Bone tumours

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bone tumors …

bone tumors
for under graduate level

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  • 1. Bone tumours Dr.Surya prakash sharma MBBS D’ortho (PG Student) MMC Chennai
  • 2. Bone tumours
    • Commonest bone tumour is secondaries from other sites
    • Commonest primary bone tumour is multiple myeloma, second osteosarcoma.
  • 3. Classification (W.H.O.)
    • Bone-forming tumours
    • Cartilage forming tumours
    • Giant-cell tumour
    • Marrow tumours
    • Vascular tumours
    • Other connective tissue tumours
    • Other tumours
    • Secondary malignant tumours of bone
  • 4. Bone forming tumours
  • 5. Cartilage forming tumours
  • 6. Giant cell tumour
    • Osteoclastoma
  • 7. Marrow tumours
    • Ewing’s sarcoma
    • Neuroectodermal tumour
    • Malignant lymphoma of bone (Primary/secondary)
    • Myeloma
  • 8. Vascular tumours
    • Benign
    • Haemangioma
    • Lymphangioma
    • Glomus tumour
    • Intermediate
    • Haemangio endothelioma
    • Haemangio pericytoma
    • Malignant
    • Angiosarcoma
    • Malignant haemangio pericytoma
  • 9. Other connective tissue tumours
    • Benign
    • Benign fibrous histiocytoma
    • Lipoma
    • Intermediate
    • Desmoplastic fibroma
    • Malignant
    • Fibrosarcoma
    • Malignant fibrous histiocytoma
    • Liposarcoma
    • Malignant mesenchymoma
    • Leiomyosarcoma
    • Undifferentiated sarcoma
  • 10. Other tumours
    • Benign
    • Neurilemmoma
    • Neurofibroma
    • Malignant
    • Chordoma
    • Adamantinoma
  • 11. Secondary malignant tumours of bone
    • From primary in:
    • Thyroid
    • Breast
    • Bronchus
    • Kidney
    • Prostate
  • 12. Diagnosis
    • Clinical examination
    • Imaging
    • Laboratory investigations
    • Biopsy
  • 13. Imaging
    • Radiographs
    • CT scan
    • MRI
    • Radio nuclide bone scan
    • Arteriogram
  • 14. Radiographs
    • Exact location of the tumour
    • Borders of the tumour
    • Pattern of bone destruction
    • Matrix formation
    • Periosteal reaction
  • 15. CT Scan
    • Very useful in early diagnosis
    • Extra osseous extension
    • Early detection of pulmonary secondaries
    • Exact measurement for limb salvage procecures (Prosthesis/allograft)
  • 16.  
  • 17.  
  • 18. MRI
    • Intra medullary extension
    • Soft tissue extension
    • Defines the relationship to the nearby major blood vessels
  • 19.  
  • 20. Radio nuclide bone scanning
    • For pre biopsy staging
    • Dissemination of tumour
    • Silent secondaries and skip lesions
  • 21. Arteriogram
    • Planning limb sparing surgery
    • Therapeutic embolization
    • To assess vascularity of tumour
  • 22. Laboratory investigations
    • Hb %
    • ESR
    • Alkaline Phosphatase
    • Serum electrophoretic pattern
    • Bence-Jones protein
    • Acid Phosphatase
  • 23. Biopsy
    • Closed biopsy
    • FNAC
    • Needle biopsy
    • Open biopsy
    • Incisional biopsy
    • Excisional biopsy
  • 24. Principles of biopsy
    • From boundary or edge of tumor
    • Take several samples
    • Incision strategically placed
    • Ideally done by the treating surgeon
    • Wound closed without drain
  • 25. Staging of the tumor
    • By Enneking (1986)
    • Based on aggressiveness of the tumor and Spread
  • 26. Staging (Enneking) Intra compartmental Extra compartmental Low grade I-A I-B High grade II-A II-B Low/High grade with metastasis III-A III-B
  • 27. Correlation of staging and management
    • I-A - Wide excision
    • I-B - Wide excision with larger clearance
    • II-A - Wide excision/amputation
    • II-B - Radical resection or disarticulation
    • III - Palliative treatment
    • Low grade intra compartmental lesions – wide resection and management of metastases
  • 28. Principles of management
    • Benign, asymptomatic lesions
    • Excisional biopsy or curettage
    • Benign, symptomatic or enlarging lesions
    • Biopsy confirmation followed by marginal resection or curettage (cystic lesions)
  • 29. Principles of management
    • Suspected malignant lesions
    • Laboratory and imaging investigations
    • Chest x-ray or CT scan of the chest
    • Biopsy confirmation
    • Surgical options
    • Ablative surgeries (amputation/disarticulation)
    • Limb sparing surgeries
    • Chemotherapy
    • Adjuvant/Neo-adjuvant
    • Radiotherapy
  • 30. Thank You