Dr. Andre Sihombing.

SpOT
Orthopaedics surgeon
Christian University of Indonesia
Etiology
 Usually no obvious cause
 Ionising radiation
 Predisposing conditions:
 Paget’s disease
 fibrous dysplasia
 retinoblastoma (genetic)
 syndromes eg. Ollier’s disease
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.
PRIMARY TUMORS OF BONE
 Bone-producing tumors
 Osteoma, osteoid osteoma, osteoblastoma
 Osteosarcoma*
 Cartilage-producing tumors
 Osteochondroma, chondroma (enchondroma)
 chondromyxoid fibroma
 chondroblastoma
 Chondrosarcoma*
 Miscellaneous tumors
 Ewing’s sarcoma*
 Giant cell tumor of bone
Tumour-like conditions of bone
 Bone cysts
 Simple bone cyst
 Aneurysmal bone cyst
 Fibrous-osseous lesions
 Fibrous dysplasia
 Eosinophilic granuloma (Langerhans histiocytosis)
 Osteochondroma - ?hamartoma
OSTEOMA
 Benign, Often craniofacial in location
 Hamartomatous / reactive not true tumor.
 Histologically are woven and lamellar bone (closely
resemble normal bone).
 Gardner Syndrome: multiple, Osteoma,
osteochondroma, GIT polyps, skin tumors.
Autosomal Dominant, Colon Cancer.
OSTEOID OSTEOMA
 Benign, second decade; males (3:1)
 1-2 cm lesion in cortex of femur or tibia
 Painful (high prostaglandin levels in lesion)
 Central nidus of vascular spaces surrounded by
interlacing reactive trabecular bone.
 Therapy - Resection of nidus - bone graft.
OSTEOBLASTOMA
 Clinically similar to osteoid osteoma (large)
 Also known as giant osteoid osteoma.
 Common location -- vertebral column
 Histology similar – but rare nidus.
 Can be locally aggressive
 Therapy - curettage/resection with bone graft.
OSTEOSARCOMA

 Common primary cancer of bone

 Young adults - 10 and 25 years
 Rare in later age – Secondary to previous irradiation
or Paget’s disease
 genetic (retinoblastoma gene)
 Metaphysis of a long bone (Knee)
 Tenderness / pain / Mass.
OSTEOSARCOMA
 Malignant mesenchymal cells that produce
Irregular lace like osteoid matrix.
 May or may not be calcified.
 pre-operative chemotherapy with surgical
resection.
 The five-year survival ~ 60%
Osteosarcoma – gross
Osteosarcoma – gross
Osteosarcoma – X-ray
Osteosarcoma Microscopy:
Malignant cells
Osteoid matrix
OSTEOCHONDROMATOSIS
 Hereditary (multiple) or sporadic (single)
 mushroom-shaped bony projections
 Lateral aspects of cartilage joints.
 Chondrosarcoma – in hereditary type.
Osteochondroma
Osteochondroma:
Osteochondroma:
Osteochondroma
Osteochondroma microscopy:
CHONDROMA (ENCHONDROMA)
 Benign, Any age
 Single or multiple sites
 Often involves small bones of hands and feet.
 Well demarcated, mature cartilage.
CHONDROMA (ENCHONDROMA)
 Hereditary – multiple enchondromatosis. Usually
over one side of the body. (Ollier’s disease).
 Maffucci's syndrome - multiple bone chondromas
and hemangiomas of soft tissue
 Increased risk for chondrosarcoma
Ollier’s Disease:
Multiple enchondroma.
CHONDROSARCOMA
 Next common to Osteosarcoma.
 Older adults 30 to 60 years.
 Location - axial skeleton (pelvis & pectoral girdles,
ribs & spine)
 Aggressive, erodes & invades soft tissue,
 Metastases to lungs, liver, kidney & brain.
CHRONDROSARCOMA
 Malignant cartilage with anaplastic chondrocytes in
spaces with focal enchondral ossification and
calcification
 Resistant to chemo  Surgical resection
 Grade I tumors have 5-year survival
rates of 90%, while high grade tumors
have poor prognosis.
 Clear cell chondrosarcoma is a histologic
variant that is associated with a better
prognosis.
Chondrosarcoma - gross
Chondrosarcoma of Pelvis

nodules of white to bluish-white cartilagenous tumor tissue eroding

and extending outward from the bone at the lower right.
Chondrosarcoma
Cartilage in chondrosarcoma:
Cartilage in chondrosarcoma:
OSTEOSARCOMA CHRONDROSARCOMA
 10-25 years of age  >40 years of age
 affects long bones  affects axial skeleton
 sensitive to  not sensitive to
chemotherapy chemotherapy
EWING’S SARCOMA:

 Rare, young, 10-20 years, Males 2:1

 Diaphysis of long bones, pelvis
 Histopath : sheets uniform round cells
cytoplasmic glycogen, extensive necrosis;
11/22 translocation
 Prognosis: very poor, <10% 5-year survival
with surgery and radiotherapy, 40% with
adjuvant chemotherapy
Ewings Sarcoma:
CT Scan Pelvis – (CWM hosp case)
Ewings: uniform round clear cells.
FIBROUS DYSPLASIA
 Etiology is unknown.
 Dysplastic proliferation of fibrous tissue & bone
tissue in localized area(s) of skeletal bone
 Three Types:
 monostotic,
 polyostotic,
 polyostotic with endocrinopathies.
Polyostotic with endocrinopathies
 3 to 5% of cases
 café au lait spots and precocious sexual
development (McCune-Albright syndrome)
 Associated with other endocrine disorders.
Fibrous Dysplasia:
Fibro-osseous tissue – dysplastic
Metastatic tumors:
Osteoblastic Metastasis: Prostate
Osteoblastic Metastasis: Prostate
Osteolytic Metastasis: Breast ca
Osteolytic Metastasis: Breast ca
Thanks