bone tumours
DESCRIPTION
bone tumorsfor under graduate levelTRANSCRIPT
Bone tumoursBone tumours
Dr.Surya prakash sharma
MBBS D’ortho (PG Student)
MMC Chennai
Bone tumours
Commonest bone tumour is secondaries from other sites
Commonest primary bone tumour is multiple myeloma, second osteosarcoma.
Classification (W.H.O.) Bone-forming tumours Cartilage forming tumours Giant-cell tumour Marrow tumours Vascular tumours Other connective tissue tumours Other tumours Secondary malignant tumours of bone
Bone forming tumours
Cartilage forming tumours
Giant cell tumour
Osteoclastoma
Marrow tumours
Ewing’s sarcoma Neuroectodermal tumour Malignant lymphoma of bone
(Primary/secondary) Myeloma
Vascular tumoursBenign Haemangioma Lymphangioma Glomus tumourIntermediate Haemangio endothelioma Haemangio pericytomaMalignant Angiosarcoma Malignant haemangio pericytoma
Other connective tissue tumours
Benign Benign fibrous
histiocytoma LipomaIntermediate Desmoplastic fibroma
Malignant Fibrosarcoma Malignant fibrous
histiocytoma Liposarcoma Malignant
mesenchymoma Leiomyosarcoma Undifferentiated sarcoma
Other tumours
Benign Neurilemmoma Neurofibroma
Malignant Chordoma Adamantinoma
Secondary malignant tumours of bone
From primary in: Thyroid Breast Bronchus Kidney Prostate
Diagnosis
Clinical examination Imaging Laboratory investigations Biopsy
Imaging
Radiographs CT scan MRI Radio nuclide bone scan Arteriogram
Radiographs
Exact location of the tumour Borders of the tumour Pattern of bone destruction Matrix formation Periosteal reaction
CT Scan
Very useful in early diagnosis Extra osseous extension Early detection of pulmonary secondaries Exact measurement for limb salvage
procecures (Prosthesis/allograft)
MRI
Intra medullary extension Soft tissue extension Defines the relationship to the nearby
major blood vessels
Radio nuclide bone scanning For pre biopsy
staging Dissemination of
tumour Silent secondaries
and skip lesions
Arteriogram Planning limb sparing
surgery Therapeutic
embolization To assess vascularity
of tumour
Laboratory investigations Hb % ESR Alkaline Phosphatase Serum electrophoretic pattern Bence-Jones protein Acid Phosphatase
Biopsy
Closed biopsy
FNAC
Needle biopsy
Open biopsy
Incisional biopsy
Excisional biopsy
Principles of biopsy
From boundary or edge of tumor Take several samples Incision strategically placed Ideally done by the treating surgeon Wound closed without drain
Staging of the tumor
By Enneking (1986) Based on aggressiveness of the tumor
and Spread
Intra compartmental Extra compartmental
Low grade I-A I-B
High grade II-A II-B
Low/High grade with metastasis
III-A III-B
Staging (Enneking)
Correlation of staging and management
I-A - Wide excision I-B - Wide excision with larger clearance II-A - Wide excision/amputation II-B - Radical resection or disarticulation III - Palliative treatment Low grade intra compartmental lesions – wide
resection and management of metastases
Principles of management
Benign, asymptomatic lesions
Excisional biopsy or curettage
Benign, symptomatic or enlarging lesions
Biopsy confirmation followed by marginal resection or curettage (cystic lesions)
Principles of management Suspected malignant lesions Laboratory and imaging investigations Chest x-ray or CT scan of the chest Biopsy confirmation
Surgical options Ablative surgeries (amputation/disarticulation) Limb sparing surgeries
Chemotherapy Adjuvant/Neo-adjuvantRadiotherapy