2. Chondrosarcoma
• In this condition cartilage cells predominate. A
true chondrosarcoma affects people between the
ages of 35 and 50 years.
• It may arise in any bone with a predilection
towards the flat bones, such as ilium and ribs etc.
• The presenting symptom is again a constant ache
with a swelling which has very recently increased
in size.
• X-ray appearances are variable but mostly
osteolytic.
• This tumour is slightly less malignant than the
previous one.
• It also metastasises mainly through blood vessels.
3.
4. Fibrosarcoma
• This tumour contains spindle-shaped fibroblasts.
• It may originate in the medullary cavity or
periosteally (when it is called periosteal
fibrosarcoma).
• The patients are usually 30 to 50 years of age and
present with pain, swelling and even pathological
fractures.
• X-ray shows an osteolytic lesion which may be
surrounded by reactive sub-periosteal new bone.
• This also produces blood-borne pulmonary
metastasis.
5.
6. Synovial-sarcoma
• This condition may affect individual of any age.
• This tumour usually arises close to a major joint
either the knee or the ankle or the wrist.
• But it may occasionally occur in connective tissue
or muscle. Metastasis occurs by blood, the
lymphatics and by migration of cells through the
tissue planes.
• Microscopically it is a tumour, composed of both
synovial cells and malignant fibroblasts.
• This tumour is extremely malignant.
7.
8. Ewing’s tumour
• This tumour arises from the reticulum cells of
the medullary cavity of the diaphysis of the
long bones.
• The tumour gradually lifts the periosteum,
which appears to resist the spread of the
tumour and may lay down layers of bone
formation giving rise to an onion-like
appearance in X-ray.
• Distant spread is mainly via the blood streams
to the lungs also to other bones.
• Lymphatic spread is rare.
9. • The tumour mainly affects the young between 10 and
20 years of age.
• Long bones are mainly affected of which the tibia is the
commonest.
• The patients present with the pain, which is of
throbbing nature and becomes worse at night.
• A history of trauma may be present.
• The patient is sometimes ill with fever which makes
this tumour so often mistaken for osteomyelitis.
• The swelling is warm and tender and has an ill-defined
margin. X-ray appearances are a rarefied area in the
medulla, the cortex may be perforated and there may
be the onion layers of calcification.
• That the tumour melts by radiotherapy as the snow in
sun-shine is the pathognomonic feature of this
condition.
10.
11. Multiple myeloma
• The tumour arises from the plasma cells of the
bone marrow.
• The tumours are found wherever there is red
marrow in the bone e.g. the skull, the trunk
bones and the ends of the longs bones.
• The tumour is usually multiple.
12. • Mostly individuals between 45 to 65 years of
age are affected.
• The patients present with bone pain, which is
root pain from collapse of a vertebra and
occasionally nephritis contribute to the
general ill-health of the patient.
• X-ray shows multiple small areas of rarefaction
in the affected bones which are usually
osteoporotic.
13.
14.
15. Special investigations
• Special investigations of the urine will show the
presence of Bence Jones protein in 50% of cases.
• Electrophoretic analysis of the plasma and urine will
show presence of excessive protein mostly albumin.
• Sternal marrow puncture will reveal typical myeloma
cells. High erythrocyte sedimentation rate is also a
feature of this condition.
• As the disease advances, general lymphadenopathy
together with enlargement of the liver and spleen and
bleeding tendency with epistaxis, haemoptysis or
haematemesis may be found.
16. Plasma cytoma
• This is an example of solitary myeloma.
• The patient presents with pain, swelling or a
pathological fracture.
• Radiologically an area of translucency at the
tumour site may be observed.
17.
18.
19. Secondary carcinoma of bone
• Bony metastasis mainly occur by blood streams
and the primary sites are mainly the thyroid,
breast, the prostate, kidney, bronchus, uterus, G.
I. tract and testis.
• About 2/3rd of cases of secondary bone deposits,
the primary is seen either in the breast or in the
prostate.
• The bones, commonly affected, are the
vertebrae, ribs, sternum, pelvis and upper ends of
the humerus and femur. The patients are usually
more than 40 years of age.
20. • The patients present either with mild bony
pain, backache or root pain or even
pathological fracture.
• X-ray may show either osteolytic (when the
primary carcinoma is in any viscus other than
prostate) or osteoblastic (when the primary
carcinoma is in the prostate) lesion.
• Bone scan shows the metastatic lesion much
earlier than the skiagraphy.
