THIS LECTURE CONTAIN DIFFERENT TYPES OF BONE TUMOR (Benign and malignant) AND THE FEATURES FOR EACH TYPE

1. Bone tumor
Nassr Saif AL-Barhi

2. Bone tumor
• refers to a neoplastic abnormal growth of tissue
in bone. It can be either benign or malignant.
• Most bone tumors are noncancerous(benign).
• Bone tumors may be classified as:
▫ "primary tumors <3rd decade.
▫ secondary tumors >3rd decade.

3. Clinical presentation
• Clinically, bone tumors present in various ways.
• The more common benign lesions are:
 frequently asymptomatic and are detected as
incidental findings.
 Many tumors, however, produce localized pain or
are noticed as a slow-growing mass.
 Sometimes, the first hint of a tumor's presence is a
sudden pathologic fracture.

4. Diagnosis
• Radiographic analysis plays an important role
in diagnosing bone tumors.
▫ Help limit the differential diagnosis
▫ Give clues to the aggressiveness of the tumor.
• Ultimately, in most instances, biopsy and
histologic study are necessary, sometimes we
need radionuclide scanning in small tumors
e.g. osteoid osteoma.

5. Benign bone tumor

6. Classification of bone tumor
according to cell type
Bone:
Osteoid osteoma
Cartilage:
Chondroma, Osteochondroma.
Fibrous tissue:
Fibroma
Uncertain:
Giant bone cyst

7. Osteoid Osteoma
• Peak incidence in 2nd and 3rd decades, M:F= 3:1
• It has a center of growing cells, called a
nidus(less than 1 cm) surrounded by a hard
shell of thickened bone.
• Most common in femur and tibia.

8. • Symptoms:
▫ An osteoid osteoma causes a dull aching pain.
▫ The pain is moderately intensity, but can be
severe, especially at night.
• The tumor is not related to previous injury or
activity.
• Over-the-counter pain medicines such as
aspirin, ibuprofen are helpful in decreasing pain.

9. Small nidus <1 cm round oval in
shape in diaphysis
• Treatment:
• is surgically cutting out
of the entire tumor,
particularly the central
core, for a good
outcome

10. Osteochondroma
• One of the commonest tumor of bone (45% of all
benign)
• It is developmental lesion which is an outgrowth
of the growth plate and is made up of both bone
and cartilage (cartilage-capped bone).
• the commonest site are the fast growing end of
long bone and the crest of ilium.
• Can be simple or multiple

11. Well defined bony exostosis
emerging from metaphysis

12. • The most common symptom of an
osteochondroma is a painless mass near the
joints
• An osteochondroma ordinarily stops growing
when a person reaches full normal growth any
further enlargment is suggestive of malignant
change.
• Treatment:
▫ Usually no treatment is required.
▫ Surgical Excision, if causes pain or put
pressure in the nerve or blood vessels.

13. Enchondroma
• benign Cartilaginous islands growth In medullary
cavity.
• It is very common and often occure in the small bone
of the hand and feet. Others femur, humerus, ribs.
• Appear inside of the bone.
• Usually begin and grow in childhood, then stop
growing but remain through adulthood.(10-20 age)

14. • Can be single or multiple
• Symptoms:
▫ Usually painless.
▫ But can causes enlarged fingers, pathologic
fracture or deformities.
• X-ray finding:
▫ Dark hole in bone, but usually they have
calcification or white spot in the hole.

17. • Treatment:
▫ No treatment is required for asymptomatic
lesions.
▫ If fracture occurs, it is usually treated with
scraping out and filling of the cavity with bone
grafting.
• Risk of transformation:
▫ < 2% will transform to chondrosarcoma.
▫ pain without pathological fracture.

18. Chondroblastoma
• It is rare type of benign tumor.
• It is appear in epiphysis usually in proximal
humrus, femur or tibia.
• Presenting with aching & tenderness adjacent
joint.
• It have potential to metastasize to the lung.

19. Well demarcated radiolucent
area in the epiphysis

20. Treatment:
• It requires surgery by scraping out and filling of
the cavity with bone grafting.

21. Fibrous dysplasia
• replacement of the medullary bone with fibrous
tissue and woven bone.
• It can affect one bone (monostotic) or many
bones(polystotic).
• Fibrous dysplasia leads to bone weakness so it
can cause angulation bent of the bone
(shepherd's crook deformity)

22. Hazy appearance (ground
glass)
Shepherd’s crook
deformity

23. Simple bone cyst
• A unicameral bone cyst is a cavity found within
a bone that is filled with straw-colored fluid.
• Appears during childhood typically in the
metaphysis.
• Not tumor tends to heal spontaneously

24. A large bubble inside the bone
mostly in metaphysis

25. Giant Cell Tumor of Bone
• is a very rare, aggressive benign tumor. It
generally occurs in between the ages of 20 and
40 years.
• very rarely seen in children or in adults older
than 65 years of age.
• is formed by fusion of several individual giant
cells into a single, larger complex cystic.

26. occurs in the end portion of
long bones (epiphysis)

27. • Localized pain.
• Pain increase with movement, decrease with
rest but it progressively increase with time
Treatment:
Radiation therapy or curettage surgery

28. Summary Tumor location
Osteoid osteoma Diaphysis
Chondroma Intermedulary
Osteochondroma Bone ends of long
bone
Chondroblastoma Epiphysis
Fibrous dysplasia Intermedulary
Simple bone cyst Metaphysis
Giant bone cyst Epiphysis

29. Summary
- Most of benign tumors are a symptomatic & an
incidental diagnosed.
- No treatment required for benign tumor except
when it cause pain or can damage epiphysis.
- Some of benign tumor can transform to
malignant, the most important symptom for
transforming is pain without pathological
fracture.

31. Malignant Bone Tumors
• The following malignant tumors will be
discussed:
▫ Osteosarcoma
▫ Chondrosarcoma
▫ Ewing’s Sarcoma
▫ Multiple Myeloma
▫ Metastatic Disease

32. OSTEOSARCOMA.
• Highly malignant tumor.
• Rapidly go to periosteum.
• Most common primary malignant tumor of bone.
• Males> females.
• Most occur in teenagers ages (10-25)
• Clinical features: localized pain is the first
Worse at night and swelling

33. Major sites of origin of osteosarcomas. The numbers
are approximate percentages.

34. Osteosarcoma

35. • Metaphysial tumor
• Radiographic terms to know:
▫ Codman’s Triangle:
▫ “Sunburst” periostial formation:
▫ Bone destruction

36. Osteosarcoma
Bone destruction

37. CHONDROSARCOMA
• Malignant tumor of cartilage.
• pelvic bones, spine, and shoulder girdle
• Males> females age 30-60.
• Slowly growing.
• Tumor may arise primarily or secondary to a
pre-existing enchondroma,exostosis or Paget’s
disease.
• Clinical presentation: dull ache and swelling

38. Chondrosarcoma
• Plain films show
• large osteolytic lesions.
• Central flecks of calcification

40. Treatment
• Unresposive to chemotherapy
• Treat with aggressive surgial resection.

41. EWING SARCOMA
• Malignant neoplasm of undifferentiated cells
arising within the marrow cavity.
• Males are affected slightly more often than
females.
• most occur in teenagers ( 5-20)
• Clinical features: thrombing pain , swelling
and tenderness
• Other symptoms including fever, anemia,
leukocytosis,

42. X-ray: concentric onion skin
layering of new periosteal
bone.

44. EWING SARCOMA(cont.)
• Gross:
▫ often affects the diaphyses of long bones with
most common sites like femur, pelvis and tibia
seen a white tan mass with necrosis and
hemorrhage..
• Frequently the tumoral cells erode cortex and
periosteum and invade surrounding tissues.
• Tx:
▫ chemotherapy, surgery and/ or radiation.
• Prognosis: 5 year survival rate of 75%

45. Multiple myeloma
• Tumor made up of malignant monoclonal
plasma cells ( B-cell).
• is the most common primary bone cancer.
• Usually affects patients Over 40 years of age.
• Patients often present with malaise, bone pain
mild anemia, hypercalcaemia, or a pathologic
fracture.
It cause osteoporosis … How???

46. Multiple Myeloma
• Classic radiographic appearance is multiple lytic
“punched out” areas in bone.
• Frequently involves the calvarium.
• Treatment consists of palliative chemotherapy or
bone marrow transplant.

47. Multiple Myeloma
• Characteristic
“punched-out” lesions

48. Multiple Myeloma
• “Punched-out” lesion

49. ImagingWhereGrowthpresentageType
Godman
Triangle
sunburst
metaphyses
rapidPain at
night
Local
tenderness
15-
25
Osteosarcom
a
Central
flacks of
calcification
Cartilage
and
metaphyses
slowDull ache
Path-
fructure
30-
60
Chondrosarco
ma
Onion skindiaphysis-Throbbing
pain
swelling .
General
illnes
>40Ewing’s
Sarcoma
Punch outBone
marrow
-Weekness
,back pain
path-
fructure
45-
65
Multiple
Myeloma

50. Metastatic Disease
• Most common malignancy in bone.
• Must be considered in any differential diagnosis
of a bone lesion in a patient Over 50 years old.
• May have virtually any appearance.
• May be lytic or blastic.
• Majority of metastases to bone originate in
Breast, Prostate, Lung, Kidney and Thyroid.

51. Metastatic Disease
• Most common sites
for bony metastases
include thoracic and
lumbar spine, pelvis,
femur, rib, proximal
humerus and skull
• Pain
• Sudden back pain

52. Metastatic Disease
• Bone mets from Lung
CA