Bone Tumours

Mohamad Bayu Sahadewa

NEOPLASIA

• Disease of cell growth, division, and

differentiation

• Benign tumors
• Localized, clear margins (encapsulated), non-
invasive, slow growing, well differentiated
» Hyperplasia : cells
grow and divide faster

» Metaplasia : normal
cells in the wrong
places

» Dysplasia : abnormal
cells
» All cancers are caused by a change in genes or
damage to genes
» Gene mutations happen in our cells all the time
» Every time a cell divides there is a risk of a
mistake when the cell makes a copy of its DNA
Bone Tumours

» Rare, but has deliberating effect

» Most of the bone tumors are benign
» Hard to diagnose

» Principles of treatments are very different

from the others tumor
How To Diagnose

» History : Age of patient

» Physical examination : Location of tumour

» Radiology

» Histopathology
How to differentiate benign vs malignant

» Tumor doubling time :?

» Consistency?
» Surrounding tissue ?
Histologic Type Benign Malignant

Hematopoietic (40%) Myeloma

Malignant lymphoma

Chondrogenic (22%) Osteochondroma Chondrosarcoma

Chondroma Dedifferentiated chondrosarcoma

Chondroblastoma Mesenchymal chondrosarcoma

Chondromyxoid fibroma
Osteogenic (19%) Osteoid osteoma Osteosarcoma
Osteoblastoma

Unknown origin (10%) Giant cell tumor Ewing tumor

Giant cell tumor

Adamantinoma

Histiocytic origin Fibrous histiocytoma Malignant fibrous histiocytoma

Fibrogenic Metaphyseal fibrous defect (fibroma) Desmoplastic fibroma

Fibrosarcoma
Notochordal Chordoma
Vascular Hemangioma Hemangioendothelioma
Hemangiopericytoma
Lipogenic Lipoma Liposarcoma
Neurogenic Neurilemmoma
 Site of the lesion.
Distribution of various lesions Distribution of various lesions in a
in a long tubular bone in a long tubular bone after skeletal
growing skeleton maturity
Clinical Manifestations of Cancer

• Fatigue is the #1 complaint

• Starts early, for unknown reasons
• May last months after tumor is gone
• Causes most severe decrease in quality of life
• Pain—may not arise until late stages
• caused by compression local tissue,
inflammation, or nerve injury (therapy)
Cachexia

Malnutrition from metabolic demands of

tumor, release of cachectin (TNF)
• anorexia, weight loss
• weakness, anemia
 Metastatic neoplasms
•Metastatic neoplasms primary origin can be in
descending frequency :
1. Prostate
2. Breast.
3. Lung.
4. GIT.
5. Kidney.
6. Thyroid.
Benign Versus Malignant Nature

 Benign lesions usually have

 well-defined sclerotic borders
 exhibit a geographic type of bone destruction
 the periosteal reaction is solid and uninterrupted, and
 there is no soft tissue mass.
 Malignant tumors often
 exhibit poorly defined borders with a wide zone of transition;
 bone destruction appears in a moth-eaten or permeative pattern, and
 the periosteum shows an interrupted, sunburst, or onion-skin reaction with an
adjacent soft tissue mass.

 NB-benign lesions may also exhibit aggressive features

 Periosteal Reactions

Solid Sunburst onion-peel Codman’s

triangle
Less malignant More malignant
What are these?
 Osteochondroma

•The most common benign bony

tumor
•Most are located at the metaphyseal
portion of long bones, particularly
the distal femur and proximal tibia.
•May be solitary and idiopathic or
multiple and genetic (called
hereditary multiple exostosis).
•Solitary osteochondroma has a
male-to-female ratio of 2:1
•Patients are generally in the
2nd decade
•Seek medical advice because
of a bony mass.
•Activity-related pain occurs
because the mass irritates
surrounding muscles.
•Compression of an adjacent
nerve causes radicular pain
or paresthesia .
Giant Cell Tumor
osteosarcoma
Ewing’s Sarcoma

Mind the site :

Epiphysis
Metaphysis
Or Diaphysis?
Chondrosarcoma
Tendon and Ligament
 Roles of Ligaments and
Joint Capsules
• Assist in Stabilization of Joint

• Restrict Movement

• Prevent Excessive Motion

 Roles of Tendons

• Attach muscle to bone

• Transmit tensile loads

• MOVE THE JOINT

Ruptures of what?