Bone tumours

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bone tumors
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Bone tumours

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

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