1. Bone tumors osama nimri

2. Bone tumors are rare tumors Occur more in young ages
accounting for less than .2% of all cancers
Occur more in young ages

3. Classification of Bone tumors
Origin: - primary
- secondary: 95%, breast, lung, prostate, kidney and thyroid
cell type:
Bone
Osteoma, osteosarcoma
Cartilage
Chondroma, Chondrosarcoma
Marrow
Hemangioma, angiosarcoma
Fibrous tissue
Fibroma, fibrosarcoma
Tumor type:
Benign: Osteoma, osteochondroma
Malignant:: Osteosarcoma, chondrosarcoma

4. Symptoms and Signs It may be asymptomatic and discovered accidentally.
Pain: may worsen at night and awakes patient, caused by tumor compression on surrounding tissue, hemorrhage in the tumor, pathological fractures also cause pain
Swelling.
Local tenderness.
Warmth

5. Pathological fracture: may be the first sign.
General: fatigue, fever, wt. loss
A mass can be felt at the tumor site.

6. Malignant vs. Benign Tumors
“Rapid growth, warmth, tenderness, and ill defined edges are suggestive of malignancy.”

7. INVESTIGATIONS

8. History and examination Imaging Biopsy Labs
Calcium: Greater than normal levels may indicate metastasis.
Serum phosphorus: Greater than normal levels may indicate bone metastasis.
PTH: Lower than normal levels may indicate bone metastasis.
ALP isoenzyme: Higher than normal ALP levels may indicate Paget's disease, osteoblastic bone cancers, osteomalacia and rickets.
LDH: High values indicate poor prognosis

9. Plain x-ray Most useful Could see: Important to notice: A lump
Bone destruction
Cortical thickening+ periosteal reaction
Cysts
Important to notice:
Where
How many
Cystic or not
Margins
destruction

10. Periosteal reaction
Periosteal reactions: periosteal hypertrophy which develops in response to periosteal irritation. They are a non-specific sign: they have many causes:
Infections
Tumors (both benign + malignant)
Healing fractures
Chronic stress

11. Periosteal reactions with benign tumors are either thick and smooth, or are completely absent!
Periosteal reactions are thinner but irregular (wavy) with malignant tumors.

12. Periosteal reactions seen in the distal tibia and fibula.

13. Periosteal reaction at the distal radius with irregular edges: malignant.

14. Osteosarcoma of the distal femur: Codman’s triangle can be seen: periosteum is being “lifted off”.

15. Midshaft periosteal reaction with smooth + thick edges: this is a benign osteoma.

16. A tibia healing from a fracture showing a smooth and thick periosteal reaction.

17. Helpful in revealing site of a small tumor Skip lesions
CT and MRI
Asses the extent of the tumor
Relation to surrounding structures
Radionuclide scanning:
Helpful in revealing site of a small tumor
Skip lesions
Silent secondary deposits

18. Multiple hot spots seen: lung cancer which has metastasized to vertebrae.

19. Biopsy * Biopsy allows us to reach a diagnosis.
* Biopsy allows us to plan for treatment.
Methods of biopsy:
Open biopsy: surgical procedure done under GA.
Zonal biopsy: open biopsy from transition zone.
Excisional biopsy: excision of the entire tumor.
Large–bore needle biopsy: aspirating cells.

20. Be aware of biopsy complications:
Hemorrhage
Wound break down
Infection
Pathological fractures

21. General Considerations About Benign Bone Tumors:
BENIGN TUMORS
General Considerations About Benign Bone Tumors:
Most bone tumors are benign, and unlikely to spread.
They can occur in any bone, but they are usually found in the biggest ones.
It could affect the femur , tibia , humerus .
 Some types are more common in specific places such as near the growth plates of the largest bones
Appearance and location of mass on radiographs are keys to diagnosis.
Benign bone tumors most often are asymptomatic

22. Benign bone tumors: Non ossifying fibroma Osteochondroma
Osteoid osteoma
Enchondroma
Giant cell tumor of bone
osteoblastoma

23. 1-NON-OSSIFYING FIBROMA
Fibrous tissue within bone ossiffy in time
Asymptomatic, incidental findings
developmental defect, seen in children
Metaphysis of long bones, occasionally multiple lesion
As bone grows , defect becomes less obvious
May enlarge and cause pathological fracture
No need for treatment, unless there is pathological fracture

24. Radiographically, the tumor presents as a well marginated radiolucent lesion, with a distinct multilocular appearance .

25. 2- Osteoid osteoma
Neoplastic proliferation of osteoid and fibrous tissue
More common in male under age of 30 year , in vertebra or long bones , less commonly in mandible or other craniofacial bones.
Small in size (<1.5 cm);oval or rounded shape
Pain(severe) worse at night ,not relieved by rest but relieved by aspirin.
Types :Cortical;Cancellous ;Subperiosteal .
Treatment: Complete removal after careful
localization by CT.

26. ON X-Ray : Nidus : a tiny radiolucent area
If in diaphysis surrounded by dense bone and thickend cortex
Metaphysisless cortical thickening

27. Male 23 years old, with a history of increasing pain in the knee, relieved by aspirin

28. Plain radiograph in a 25-year-old male with cortical osteoid osteoma
Plain radiograph in a 25-year-old male with cortical osteoid osteoma. shows a radiolucent nidus surrounded by fusiform cortical thickening

29. 3- Osteochondroma(exostosis)
Commonest benign tumor of bone
Mature bone with cartilaginous cap.
Common sites are the fast growing sites of
long bones(lower end of femur and upper end of tibia) and crest of ileum and shoulder.
It occurs most frequently in male under age of 25 year.
Small risk of malignant transformation(<1%)
solitary

30. Osteochondroma Symptoms X-Ray:
A hard, immobile, detectable mass that is painless
Lower-than-normal-height for age
Soreness of the adjacent muscles
One leg or arm may be longer than the other
Pressure or irritation with exercise
X-Ray:
Exostosis: well defined bony projection
Cartilage maybe calcified if lesions are large

31. Osteochondroma

32. Treatment
Only if causing symptoms or;If becoming bigger and more painful
By excision

33. Thank You
Done By : Osama Nimri