Scribd
Upload
160 views41 pages

Bone Tumor

Tumors of Bone can be benign or malignant. Most bone tumors are benign and occur in patients under 30 years old. A new bone tumor in an elderly patient is more likely to be malignant. The most common benign bone lesions are enchondromas while the most common primary malignant bone tumor is osteosarcoma. Imaging such as x-rays, CT, and MRI are important for determining the location, extent, and aggressiveness of bone tumors to help reach an accurate diagnosis and staging. A tissue biopsy is usually required for a definitive diagnosis.

Uploaded by

Zarna_Mehta_348
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
160 views41 pages

Bone Tumor

Tumors of Bone can be benign or malignant. Most bone tumors are benign and occur in patients under 30 years old. A new bone tumor in an elderly patient is more likely to be malignant. The most common benign bone lesions are enchondromas while the most common primary malignant bone tumor is osteosarcoma. Imaging such as x-rays, CT, and MRI are important for determining the location, extent, and aggressiveness of bone tumors to help reach an accurate diagnosis and staging. A tissue biopsy is usually required for a definitive diagnosis.

Uploaded by

Zarna_Mehta_348
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 41

Tumors of Bone

Patrick Henderson, M-IV


USCSOM
August 28, 2007
Intro
 Bone tumors are very diverse in morphology and
biological potential (can be no big deal or rapidly fatal)
 MOST bone tumors are benign lesions
 Most benign lesions are seen <30 years of age
 A new bone tumor in the elderly is more likely to be
malignant
 No bone is safe (though most primaries are in long
bones)
 Locale in the bone gives important Dx info
 More common benign lesions typically present as
incidental findings (non-painful, stable size)
 Be cautious with painful lesions and those that grow
relatively fast (over weeks or months)
 Pathological fracture can be the first sign of tumor
 Bone neoplasms are very difficult to diagnose
specifically on radiologic testing alone
 So why is radiology important?
 Exact location of lesion
 Extent of growth/metastasis
 Aggressiveness

 Best test for Dx= X-ray


 Best test for staging= CT or MRI
 Quick shout out to the pathologists– histologic
grade is the most important prognostic feature
of bone sarcomas and essential for staging
most of the bone tumor types.
Cases
Find the lesion

Example:
Cases
Find the lesion

Example:

RIGHT THERE!
Case I
 16 yr old white male with pain in his left upper
arm.
 Mild swelling and tenderness
 Pain progressively getting worse for ~ 3 months

 Recent onset of mild fever


Imaging:
Imaging:

**
Biopsy material showed a highly cellular, infiltrative neoplasm
consisting of sheets of tightly packed, round cells with very scant
cytoplasm ("round blue cell tumor"). Occasional Homer-Wright rosettes
Dx: Ewing’s Sarcoma (or PNET)
 #2 primary bone malignancy in kids (5-15 is
most common age group
 Much more common in Caucasians
 Typically in the diaphysis of long tubular
bones or in large flat bone
 Lytic tumor w/ permeative margins extending
into the soft tissue
 Periostial rxn creates sheets of reactive bone in
an onion-skin fashion
Another most excellent
example of “onion-
skinning”
Case II
 33 yr old black female with sudden severe
hand pain after very minor trauma.
 Completely healthy otherwise.
 All labs normal
Dx: Enchondroma
 Benign cartilagenous tumors but hard to
distinguish from a low grade chondrosarcoma
 Acral bones-- the most common primary hand
tumor
 Usually solitary, usually incidental finding
(non-painful unless associated with fracture)
 Get hand films and look for dec. lucency but
not so much as a cyst (more ground-glass) w/
or w/o areas of stippled calcifications or rings
For boards and wards:
 Multiple enchondromas = ____________
 Multiple enchondromas + hemanigiomas of
soft tissue = _____________
For boards and wards:

 Multiple enchondromas = Ollier’s Dz


 Multiple enchondromas + hemangiomas of
soft tissue = Maffucci syndrome
Case III
 50 yr old white male with back pain
 Mainly lower spine/sacral pain, progressive ~ 8
months
 New onset rectal pain and constipation
CT guided FNA confirmed…
Dx: Chordoma
 Arises from notochord remnants. Thus is
typically midline along the spine and usually
at the ends (Sacrococc or occ/cervical jxn)
 Males>Females, middle age
 + staining w/ S-100 and epithelial markers
 Locally invasive until very late in disease
where mets can go to the lungs, LN, skin.
Case IV
 21 yr old male with new onset chest pain
today, worse on inhalation.
 ROS significant for an ongoing aching leg pain for
the past 6 months which he has put off seeing a
doctor for.
Dx: The dreaded Osteosarcoma
 #1 primary bone malignancy
 Associated with RB1 and p53 gene mutations
 1000x greater risk w/ Hx of hereditary retinoblastoma
 Member of the Li-Fraumeni Syndrome family

 Bimodal age spike: young and elderly


 75% <age 20
 Osteosarcoma in elderly usually from predisposing
mechanism (secondary)
 Paget Dz, bone infarcts, history of radiation, etc

 Most patients die from pulmonary complications


after metastatic seeding of the lungs (ex:
pneumothorax)
 Metaphysial tumor
 60% at the knee (distal femur or prox tibia)
 Radiographic terms to know:
 Codman’s Triangle:

 “Sunburst” periostial formation:


 AKA “Hair on end”
For the future Surgeons:
 Rotationplasty is a new solution to disfiguring
surgical resections of lower limb sarcomas:
Quick Hits:

Gout
Incidental
finding on
knee xray

Fabella = posterior sesmoids or


little confused knee caps
13 yr old
boy with
superior
tibial pain,
r/o neoplasm
w/ xray
shows:

Osgood Schlatter
Metastatic Disease
 Most common malignant lesion of bone
 Bone is # 3 on the list of favorite places for mobile
cancers to go
 Malignant lesions are more likely to be in axial bones
 Typically multifocal BUT renal and thyroid
carcinomas are notorious for producing only a
solitary lesion
 Can be lytic, blastic, or both:
 Lung is Lytic, Prostate Produces, Breast does Both
Mets (cont)
 Adults  Kids
 Lung  NB
 Prostate  Wilm’s
 Breast  OS
 Kidney  Ewing’s
 Rhabdomyosarcoma
The End

Thanks for your attention and good luck


on applications!
Bibliography
 Robbin’s and Cotran, Pathological Basis of Disease, 7th Edition
 MD Murphey, MR Robbin, GA McRae, DJ Flemming, HT Temple, and
MJ Kransdorf
The Many Faces of Osteosarcoma
RadioGraphics 1997; 17: 1205
 William R. Reinus, Louis A. Gilula IESS Committee
Radiology of Ewing's sarcoma: Intergroup Ewing's Sarcoma Study
(IESS)
RadioGraphics 1984; 4: 929-944.

 Washington Univ. in St. Louis (website)


 Harvard Medical School (website)
 Learning Radiology.com (website… duh)
 Bonetumor.org (You’re not even reading this are you?)

You might also like