

Osteoid osteoma

Brodie

s abscess

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Lytic Lesions in Children

Eosinophilic granuloma

Leukemia

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Lytic Lesions in Adults

Metastatic lesionsLung

RenalThyroid

Multiple myeloma

Primary bone tumor

Metastatic thyroid carcinoma

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Lytic Lesions in Adults

Metastatic lesionsLungRenalThyroid

Multiple myelomaPrimary bone tumor

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Lytic Lesions in Adults

Metastatic lesionsLungRenalThyroid

Multiple myeloma

Primary bone tumor

Chondrosarcoma

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Blastic Lesions inChildren

Lymphoma

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Blastic Lesions in AdultsMetastatic disease

Breast femaleProstate male

Lymphoma

Paget

s diseaseFluorosis

Prostatic Ca.

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Blastic Lesions in Adults

Metastatic diseaseBreast femaleProstate male

LymphomaPaget

s diseaseFluorosis

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Blastic Lesions in Adults

Metastatic diseaseBreast femaleProstate male

Lymphoma

Paget

s diseaseFluorosis

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Blastic Lesions in Adults

Metastatic diseaseBreast femaleProstate male

Lymphoma

Paget

s disease

Fluorosis

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Other Clues

Soft Tissue Extension

Benign vs. Malignant

Soft Tissue Extension

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Soft Tissue Extension

Usually implies malignancyMore likely to form discrete soft tissue mass

Benign conditions with soft tissueextension

OsteomyelitisUsually infiltration of fat

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lymphoma

Soft Tissue Extension

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Benign vs. Malignant

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