1. BONE TUMORs Dr.Farzad Ravari MPH, M.D Specialist Orthopedic Surgeon

2. SIGN & SX *MOST COMMON AGE< 30 Y/O IN PRIMARY TUMOR *>50 Y/O IN METASTATIC TUMORS *PAIN ESP.AT NIGHT OR REST *MASS *PATHOLOGIC FX

3. P/E LOCATION SHAPE CONSISTENCY MOBILITY TENDERNESS SKIN TEMPERATURE LYMPH NODE

4. CLASSIFICATION BENIGN STG 1= LATENT: intra capsular,no sx,xr= thinscelerotic border >>>>> NO NEED TO TREAT STG 2= ACTIVE: INTERACAPSULAR+RAPID GROWING+PATH FX >>>>> TREAT= CURTAGE STG 3= EXTRACAPSULAR+ PATH FX,MRI=MASS TREAT= WIDE OR RADICAL RESECTION

5. MALIGNANT TUMOR STG 1A= LOW GRADE+INTERA COMPARTMENTAL STG 1B= LOW GRADE +EXTERA COMP. STG 2 A=HIGH GRADE +INTERACOMPARTMENTAL STG 2 B = HIGH GRADE + EXTRA COMP. STG 3= + METASTASIS

6. ENNEKING 4 QUESTIONS 1-ANATOMIC LOCATION 2- TUMOR ACTION TO BONE(DESTRUCTION PATTERN) BONE REACTION TO TUMOR(PERIOSTEAL REACTION) INTERATUMORAL DENSITY

7. ANATOMIC LOCATION SPINE POST ELEMENT=ABC ANT ELEMENT CHILD=HT-X,HEMANGIOMA ADULT=CHORDOMA, HEMANGIOMA, PAGET, MM,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

8. EPIPHYSIS - METAPHYSIS CHONDROBLASTOMA L.G. OSTEO. SARCOMA EOS. GRANULOMA DESMOID TUMOR AB C, UBC H.G OSTEO.SARCOMA OSTEOBLASTOMA FIBROUS DYSPLASIA GAINT CELL TUMOR

9. DIAPHYSIS PARAOSTEAL FIB.DYSPLASIA HIST-X EWING SARCOMA OSTEOBLASTOMA ADAMANTINOMA LIPOMA METASTASIS MYOSITIS OSSIFICANT OSTEOSARCOMA CHONDROSARCOMA ECHONDROMA

10. RIBS CHILD: FIBROUS DYSPLASIA EWING SARCOMA ADULT: EWING SARCOMA CHONDROSARCOMA FIBROUS DYSPLASIA MULTIPLE MYELOMA METASTASIS

11. DESTRUCTIVE EFFECT GEOGRAPHIC PATTERN LESION >1 CM UBC FIB.DYSPLASIA CHONDRMYXOID FIBROMA NON OSS.FIBROMA GCT 50%

12. MOTH EATEN PATTERN LESION 2-5 MM OSTEOMYELITIS GAUCHER METASTASIS CHONDROSARCOMA MYELOMA LYMPHOMA EOS.GRANULOMA

13. PERMEATIVE LESION <1 MM OSTEOMYELITIS EWING SARCOMA OST.SARCOMA MYELOMA GAUCHER EOS.GRANULOMA

14. PERIOSTEAL REACTION CODEMAN TRIANGLE ABC OSTEOMYELITIS GCT

15. ONION SKIN EWING SARCMA OSTEOMYELITIS OSTEO SARCOMA

16. SUNBURST OSTEOSARCOMA EWING SARCOMA PROSTAT METASTASIS MAJOR THALASEMIA SICKLE CELL ANEMIA

17. DENSE THICK OSTEOID OSTEOMA TRAUMA INFECTION

18. Reaction of Bone to Tumor REAM SCLEROSIS : BENIGN TUMOR BENDING: RICKETS, FIB.DYSPLASIA, PAGETS EXPANSION: 80% benign tumor, primary sarcoma,metastasis of kidney & thyroid Eccentric expansion: chon.mix.fibroma,abc, L.G SARCOMA FINGER IN BALLON SIGN :ABC

19. INTERA TUMORAL DENSITY COLUMBOUS CLOUD OSTEOSARCOMA

20. POP CORN ENCHONDROMA

21. Spotty Density or Wind Blown CHONDROSARCOMA

22. Ground Glass Appearance FIBROUS DYSPLASIA OSTEO SARCOMA

23. Case presentation 65y/o male with kn p for 1mo P/E= Local tend in mjl Routin lab=WNL CXR=NAD Bone scan= Increase uptake in prox tibia

24. MRI

25. 3 weeks later Biopsy done : Result no malignant cell detected Repeated biopsy =same

26. 6 MONTHS LATER Pain increase Knee instability Hip pain Limping Limb shortening Again biopsy= nothing

27. 7 months later Limping increase Shortening about 4cm Routin lab=WNL

28. AFTER 8 MONTHS KNEE SLX HIP DESTRCTION WHEEL CHAIR BOUD

29. ??? ??? Z I G M A 4TH STAGE NEURO-PATHIC PHASE FTA ABS+++

30. SYPHILIS 1 ST STG=10-90 days,>>>>>>>chancre 2 nd STG=4-10 wks after chancre>>skin rash, very contagious, mucosal sore 3 rd STG=nervous sx>>>> headache, stiff nk, paralysis 4 th STG=neuropathic &osteopathic >>>absorbsion of bones & destruction of joints