Agung Malinda Wijaya,dr

Type
Malignancy:
 Benign
 Malignant ( Cancer/Neoplasma )

Origin :
 Local
 Metastatic
Definition n Epidemiology
osteosarcoma is a primary intramedullary high grade
malignant tumour in which the neoplastic cells produce
osteoid, even if only in small amounts. (Bone Forming
Tumors)
 Most common primary malignant tumour of bone
 Incidence of 4-5 per million population.
 Most frequently occurs in the second decade
 Males : females in a ratio of 3:2
 Most common is in metaphyse of long bones
particular, the distal femur, proximal tibia, and
proximal humerus
Clinical features
 Symptom
 commonly difficult to interpret
 Pain: deep, boring and severe
 Sign
 painful, tender mass
 Decreased range of motion, limitation of normal
function
 oedema & localized warmth
 telangectasias and bruit on auscultation
 Pathological fracture
 Lab finding:
 alkaline phosphatase
 lactic acid dehydrogenase
Radiology
 Extremely variable
 osteoblastic - osteolytic
 In most cases:
 mixed lytic/blastic lesion
 cortical destruction
 Extension in to soft tissue.
 Periosteal reactive bone formation
Macroscopy
 large (over 5 cm)
 metaphyseally centered
 fleshy or hard tumour
which may contain
cartilage.
Prognosis
 Untreated, conventional osteosarcoma is universally
fatal.
 Aggressive local growth and rapid haematogenous
systemic dissemination
 Response to pre-operative therapy is currently the
most sensitive indicator for prognostic factor
Definiton n Epidemiology
Giant Cell Tumor (G.C.T.) of bone is a benign bone
tumor which contain giant cells
Incidence : 13% of all bone tumor
• Sex : Male > Female
• Age : 2nd -4th decade >>>
• Location : Distal femur,Proximal tibia, Distal radius
• Staging : stage 2 - Stage 3
Symptoms
 Pain at the area of tumor, increasingly
 Weaken bone, fracture
 Mass +, hard n fix but not painly
Treatment
Resection & reconstruction with prosthesis
Curette & stabilization
Amputation
Epidemology N Pathophisiology
 Most common variety of bone tumors
 Approximately 70% of all malignant bone tumors are
metastatic in origin
 Particularly in older patients
 Cancers of the breast, prostate, lung, and kidney
account for 80% of all metastatic cancers to bone
Metastase → bone marow
 Vascular
 Lymphatic
Proccess
 Osteoblastic
 osteolytic
Clinical Presentation
 > 40 yo
 Axial skeleton and proximal segments of limb bones
 “Silent”
 Other signs of malignancy (weight loss, anemia,
increase: esr, alp, etc)
Imaging
 Plain RO
 Not always visible
 Visible when 30-50% lytic procces
 Bone scan
 Screening
 CT-scan & MRI
 Aditional
Lytic lesions
 the most common
 75% of all metastatic lesions
 Carcinoma of the kidney, lung, breast, gastrointestinal
(GI) tract, or thyroid
Sclerotic lesions
 15% of all metastatic lesions
 In men caused by a prostatic gland cancer or a
seminoma
 In women caused by carcinoma of the breast, uterus or
ovary
 In both genders caused by carcinoid tumors, bladder
tumors neurogenic tumors,
Mixed lesions
 10% of all metastatic lesions
 Breast and lung tumors
Treatment
 No operatif
 Operatif
 Operatif + other modalities
Thank you for the attention