COMMON PRIMARY TUMORS OF BONE

Jeffrey Muir, Mohit Bhandari and Brett Dunlop

The Canadian Journal of Diagnosis (2001)

Supervisor :
dr. Ganda Purba, Sp. OT., M.Kes
By :
Anjar Nuryanto
I11110050

BACKGROUND
Cancer is second only to heart disease and stroke
as the leading cause of death in North America
Lung cancer most prevalent neoplasm
Primary bone tumors are relatively rare
occurance
Primary malignant bone tumors 1:100.000
Secondary malignant bone tumors
35:100.000
Early detection

Radiographic

Treatment

IDENTIFICATION OF BONE TUMORS

Patient history

Most AccurateDiagnosis

Phiysical examination
Plain film
Radiographic examination

Bone Biopsy

CT-Scan
MRI

Laboratory

Serum calcium

Bone destruction

Serum alkaline phospatase

Osteosarcoma

Serum electrophoresis

Multiple myeloma

IDENTIFICATION OF BONE TUMORS

RADIOGRAPHIC ANALYSIS
Radiographic is key in locating and identifying
bone lessions
ABCs pattern
A : Alligment of skeletal muscle
B : Bone density and trabecular pattern
C : Cartilagineous tissue and joint spaces
s : Soft tissue reactions and appearances

RADIOGRAPHIC ANALYSIS
Finding
Osteolytic Radioluscent
Osteoblastic Sclerotic lesions
Combination

DIFFERENTIAL DIAGNOSES
Its difficult to differentiate between tumor and
cancer.

DIFFERENTIAL DIAGNOSES

COMMON PRIMARY TUMORS

Common primary bone tumors may be seen by
primary physician
Osteochondroma
Benign tumors
Osteoid osteoma

Osteosarcoma
Malignant
tumors

Multiple myeloma
Quasi malignant
giant cell tumor

COMMON BENIGN TUMORS

Osteochondroma
Osteoid osteoma
Endochondroma

OSTEOCHONDROMA
Predilection : Tubular bones and knee joint
Symptoms
Hard mass near the joint
Painless
Two types
Pedinculated
Present at hip and knee as bony stalk covered a cartilagineous domed cap
Sessile
A broad based exostosis lacking and elongated portion. Present at
metaphyseal / diaphyseal portion of the proximal humerus, femur
and scapula

OSTEOCHONDROMA
Osteochondroma is asymptomatic, unless they
impinge an a surronding neurovascular structure
or affect local joint function.
A fracture through the stalk causes severe pain
and localized swelling
A
key
radiographic
finding
is
that
osteochondroma is oriented almost exclusively
away from the involment joint

OSTEOID OSTEOMA
Second most common benign bone tumor
Often in adolescent male ( < 15 years old)
Location
Femur and tibia
Posterior element of vertebral body
In rares cases, in the ribs, clavicle and humerus

OSTEOID OSTEOMA
Symptoms
Severe, deep, aching pain
Worse at night
Not relieved by rest
Relieved by acetylsalicylic acid
Profuse sweating
Increased skin temperature
Localized pain
Point tenderness
Decrease ROM

OSTEOID OSTEOMA
Radiographic Finding
Sclerotic
Luscent nidus

ENDOCHONDROMA
The most common benign tumor of the hand
Affect children and young adults, mainly in the
second and third decade
The small tubular bones of the hand and
phalanges are the preferential location for 90%
of all endochondroma
Symptoms
Painless tumors
Pathologic fracture

Radiographic
Metaphysis radioluscent with
well defined margin of
cortical bone

COMMON MALIGNANT TUMORS

Multiple Myeloma
Osteosarcoma
Chondrosarcoma
Ewings sarcoma

MULTIPLE MYELOMA
A serious neoplasm of plasma cell proliferation
which originates in the bone marrow and
involves several skeletal sites
Affect patients between the ages of 50-70 years
Radiographic finding
Lesion found spesific location within the
skeletal system especially the vertebral bodies
and skull
Degeneration of one pedicle of a vertebral
body, osteopenia of vertebral body makes
compression fracture

MULTIPLE MYELOMA
Systemic sign
Anemia
Production of abnormal serum and urine
proteins
Renal disease
Pain is relieved at night and with rest
Aggravated during the day and during weight
beiring

OSTEOSARCOMA
Most common malignant bone neoplasm in
children
Affect children and young adults before their age
25 years

OSTEOSARCOMA
Sign and symptoms
Cachexia, weight loss, fever, and painful
swelling at the site of the lesion
The site will be firm, put not necessarily hard
to the touch in the early stages
Most often affect the knee and shoulder
Radiographic finding
Ivory sklerotic lesion in the metaphysis
A soft tissue reaction Sunray radiation
pattern.

CHONDROSARCOMA
Predominantly affect men between40-60 years
Location
Pelvis and proximal femur
Symptoms
Painful and palpable mass
Radiographic finding
luscent, expansive lesion with a wall defined sclerotic
margin
The central chondrosarcoma occur mainly in the femur
and humerus as a metaphyseal or diaphyseal lesion
The peripheral chondrosarcoma affect mainly pelvis and
shoulder girdle and has characteristic soft tissue mass
associated with the tumors

EWINGS SARCOMA
Relatively uncommon bone neoplasm found
predominantly in patients under 25 years old
Affect the long bone of skeleton
Symptoms :
Localized pain
Swelling
Local temperature elevation
Anemia

EWINGS SARCOMA
Radiographic finding :
Periosteal reaction
Periosteal irregularity, which has been coined
the onion skin reaction

QUASI MALIGNANT TUMORS

Giant cell tumors (GTCs), comprise 15% of all
benign bone tumor, but also account for 5-8% of
malignant bone tumors
Found primary in the third to fifth decade, after
closure of growt plate
Location
Long tubular bones of the appendicular
skeleton (knee)
Sacrum and patella bone

QUASI MALIGNANT TUMORS

Symptoms
Swelling arround the affected joint
Decrease ROM, dull, and aching pain
Radiographic finding
Radioluscent lesion of the metaphysis,
adjucent to the articular surface