BONE TUMOURS
DR Valentine Mandizvidza
BONE TUMOURS
1. Benign tumours
2. Malignant tumours
Further classified as
1.Primary
2.Secondary
Bone Tumours
Further classified according to tissue of origin
- bone-forming(osteogenic)
- cartilage-forming (chondrogenic)
- fibrous (fibrogenic)
-vascular
Role of Imaging
1. Detection
2. Diagnosis
3. Surgical staging
4. follow-up
Imaging
40-50% trabecular bone distraction before an
area of lucency is demonstrated
Cortical destruction is far more easily seen
Difficult to detect in areas such as the spine and
pelvis
DIAGNOSIS OF BONE TUMOURS
Clinical History and Examination
Used in conjuction with radiographic findings to
come up with differential diagnoses
Clinical History and Examination
Age
Previous medical history
Family history
– Ollier’s disease (multiple enchondromas)
Ethnic/ geographic origin
– KS(HIV), Burkitt’s lymphoma(tropical Africa)
AGE
AGE
Radiographic Assessment
1. Site in skeleton WHICH BONE IS AFFECTED?
2. Location in bone WHERE IN THE BONE IS THE LESION?
– OS (metaphysis or metadiaphysis
– ES (metaphysis or diaphysis)
– Epiphyseal lesion in a child (chondroblastoma, langerhans cell histiocytosis,
abcess)
3. Pattern of bone destruction
WHAT IS THE TUMOUR DOING
TO THE BONE?
4. Periosteal reaction WHAT FORM IF ANY IS PRESENT?
5. Matrix WHAT TYPE OF MATRIX MINERALIZATION?
Radiographic Assessment
PATTERN OF BONE DESTRUCTION
• Fast/ Slow growth
• Permeative or moth eaten/ well defined
margins
Lytic, expansile & well defined ABC
Radiographic Assessment
Radiographic
Assessment
PERIOSTEAL REACTION
Shell
Lamellar
Interrupted
Combined
Radiographic Assessment
Radiographic Assessment
MATRIX
Osteiod, cloud to ivory-like
Cartilage is stippled, popcorn in appearance
Enneking Classification of Benign Bone
Tumours
STAGE
DESCRIPTION
TUMOUR EXAMPLES
1
Inactive
NOF, Enchondroma
2
Active
GCT, ABC, UBC,
Chondroblastoma
3
Aggressive
GCT, ABC
Enneking Classification of Malignant
Bone Tumors
Stage
Description
IA
Low grade, intracompartmental
IB
Low grade, extracompartmental
II A
High grade, intracompartmental
II B
High grade extracompartmental
III
Metastatic disease
American Joint Commission for Cancer
(AJCC)
Classification System for Bone
Tumours
Stage
Grade
Size of Tumour
Regional
Nodes
Metaatasis
IA
G1-G2
T1
N0
M0
IB
G1-G2
T2
N0
M0
II A
G3-G4
T1
N0
M0
II B
G3-G4
T2
N0
M0
III
Any
T3
N0
M0
IV A
Any
Any
N1
M0
IV B
Any
Any
Any Nodal
Status
M1
Dahlin Modification of Lichtenstein Classification System
Cell Type
Benign
Malignant
Bone
Osteoid osteoma, osteoblastoma
Osteosarcoma
Cartilage
Enchondroma, osteochondroma,
chondrosarcoma,
chondroblastoma, chondromyxoid
fibroma, periosteal chondroma
Fibrous
Nonossifying fibroma
Fibrosarcoma, Malignant fibrous
histiocytoma
Vascular
Hemangioma
Hemangioendothelioma,
Hemangiopericytoma
hematopoietic
Myeloma
lymphoma
Nerve
neurilemmoma
Malignant peripheral nervesheath tumor
Lipogenic
lipoma
liposarcoma
Notochordal
Notochordal rest
chordoma
Unknown
Giant cell tumor, ABC,SBC
Ewing sarcoma, Adamantinoma
BENIGN BONE TUMOURS
ABC
SBC
GCT
BENIGN BONE TUMOURS
OSTEOCHONDROMA
ENCHONDROMA
Malignant bone forming tumours
OSTEOSARCOMA
.
CHONDROSARCOMA
EWING’S SARCOMA
MULTIPLE MYELOMA
METASTATIC BONE DISEASE
OSTEOLYTIC
OSTEOBLASTIC
MIXED (osteolytic/osteoblastic)
Lung
Prostate
Breast
Thyroid
Bladder
Kidney
Gastrointestinal
breast
lung
prostate
Tumours occurring in the vertebrae
Anterior (vertebral Body)
Posterior elements
Giant cell tumour
Osteoid osteoma
Metastatic disease
Osteoblastoma
Multiple myeloma
Aneurysmal bone cyst
Ependymoma
Chordoma
Lymphoma
Primary bone tumours (chondrosarcoma, osteosarcoma)