- Most bone tumors are benign and asymptomatic, though some cause pain or are detected as masses. Malignant bone tumors are rare but include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. - Osteosarcoma most commonly affects teenagers and young adults, usually in the long bones, and presents as pain or a swelling mass. Treatment involves chemotherapy and surgery. - Chondrosarcoma forms cartilage and most often affects older adults, usually in the skull, jaw, or collarbone. Surgery is the main treatment. - Ewing's sarcoma typically affects children and young adults, usually in long bones, and presents as intermittent pain and swelling. Chem

1. BONE TUMORS
Prepared by Marwan
Nassar

2. CONTENTS
* Introduction
* Classification
* Clinical presentation
* Benign tumors of bone
* Malignant tumors of bone
* Manegmaent
* Conclusion

3. INTRODUCTION
refers to a neoplastic abnormal growth of tissue in bone. It
can be either benign or malignant.
Most bone tumors are benign.
Bone tumors may be classified as:
• primary tumors- malignancy is very rare Commonest primary
bone tumor is multiple myeloma =plasmacytoma , second
osteosarcoma.
• <3rd decade.
• secondary tumors - e.g. Thyroid * Breast * Bronchus * Kidney *
Prostate
• >3rd decade.
Commonest bone tumour is secondaries

4. CLASSIFICATIONS
based on histologic criteria, particularly on the type of
differentiation shown by tumor cells
-metastasis
lymphoma ,MM
-haemopoietic:
-osteogenic
-chondrogenic
-Marrow Ewing
,Giant-cell ,, Vascular , Other connective tissue
tumours

6. CLINICAL
PRESENTATION
Clinically, bone tumors present in various ways.
The more common benign lesions are:
• frequently asymptomatic and are detected as
incidental findings.
• localized pain or are noticed as a slow-growing
mass.
• Sometimes, the first hint of a tumor's presence is a
sudden pathologic fracture.

7. SECONDARY TUMORS
*Spine is the third most common site for Mets
* Liver > Lung > Spine “batson venous”
*10% are symptomatic
*most sites :spine, proximal humerus ,proximal femor
*Lytic
vascular MM
by the release of osteoclastogenic agents
*Sclerotic
e.g. prostate/ release of factors that stimulate osteoblast
proliferation, differentiation
*Mixed
May occur in very aggressive destructive with no healing

9. TREATMENT
*palliative in nature
to prevent further progression and metastasis *and inhibit
pathologic fracture, pain or hypercalcemia.
*individual lesions are surgically excised
*bisphosphonates has shown a decrease in bone resorption
*bone-targeted therapies, such as denosumab.

10. PRIMARY BENIGN
BONE TUMERS
Osteoid Osteoma
Osteoblastoma
OSTEOCHONDROMA
Chondroblastoma
Fibrous dysplasia
Simple bone cyst
Giant cell
Enchondroma

11. OSTEOGENIC
*Osteoid osteoma :small painful produce dense
cortical reaction
*osteoblastoma :larger and more aggressive
than osteoid osteoma
*osteosarcoma :malignant most common in lower femur and
upper tibia

12. OSTEOID OSTEOMA
Benign bone forming tumor small but very painful
It has a center of growing cells, called a nidus =vascularized tumer(less
than 1 cm) surrounded by a hard shell of reactive thickened bone.
Clinical Features.
• Age: young persons 20-30y
• Sex: males:female - 3:1.
• Site: Frequently in the femur or in the tibia.
• In head and neck→ Cervical spine > mandible and maxilla.
• Chief symptoms → severe pain → unrelenting and sharp, worse at night.
• Classically, the pain is relieved by aspirin.

14. Treatment:
• is surgically cutting out of the entire
tumor, particularly the central core, for a
good outcome

15. OSTEOBLASTOMA (GIANT OSTEOID
OSTEOMA)
• Osteoblastoma accounts →1% of primary bone tumors.
• It is typically a slow-growing, benign bone tumor.
Clinical Features
• Age: in young persons, 20-30 years.
• Sex: Males>Females.
• C/P: characterized clinically by pain and swelling. pain →
more generalized and less likely relieved by salicylates.
• Most common site → vertebral column. • Mandible >
Maxilla • Occurs in Periosteal, cortical, or medullary location

17. OSTEOCHONDROMA
One of the commonest tumor of bone (45% of all benign)
It is developmental lesion which is an outgrowth of the growth plate
and is made up of both bone and cartilage (cartilage-capped bone).
*Can be simple or multiple
• Occurs frequently in the metaphyseal region of the long bones
• Osteochondroma can eventually transform into a chondrosarcoma
in 1–3%

18. Etiology: theories Developmental, Reparative, and Traumatic
Radiation-induced osteochondroma Stress

19. CLINICAL FEATURES
• Age- 13-78 years
• Sex: females> males
• Site: coronoid process and the mandibular condyle are the
affected.
• slow growing.

20. The most common symptom of an osteochondroma is
a painless mass near the joints
An osteochondroma ordinarily stops growing when a
person reaches full normal growth any further
enlargment is suggestive of malignant change.
Treatment:
• Usually no treatment is required.
• Surgical Excision, if causes pain or put pressure in the
nerve or blood vessels.

21. Clinical presentation: • facial asymmetry, malocclusion, cross-bite on contra-
lateral side and lateral open-bite on the affected side, deviation on opening,
hypomobility, pain and clicking

23. ENCHONDROMA
plate remnants that are not resorbed and either persist or begin to grow
in the medullary canal on the metaphyseal side of the growth plate.
benign Cartilaginous islands growth In medullary cavity.
about 10% of benign osseous tumors,
It is very common and often occure in the small bone of the
hand and feet. Others femur, humerus, ribs.
Appear inside of the bone.
Usually begin and grow in childhood, then stop growing but
remain through adulthood.(10-20 age)

24. Can be single or multiple
Symptoms:
• Usually painless.
• But can causes enlarged fingers, pathologic
fracture or deformities.
X-ray finding:
• Dark hole in bone, but usually they have
calcification or white spot in the hole.

27. Treatment:
• No treatment is required for asymptomatic lesions.
• If fracture occurs, it is usually treated with scraping out
and filling of the cavity with bone grafting.
Risk of transformation:
• < 2% will transform to chondrosarcoma.
• pain without pathological fracture.

28. CHONDROBLASTOMA
It is rare type of benign tumor.
Genatic /signaling problem
It is appear in epiphysis usually in proximal humrus, femur or tibia.
Presenting with aching & tenderness adjacent joint. Fluid buildup
and affect motion
most chondroblastomas are small, well-marginated lesions, a small
subset of chondroblastomas behave in a much more aggressive
fashion. Some nonetheless become very large or have the capability
of metastasizing to the lungs and soft tissues.

30. TREATMENT
It requires surgery by scraping out and filling of
the cavity with bone grafting .

31. FIBROUS DYSPLASIA
Replacement of the medullary bone with fibrous tissue
and woven bone .
bone that is weak and prone to expansion. As a result,
most complications result from fracture, deformity,
functional impairment and pain.
Disease occurs along a broad clinical spectrum
ranging from asymptomatic, incidental lesions to
severe disabling disease.
It can affect one bone (monostotic) or many bones
(polystotic) .

32. Gsα signaling mutation results in impaired differentiation and
proliferation of bone stromal cells .
Fibrous dysplasia leads to bone weakness so
it can cause angulation bent of the bone
(shepherd’s crook deformity)

33. SIMPLE BONE CYST
Theory :venous obstruction within the bone appears to be a
likely cause of such simple bone cysts.
A unicameral bone cyst is a cavity found
within a bone that is filled with straw-
colored fluid. No wall
Appears during childhood typically in the
metaphysis.
Presentation pathologic fracture

34. Aneurismal type can arise secondarily within a pre-existing bone tumor, because the
abnormal bone causes changes in hemodynamics

35. GIANT CELL TUMOR
OF BONE
is a very rare, aggressive benign tumor. It
generally occurs in between the ages of 20
and 40 years.
very rarely seen in children or in adults older
than 65 years of age.
is formed by fusion of several individual giant
cells into a single, larger complex cystic.

36. Localized pain.
Pain increase with movement, decrease
with rest but it progressively increase
with time
Treatment:
Radiation therapy or curettage surgery

38. SUMMARY
-Most of benign tumors are a symptomatic & an
incidental diagnosed.
-No treatment required for benign tumor except when it
cause pain or can damage epiphysis.
-Some of benign tumor can transform to malignant, the
most important symptom for transforming is pain
without pathological fracture.

39. MALIGNANT TUMORS
OSTEOSARCOMA
CHONDROSARCOMA
EWINGS SARCOMA
Multiple Myeloma

40. OSTEOSARCOMA /
OSTEOGENIC SARCOMA
• Osteosarcoma is the third most common cancer in
adolescence, occurring less frequently than only lymphomas
and brain tumors.
• It is thought to arise from a primitive mesenchymal bone
forming cell and is characterized by production of osteoid

41. ETIOLOGY
• Radiation History : 2% of osteosarcomas.
• pre-existing benign bone disorders –bone dysplasia,
fibrous dysplasia, Pagets disease
• Viral origin40
• Genetic predisposition
Rb, p53, SAS (sarcoma amplified sequence)
• Syndromes – Li-Fraumeni syndrome - Rothmund-
Thompson syndrome

42. CLASSIFICATION OF
OSTEOSARCOMA
Primary osteosarcomas :
* Osteoblastic (50%) *Chondroblastic (25%) * Fibroblastic
(25%)
• Secondary osteosarcomas
*Paget’s disease and after radiation exposure.

43. CLINICAL FEATURES
• Sex- M>F • Age – 3 rd and 4th decade
• Site - metaphysial growth plates of extremities of long
bones
• femur>tibia>humerus>skull or jaw>pelvis
*C/P:
Painless or painful bony swelling
• Facial deformity, loose teeth, toothache,
• Numbness & limited mouth opening
• Suppuration

44. TREATMENT
• Long bone involvement→ amputation is a prime requisite.
• Radical resection
• neoadjuvent chemotherapy →facilitate subsequent surgical
removal by shrinking the tumor.
• Adjuvant chemotherapy in combination with surgery,
including resection of pulmonary metastases, has appeared
to offer promise of increased survival from this disease
• Overall 5 years survival – 63%

45. CHONDROSARCOMA
• Chondrosarcoma is a malignant tumor characterized by the
formation of cartilage.
• Comprise about 10% of all primary tumors
Types:
• Primary: arise directly from the cartilage
• Secondary: develop in a pre-existing benign cartilaginous
tumor.
→ lobular, blue-gray to gray-white,
translucent, glistening surface

46. CLINICAL FEATURES
• Age: 6th - 7 th decade
• No significant sex predilection
• Site: In head and neck→ maxilla, mandible, base of the
skull, cervical vertebrae, nasal cavity and nasal septum.
• c/p: painless mass or swelling, loosening of teeth.
• Maxillary tumors may cause nasal obstruction, congestion ,
epistaxis, photophobia, or visual loss.

47. TREATMENT AND
PROGNOSIS
• Prognosis in chondrosarcoma depends primarily on the
ability to adequately excise the tumor
• Radical surgical excision.
• Radiation and chemotherapy are less effective
• 5-year survival rate →43% to 95 %

48. EWINGS SARCOMA
• Ewing’s sarcoma is a sarcoma of the bone.
• uncommonly involve the head and neck
• Incidence →1-3 cases per million of population per year.
• James Ewing (1866–1943) first described the tumor
Pathogenesis
• Balanced t(11:22) (q24;q12) chromosomal translocation-
85%
Dysregulated signaling of receptor tyrosine kinase. • Altered
pathways of RB and p53

49. CLINICAL FEATURES
• Age: children and young adults, 5-25 years,
• Male: female= 2:1
• uncommon in blacks.
• Site: long bones of the extremities, In head and neck region, It
involves skull, clavicle, maxilla and mandible. Mandible ˃ maxilla.
• Earliest sign: Pain, usually of an intermittent nature, and Swelling of
the involved bone
• Facial neuralgia and lip paresthesia
• Jaw swelling
• Ulcerated intraoral mass
• Low -grade fever
• Elevated WBC
• Extraskeletal form- Ewing’s Sarcoma of soft tissue. ‘onion skin’
appearance

50. Onion apperance

51. TREATMENT AND
PROGNOSIS
• Chemotherapy
• Radiation therapy
• Surgery
• Five-year survival with a combination of surgery and
chemotherapy is 74%.

52. MULTIPLE MYELOMA
• Most common primary neoplasm of the skeletal system.
• Malignancy of plasma cells.
• Underlying pathology → Expansion of a single line of
plasma cells that replace normal bone marrow and produce
monoclonal immunoglobulins.
• Diffuse disease of the bone marrow.
Etiology
• Radiation exposure
• Occupational exposure • Chemical exposure • Frequent
aberrations of chromosomes 1 and 14 • Mutations of the ras
oncogene and p53 gene mutations • Interleukin-6 (IL-6

53. CLINICAL
PRESENTATION
• Age: 60-65 years
• Sex: males> females
• More common among black people
• Site: mandible> maxilla
• Number of lytic foci or diffuse demineralization.
• Anemia, azotemia, hypercalcemia, recurrent infection.
• Extramedullary plasmacytoma- tonsils, nasopharynx, or
paranasal sinuses

54. TREATMENT AND
PROGNOSIS.
• Bisphosphonate therapy → reduction of osteoclastic
activity and bone mineralization maintenance.
• Chemotherapy • Extramedullary plasmacytoma → radiation
therapy
• Infection, anemia and kidney failure are the most common
immediate causes of death

56. Signs and
symptoms
biobsy
Staging Treatment

58. Thank you