Orthopedics

1. Bone Tumours
Wahby Ghalib
CABMS, FJMC, MRCS

2. Classification
•Primary:
Benign
Malignant
• Secondary (Metastaic)

3. Benign bone tumors
• Bone : Osteoid osteoma, osteoblastoma
• Cartilage : Enchondroma, chondroblastoma &
osteochondroma
• Blood vessels : Haemangioma
• Others : Giant cell tumour

4. Benign tumour-like lesions
• Bone cysts : simple & aneurysmal
• Fibrous cortical defect

5. Staging of benign bone tumours
• Latent
• Active
• Aggressive

6. Surgery for benign bone
tumours
• Intralesional excision
• Marginal excision

7. Primary malignant bone
tumours
• Bone: Osteosarcoma
• Cartilage: Chondrosarcoma
• Bone marrow: Ewing sarcoma & myeloma
• Connective tissue: fibrosarcoma
• Others: Chordoma & adamantinoma

8. Metastatic bone disease
• Breast: Most common
• Prostate: Blastic lesions
• Lung
• Colon
• Kidney
• Thyroid

9. • Site: axial skeleton, proximal femora and
humeri
• C/F: pain, pathologic #, hypercalcaemia
• Thyroid and renal deposits: hypervascular
• Rx: Bisphosphonates, stabilization, RTx

10. Staging of malignant tumours
(Enneking)
• I : Low grade
• II : High grade
• III : Sarcoma with metastasis
• A : Intra- compartmental
• B : Extra-compartmental

11. Surgery for primary malignant
bone tumours
• Wide excision : safe margins
• This includes : amputation
limb – salvage surgery

12. Chemotherapy
• Preoperative : (neoadjuvant) 8-12 w
• After tumour resection : check tumour
necrosis
• Postoperative : 6-12 m

13. Radiotherapy
• Residual tumour
• Inaccessible tumour
• Painful metastasis

14. Benign bone tumours

15. Fibrous cortical defect
• = non-ossifying fibroma
• Very common
• Child
• Accidentally on XR
• Pain or pathologic fracture

16. • No malignant potential
• Rx : curettage + bone graft

20. Osteoid osteoma
• Patient < 30 yr
• Pain > at night relieved by aspirin
• In spine 🡪 painful scoliosis
• No malignant potential

21. • XR : radioluscent nidus surrounded
by sclerosis
• Any bone except the skull
• Rx : removal of nidus: surgery or
radiofrequency ablation

26. osteoblastoma
• = O.O. but nidus > 1.5 cm

27. Compact (ivory) osteoma
• Rare
• Young adult
• Painless lump on outer or inner
table of skull

28. Enchondroma
• More in tubular bones of hand
• Accidentally or pain / pathologic #
• XR : lytic lesion + flecks of calcification
• Malignant risk : 2%
• Ollier disease and Maffucci syndrome
• Rx : curettage + bone graft

30. Picture 4. Frontal radiograph of the right thigh demonstrates coarse
calcifications in the distal femur.

31. Osteochondroma
• = exostosis
• Commonest benign bone tumour
• It is bone outgrowth covered by
cartilage

32. • Hereditary multiple exostosis : AD
• Malignant risk : 1% solitary
6% multiple
• If continues to grow > 18 yr suspect
malignancy
• Rx : excision

36. thanx