Bone tumors

Classification

1. Primary

2. Metastatic -3rd common site of hematogenous metastasis

Liver >Lungs > Bone

Primary Bone tumors

Osseous tumors Non Osseous Tumors

Osseous tumors

Benign Malignant

Bone forming/osteoblastic

Osteoma Osteod osteomaOsteoblastoima

Osteosarcoma

Cartilage forming Enchondroma OsteochondromaChondroblastoma

Chondrosarcoma

Hematopoietic Myeloma Lymphoma

Unknown Giant Cell tumor Malignant GCTEwing’s sarcoma

Notochordal Chordoma

Non Osseous Tumors

Vascular Hemangioma Hemangio endothelioma Pericytoma

Fibrogenic Non ossifying fibroma

Fibrosarcoma

Neurogenic NeurilemmomaShwannoma

MPNST

Lipogenic Lipoma Liposarcoma

Histiocytic Fiberous histiocytoma

Malignant Fibrous Histiocytoma

Gardner syndrome, also known as familial colorectal polyposis,[1] is an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon.[2] The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts,[3] as well as the occurrence of desmoid tumors in approximately 15% of affected individuals.

Osteosarcoma

MC primary tumor of bone Tumor cells can produce osteiod – tumor ostiod /

tumor bone Malignancy of mesenchyme Two types

1. Central / medullary

2. Surface / parosteal / Perosteal Pathogenesis

1. Primary

2. Secondary

Pathogenesis

Genetic Constitutional factors Environmental Factors

Genetic

RB gene mutation – 1000 times more risk 13q14 Homozygous mutation in RB locus Mutation in p53 gene Over expression of MDM2

Constitutional factors

10- 20 yrs – maximum Bone growth Males more risk – inc osteoblastic activity Inc risk in paget’s disease Metaphysis - osteogenesis

Pathogenesis

Metaphysis Medullary cavity Perisoteal eleation – codmann’s triangle Xray – metaphyseal radio dense lesion with

codmann’s triangle Sunburst / sunray appearance

Gross

Fleshy tumor Expands laterally

Microscopy

Tumor cells– very in shape –giant cells- spindle ,oval polgonal cells

Osteiod – not rimmed by osteoblast But surrounded by tumor cells Varients –1. Chondroblastic2. Fibroblastic3. Small cell4. telangectactic

Chondroblastic osteosarcoma

Mandible can be involved

Fibroblastic Osteosarcoma

Small cell osteosarcoma

Telangectatic

T/t

Limb salvaged surgery

Extra skeletal osteosarcoma

Mediastinum Breast retroperitonim

Surface Osteosarcoma

1. Parosteal / Juxta cortical Osteosarcoma

2. Periosteal osteosarcoma

Ewing’s sarcoma

Highly malignant small round cell tumor More in females 5 – 20 yrs Cell of origin – Primitive Neurectodermal cells

Variants of ES

1. Classic / Skeletal ES

2. Soft tissue Ewing’s sarcoma

3. PNET