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Bone tumors

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Bone tumors

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Bone tumors

  1. 1. BONE TUMORS
  2. 2. • Bone tumors diverse in size & gross & histologic features • Inocuous to rapidly fatal • Critical to diagnose , stage & treat • Classified according to normal tissue type they recapitulate or normal cell
  3. 3. • Benign tumors within first 3 decades of life • Elderly malignant • Cause – unknown , genetic alterations • Benign lesions – asymptomatic • Pain , slow growing mass , sudden pathologic fracture • Radiology & biopsy
  4. 4. BONE FORMING TUMORS • Production of bone by neoplastic cells • Tumor bone deposit as woven trabeculae & variably mineralized
  5. 5. Osteosarcoma • Malignant mesenchymal tumor in which the cancerous cells produce bone matrix • Paget disease , bone infarcts & prior irradiation
  6. 6. • Metaphyseal region of long bones of extremities • Depending on their location within bone – medullary & parosteal
  7. 7. Medullary / central osteosarcoma • Common, 10-20yrs, male common • Metaphysis of long bones – lower end of femur & upper end of tibia
  8. 8. Based on pathogenesis – primary & secondary • Primary – unknown etiology, evidence linking with genetic factors, period of active growth, environmental infleunces • Hereditary retinoblastoma
  9. 9. • Secondary – preexisting bone diseases – paget’s disease of bone, fibrous dysplasia, multiple osteochondromas, chronic osteomyelitis, infarcts & # • More aggressive
  10. 10. Medullary osteosarcoma – highly malignant • Metaphysis -> extends centrally & expands laterally on either side breaking through the cortex & lifting periosteum -> surrounding soft tissue • X – ray – sunburst pattern due to osteogenesis within the tumor Codmann’s triangle – formed at the angle between elevated periosteum & underlying surface of cortex
  11. 11. • Clinical features – pain, tenderness & swelling • Alkaline phosphatase raised • Metastasis – rapidly, hematogenous route – lungs, bones, brain
  12. 12. Morphology • Grey white, bulky, mass • c/s – greywhite, areas of hemorrhage & necrosis, hard & gritty if abundant osteiod & cartilage present, cystic degeneration
  13. 13. osteosarcoma of upper end of tibia
  14. 14. Osteosarcoma- Femur
  15. 15. • Tumor cells have large hyperchromatic nuclei , bizarre tumor giant cells • Formation of bone by tumor cells- lace like architecture , deposited in broad sheets or primitive trabeculae
  16. 16. Osteosarcoma
  17. 17. Clincal course• Painful & progressively enlarging mass • Sudden fracture • X – ray –large destructive , mixed lytic & blastic mass with permeative margins • Breaks through cortex , lifts periosteum – reactive periosteal bone formation
  18. 18. • Codman’s triangle • Chemotherapy & limb salvage therapy
  19. 19. Parosteal / Juxtacortical osteosarcoma • Uncommon, better prognosis • Older age grp • Lower end of femur, upper end of humerus
  20. 20. MISCELLANEOUS TUMORS Ewing sarcoma • 10 -15 yrs, highly malignant • Shafts & metaphysis of long bones • Arise in medullary cavity , invades cortex & periosteum producing soft tissue mass • Tan with areas of hemorrhage & necrosis
  21. 21. • Sheets of uniform small , round cells with scant cytoplasm • Homer- Wright rosettes – around bld vessels • Painful enlarging mass
  22. 22. Ewing sarcoma
  23. 23. Ewing sarcoma
  24. 24. • Plain x- ray – destructive lytic tumor with permeative margins • Periosteal reaction produces layers of reactive bone deposited in onion-skin fashion • Treatment chemotherapy & surgery
  25. 25. Giant cell tumor • Osteoclastoma • Benign but locally aggressive neoplasm • 20-40yrs • Monocyte macrophage lineage
  26. 26. Morphology• Large red brown , undergo cystic degeneration • Uniform oval mononuclear cells with indistinct cell membrane , grow in syncytium
  27. 27. • Scattered within background are numerous osteoclast type giant cells • Necrosis , hemorrhage , hemosiderin deposition , reactive bone formation
  28. 28. Osteoclastoma
  29. 29. Osteoclastoma
  30. 30. • Involves epiphysis & metaphyses • Arise around knee , solitary • Arthritic symptoms • X – ray – large purely lytic , eccentric & erode into subchondral plate , overlying cortex destroyed
  31. 31. Giant cell tumor - MRI
  32. 32. THANK YOU

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