Bone
tumors
Contents of This Template
Here’s what you’ll find in this presentation:
1. Bone tumors and its classification.
2. Osteogenic, Chondrogenic, Undefined bone tumors
3. Investigation of a suspicous bony lesion.
4. Management of primary bone tumors
Introduction
Bone tumors develop when
cells within a bone divide
uncontrollably, forming a lump
or mass of abnormal tissue.
Understanding bone tumors
• early detection
• accurate diagnosis
• effective treatment
Classification
Benign
Bone
Primary
tumors
Malignant
Secondary
(Metastatic)
WHO classification of bone tumors
Most common primary
malignant tumor of bone
after excluding multiple
myeloma
2nd most common bone
sarcoma in children
Osteogenic tumors
• Produce unmineralized osteoid or under-mineralized woven bone
• Can be categorized as follows
Bone forming
tumors
Benign Malignant
Osteoid
Osteosarcoma
osteoma
Osteoblastoma
Osteoid osteoma Osteoblastoma
Similar histology
Differs clinically and
radiographically
Osteoid osteoma Osteoblastoma
<2cm in size >2cm in size(larger)
Pain is responsive to aspirin Pain is unresponsive to aspirin
(NSAIDS)
Occur in young patients(above 5 and Commonly seen in teenagers and
below 30) children
Predilection for the long Predilection for the spine
bones(particularly the femur)
Osteosarcoma
Most common primary malignant
bone tumor. (after excluding
hemopoietic tumors->Myeloma)
They may present as painful,
progressively enlarging mass.
Sometimes pathological fracture is
the first indication
Bimodal age distribution(
Osteosarcoma cont.
Two types
• Primary (arising de nova)
• Secondary -> Arising in abnormal
bone (previous irradiation,
paget’s disease, fibrous
dysplasia, bone infarcts, chronic
osteomyelitis)
Osteosarcoma cont.
X ray
• Codman’s triangle → Elevation of
periosteum
• Sunburst appearance → New
bone formation
Osteosarcoma cont.
Chondrogenic tumors
• These tumors are characterized by the formation of hyaline cartilage. Benign cartilaginous
tumors are much more common than malignant ones.
Cartilage forming
tumors
Benign Malignant
Chondroma
Chondrosarcoma
Osteochondroma
Chondroblastoma
Chondromyxoid
fibroma
Osteochondroma
• Known as exostosis.
• Benign cartilage-capped tumor that is attached to the underlying skeleton by a bony stalk
Osteochondroma
• Known as exostosis.
• Benign cartilage-capped tumor that is attached to the underlying skeleton by a bony stalk
Osteochondroma
• Osteochondromas tend to grow with skeletal maturity and stop once growth
stops.
Osteochondroma
• Solitary / Multiple
• Usually arise from the metaphysis
• Mushroom shaped
• Rarely gives rise to Chondrosarcomas
Chondroma
• Benign tumors of hyaline cartilage that usually occur in bones of
endochondral origin.
• 2 types
Enchondroma → Arise within the medullary cavity
Juxtacortical chondroma→ On the cortical surface
Enchondroma
• Intramedullary neoplasm
• Commonest location
Tubular bones of the hand
Femur
Humerus
• Multiple enchondromas occur in Ollier disease and Maffucci syndrome.
Enchondroma
• Intramedullary neoplasm
• Commonest location
Tubular bones of the hand
Femur
Humerus
• Multiple enchondromas occur in Ollier disease and Maffucci syndrome.
Juxtacortical chondroma(periosteal chondroma)
• Rare benign neoplasm occurring at the surface of the bone.
• Commonly present with pain and occasionally palpable lump
Chondrosarcoma
Malignant tumor that produces
cartilage.
2nd most common primary malignant
bone tumors after osteosarcoma
Tumors of adulthood and old age>50
years
• Arises de novo or from a precursor
lesion like chondromatosis, or
exostosis
• Sites – commonly arise in the axial
skeleton, especially pelvis and ribs
Undefined tumors
Undefined
tumors
Aneurysmal bony
Giant cell tumor Ewing sarcoma cyst
Giant cell tumor(osteoclastoma)
• Benign, but locally aggressive X ray :Eccentric
osteolytic lesion
neoplasm (according to WHO involving epiphysis
intermediate) and adjacent
metaphysis.
• Tend to recur after excision (SOAP BUBBLE)
• Rarely, malignant behavior
• 20% of benign primary bone
tumors
• Peak age 25 – 45 years
•Typically affects ends of long
bones.
Ewing sarcoma
Believed to be arise from
mesenchymal stem cells in the bone
marrow.
2nd most common sarcoma after
osteosarcoma in children.
Common in adolescents(10-20 years)
This clinically mimics Osteomyelitis
High ESR
Low grade fever
Ewing sarcoma
Characteristic periosteal reaction
produces layers of reactive bone
deposited in an ONION skin Fashion
Investigating a suspicious lesion
Biopsy
History Examination Radiography & other
tests
Parameters affecting the diagnosis of bone
tumors
• Age of the patient
• Type of the bone involved
• Long bones / flat bones / short bones
• Site of the bone
• Epiphysis / Metaphysis / Diaphysis
• Medullary / cortical /periosteal
• Radiological appearance
• Microscopy with adequate sampling of the specimen
Clinical presentation of bone tumors
• Pain
Night pain
Not responding to analgesia
• Pathological fracture
has been reported in osteosarcomas and
chondrosarcomas
• Swelling & Tenderness over the affected bone
X rays
All patients with the suspicion of a lesion of
bone should be investigated with plain X rays
When assessing a suspicious lesion on X ray
there are a number of questions that should be
asked
X- rays
Some tumors also have some classic X-ray findings
ONION skin Fashion Codman’s triangle Soap bubble
& sunburst appearance
appearance
CT
➢ Ct scan extends the range
of X-ray diagnosis.
(because reconstruct an
3D image)
➢ Shows both intraosseous
and extraosseous
extension of the tumor and
the relationship to
surrounding structures
➢ Ct is essential to staging in
bone and soft tissue
sarcomas.
MRI
•Allows further characterization of lesion and
defines the local extension of the lesion.
•It is very useful in the assessment of Tumor
spread within the bone , into the nearby joint ,
into the soft tissues.
•It may demonstrate certain features
consistent within certain lesions.
Biopsy
• GOLD STANDARD for Diagnosis of abnormal lesion in bone
However
Q→ Imaging should be performed before the biopsy?
Tissue disruption make radiological assessment more difficult.
• In biopsy these principles should be followed
Management of primary bone tumors
• Management of bone sarcomas carried out by
a MULTIDISCIPLINARY TEAM including
clinicians, pathologists, radiologists and
oncologist together
• Management depends on tumor type, stage
and grade and patient preferences.
• Treatment options for Malignant
1. Surgery
2. Radiotherapy
3. Chemotherapy
• For Benign
1. Surgery
1.Surgery
• Earlier it was, amputation of the entire leg or
arm.
• But with the advancement of radiology and
other diagnostic methods limb salvage
surgery was possible.
• Preserve the limb function by replacing the
missing bony part with prosthetics or autograft
if possible.
2.Radiotherapy
• Radiotherapy is often used as adjunctive
therapy in primary bone cancers.
3.Chemotherapy
• Multiple chemotherapy agents are used in the
management of Primary bone cancers.
• They are used as Neoadjuvant or Adjuvant
therapies.
Thank you
