Management of bone tumours

Neoplasms of bone
Osteoblast origin
Benign
Osteoma
Osteoid osteoma
Osteoblastoma
Malignant
Osteosarcoma
Chondroblast origin
Benign
Chondroma
Osteochondroma*
Chondroblastoma
Malignant
Chondrosarcoma
Unknown cell of origin
Giant cell tumour
(Osteoclastoma)
Ewings tumour
Connective tissue
tumours :
(Vascular , Neural, etc)

Metastases

Tumour like conditions
Fibrosseous lesions
Fibrous dysplasia
Osteofibrous dysplasia ( Ossifying fibroma)
Metaphyseal fibrous defect (non ossifying
fibroma)
Cysts
Solitary bone cyst (unicameral bone cyst)
Aneurysmal bone cyst
Ganglion cyst
Modes of presentation
Lump
Pathological fracture
Pain
Pressure effects
Incidental finding
Secondaries
Exostosis
Osteochondroma (actually a hamartoma)
Growing end of long bones
Problems lump. Malignant change rare
Multiple (diaphyseal aclasis) can interfere
with growth

Excise if single, causing problems tumour
is larger than it appears on X-ray
Exostosis
Exostosis
Chondromata
Others
Fibrous
cortical defect
Aneurysmal bone cyst
Fibrous dysplasia
Osteoclastoma
Giant cell tumour
Expands the bone
Classically asymmetrical
Occurs at the site of epiphysis
Lytic. Septate
Egg shell crackling

Osteoclastoma
Osteoclastoma - treatment
Curettage and bone grafting
Pamidronate
Allograft / autograft bone
Bone cement
Prostheses

NO radiotherapy
Ewings tumour
Classically mid shaft
Onion peel appearance
Respond to RT

Osteosarcoma
Common at growing end of long bones
Occur in the second decade (2
nd
peak due
to Pagets disease)
Warm swelling
X-ray Codmans triangle, sunray spicules,
bone destruction, cortex breached
CT-scan for extent. Also CT chest
Biopsy incision or true-cut

Osteosarcoma
Osteosarcoma -treatment
Excision, DXRT, Chemo

Excision amputation, limb conserving

Custom made prostheses, allograft
Chondrosarcoma
Occur in older patients
Affect the axial skeleton


Treatment Surgical (not responsive to
Chemo, DXRT)
Chondrosarcoma
Secondaries in bone
Commonly lytic
Common primaries lung, thyroid, breast,
kidney, prostate
Multiple myeloma
Sclerotic prostate, breast, colon
50% of bone must be destroyed to be seen
on X-ray
CT, Bone scan seen as hot spots.
Myeloma is cold
Ca- Breast
Multiple myeloma
Secondaries -treatment
Wherever possible fix.
Use bone cement.
Aim is to get early mobilization
Soft tissue sarcomas
Can occur anywhere
Limbs, abdominal
wall, retro-peritoneum
Radical excision + RT
+ CT