Bone tumours 2

Aneuryasmal bone cyst It mainly affect young adult, and it locate in The long bone metaphysis . The patient mainly complain from pain and in large cyst visible or palpable mass may be detected . X-ray :well defined radiolucent cyst , trabiculated and eccentrically located , usually in the metaphysis , the lesion is expandable (ballooning) . Treatment : by curettage and bone graft

Comparison between simple bone cyst and aneurysmal bone cyst

Giant cell tumor It is a lesion of uncertain origin ; it appear in mature bone , most commonly in the distal femur , proximal tibia , proximal humerus and distal radius . It characteristically extends up to the subarticular bone plate . The patient is usually young adult (20-40) years old who complains of pain at the end of the long bone . On examination : there is palpable mass .

Giant cell tumor cont. X-ray :radiolucent area located eccentrically at the end of the long bone , the cortex is thin and ballooned , the lesion is trabiculated and it is characteristically extend to the subchondral bone . Treatment : well confined , slow growing lesion can be treated by curettage and bone graft , bigger lesion treated by excision and bone graft some time with prosthetic replacement . If the tumor is rapidly enlarged and aggressive , amputation is indicated

Giant cell tumor

Malignant bone tumors

Osteogenic sarcoma It is highly malignant bone forming tumor , It arise within the bone and spread rapidly out ward towards the periosteium and the soft tissue . It affect mainly the children , adolescent and old age group . It affect any bone but mainly the metaphysis of the long bones especially around the knee joint and proximal end of humerus .

osteogenic sarcoma cont. Clinically : pain is the first symptom , gradually increase in severity . some time the patient presented with lump or pathological fracture . On examination : in early case local tenderness , in late cases palpable mass can be felt and swelling can be seen .

investigation Blood invest. : ESR increase serum alkaline phosphatase Radiological investigation : 1- plain x-ray :hazy osteolytic area which is non homogenous and alternate with osteoblastic areas , the tumor destruct the cortex and extend to the adjacent soft tissue ; when this happened streaks of new bone appear radiating out ward from the cortex (sun burst) appearance . periosteal reaction is present in form called (Codman's triangle) ; these two findings are typical for osteogenic sarcoma

Osteogenic sarcoma (codman tiangle)

Osteogenic sarcoma (sun-burst) appearance

2- radioisotope scan . 3- C.T . 4- MRI . 5- chest x-ray to detect metastasis . Other invest. Incisional biopsy .

treatment Since this tumor is highly malignant and aggressive ; radical surgery combined with chemotherapy and radiotherapy is indicated . Radical surgery : it mean amputation through or above the joint proximal to the lesion and proximal to the origin of any affected muscle . Chemotherapy : methoterexate is used pre-operative and post-operative . Prognosis : improved in the last few years due to improvement in the invest. , diagnosis and treatment .

Ewing sarcoma It arise from the bone marrow , the age affected are usually children and adolescent (10-20)years old , it affect the tubular bone , it is highly malignant tumor and carry bad prognosis . Clinically :pain (which is usually throbbing in nature) , swelling (tender) , generalized illness and pyrexia . ESR is increase . C.T. MRI . Bone scan . All are helpful .

x-ray : destructive osteolytic diaphyseal lesion , new bone formation in fusiform layering around the lesion so-called onion-peel appearance . Differential diagnosis : 1- bone infection . 2-osteoid osteioma Treatment : the prognosis is always poor , and surgery alone do little to improve it . The tumor is very sensitive to radiotherapy and chemotherapy but over all survival is not much improved

Ewing sarcoma(periosteal reaction)

Metastatic bone tumor Skeleton is one of the commonest site of the secondary cancer . In patients over 50 years old , bone metastasis are seen more frequently than all primary malignant bone tumors together .

The commonest source of secondary tumor in bone (from the commonest to less common )are : 1- ca. breast . 2- ca. prostate . 3- ca. kidney . 4- ca. lung . 5- ca. thyroid . The commonest site of secondary bone tumor are: Vertebrae , pelvis ,proximal femur and humerus . Metastasis is usually osteolytic but osteoblastic lesion seen in secondary tumor of prostate .

Clinically :the presenting symptoms of secondary bone tumor is usually , pain or back ache and pathological fracture. Investigation :x-ray , bone scan , biopsy . In children secondary bone tumor is usually from adrenal neuroblastoma . Treatment :by the time the patient develop sec. bone tumor the prognosis is usually hopeless . in most of cases the treatment is symptomatic i.e. to search for primary tumor is value less .

It is important to get the patient live the remaining of his life comfortably by : 1- controlling the pain by analgesics or narcotics . 2- radiotherapy to decrease the pain and the metastatic activity . 3- fixation of the pathological fracture . 4- sever pain some time need nerve or spinal tract ablation