The term bone tumor is a broad term used for benign and malignant neoplasm. metastatic deposits in the bone are common than the primary bone tumors. most primary bone tumors occur in children and young adult.

2. INTRODUCTION
•The term bone tumor is a broad term used for
benign and malignant neoplasm.
• metastatic deposits in the bone are common than
the primary bone tumors.
• most primary bone tumors occur in children and
young adult.

3. WHO Nomenclature & Classifications
1 Bone forming tumors
Benign Osteoid osteoma, osteoma, Osteoblastoma
Indeterminate Aggressive osteoblastoma
Malignant Osteosarcoma
2 Cartilage forming tumors
Benign Osteochondroma, Chondroblastoma,
Malignant Chondrosarcoma
3 Gaint cell tumor(Osteoclastoma)
4 Marrow tumor
primary tumor commonest Multiple myeloma
5 Vascular tumor
Benign hemangioma
Malignant Angiosarcoma

4. Osteoma
•It is a benign tumor composed of sclerotic, well formed bone
protruding from cortical surface of a bone.
• The bone involved most often are the skull and facial.
• Generally, the tumor has no clinical significance except that it may
produce visible swelling.
• Sometimes it may bulge into the air sinuses and cause obstruction to
the sinus cavity, and leading to pain.

5. Treatment
•No treatment is generally required except for cosmetic reasons.
• Simple excision is sufficient.

6. Osteoid osteoma
•It is the most commonest true benign tumor of the bone.
• Pathologically, it consists of a nidus of tangled arrays of partially
mineralized osteoid trabeculae surrounded by dense sclerotic bone.
•Tumor is mainly located at diaphysis of long bones.
• posterior elements of the vertebrae are common site.
Clinical Features:
-Seen commonly between the age of 5-25 yrs
- bone of the lower extermity are more commonly affected; Tibia
- nagging pain, worst at night and relieved by salicylates
- Mild tenderness at the site of the lesions
-palpable swelling if it is superficial

7. Contd….
•Diagnosis:
-Confirmed by X-Ray: tumor is visible aa a zone of sclerosis surrounding
a radiolucent nidus usually less than 1 cm in size.
-CT scan
Treatment:
-Complete excision of the nidus along with the sclerotic bone is done.
- Prognosis is good.

8. Osteoblastoma
• It is a benign tumor consisting of vascular osteoid and new bone.
• It occurs in the jaw and the spine.
• If in long bones, it occurs in the diaphysis or metaphysis, but never in
the epiphysis.
• It occurs in patients in their 2nd decade of life.
•The patients with aching pain.
• Radiologically, it is a well-defined radiolucent expansible bone lesion 2-
12 cm in size.
• There is minimal reactive new bone formation.
• Treatment is by curettage.

9. Chondroblastoma
• It is a cartilaginous tumor containing characteristic multiple calcium
deposit.
• It occurs in young adults and is located around the epiphyseal plate.
• Bones around the knee are commonly affected.
• Radiologically, There is a well- defined lytic lession surrounded by a
zone of sclerosis.
• Are of calcification within the tumor substance give rise to a mottled
appearance.
• Treatment is by curettage and bone grafting.

10. Hemangioma of the bone
• This is the benign tumor of angiomatous origin commonly affecting the
vertebrae and skull.
• It occurs in young adults.
•Common presenting symptoms are persistent pain and features of cord
compression.
• Typically, one of the lumbar vertebrae is affected.
• Radiologically, it appears as loss of horizontal striation and prominence
of vertical striation of the affected vertebral body.
• Treatment is by radiotherapy.

11. Osteoclastoma(GCT)
• Giant cell tumor is a common bone tumor.
• The tumor consist of undifferentiated spindle cells, profusely
interspersed with multi-nucleate giant cell.
• The tumor stroma is highly vascular.
• The tumor is seen commonly in the age group of 20-40 years i.e after
epiphyseal fusion.
•The bone affected commonly are those around the knee and lower end
of the radius.
Clinical Features:-
-Swelling & vague pain
-Pathological fracture

12. Contd……
Examination:-
-Examination reveals a bony swelling
- surface of the swelling is smooth
- limb may be deformed
Diagnosis:-
-Lytic lesion seen in X-ray
-Soap- bubble appearance seen
-No calcification seen within the tumor

13. Contd……
Treatment:-
- Whenever possible, excision of the tumor is the best treatment.
-If excision is not possible then radiotherapy is done.
-Following treatment methods are commonly used:
a. Excision:-
- It is the treatment of choice when the tumor affects a bone whose
removal does not hamper with function e.g., fibula, lower end of
ulna

14. Contd……
b. Excision with reconstruction:-
- When excision of a tumor at some site may result in significant
functional impairment & reconstructed by as follows-
 Arthrodesis by the Turn-O- Plasty procedure
 Arthrodesis by bridging the gap by double fibula, one taken from
same extremity and other from the opposite leg.
 Arthroplasty- Tumor is excised and attempt is made to reconstruct
the joint in some way. It can be carried out using an autograft.
c. Curettage with or without supplemetary procedure:-
- High reoccurrence rate
- Cryotherapy: Liquid nitrogen is used to producea freezing effect and
thus kill the residual cells and thermal burning of the cells by using
cautrization.

15. Contd……
d. Amputation:-
e. Radiotherapy:-
- It is preferred treatment for GCT affecting the vertebrae
Prognosis:
- Recurrence is more common.

16. Osteosarcoma
- It is the second most common and high malignant primary bone
tumor.
- It is defined as a malignant tumor of the mesenchymal cells
characterized by formation of osteoid or bone by the tumor cell.
- It occurs between the age of 15-25 years.
- lower end of femur , upper end of the tibia and upper end of
humerus most common site.
- It looks like greyish white , hard.
- Histologically tumors vary in the richness of the osteoid,
cartilaginous or vascular components.

17. Contd……
Clinical Features:
- Pain is usually the first symptoms soon followed by swelling
- Pain is constant and boring and becomes worse as the swelling
increase in size.
- h/o trauma
- sometime pathological fracture
Examination:
- Swelling at the metaphysis region.
- Shinny with prominent vein seen over the skin
- Margin of swelling are not well defined
- Regional lymphnodes may be enlarged

18. Contd……
Investigation
- X-ray shows the irregular destruction in the metaphysis,
overshadowed by the new bone formation.
- Codman’s triangle: A triangle area of subperiosteal new bone is seen
at the tumor host cortex junction at the ends of the tumor.
- Serum Alkaline Phosphatase
- Biopsy

19. Contd……
Treatment
- Confirmation of the diagnosis
- Evaluation of spread of tumor
- To plan amputation surgery
- Treatment of the tumor
 Local Control: surgical ablation, amputation
 Radiotherapy
 Chemotherapy Immunotherapy
- Portion of the tumor is implanted into a sarcoma survivor and is
removed after 14 days.

20. Contd……
Follow up:
- Checked up every 6-8 wks
- Any evidence of recurrence of the primary tumor.
Prognosis:
- Without treatment death occurs within 2 yrs, usually within 6 month
of detection of metastasis.
- 5 yrs survival with surgery alone is 20%
- With surgery and adjuvant therapy, 5 yrs survival is 70%

21. THANK YOU