Bone tumours- presentation
 pain
 swelling
 pathologic fracture
General characteristics
 malignant primary bone tumours are
rare- in total only 6 mln population/
year
 although rare they are highly
aggressive
 all present with mechanical pain
followed later by sweling
 delays in diagnosis are common
X- Ray feature ssuggestive of bone
tumours include
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bone destruction
new bone formation
soft tissue swelling
periosteal elevation
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Metastases are blood-borne and
usually arise first in the lungs
Giant cell tumour (Osteoclastoma)
 young adults
 location: epiphysis (especially the
knee)
 X Ray: osteolytic and slowly
progressive
 although benign histologically they
may behave in a biologically malignant
way and metastases occur in 1%
 treatment: detailed and thorough
curettage
Ewing’s sarcoma
 children
 location: long bones ( typically
the diaphysis ) and limb girdles
 X Ray: large soft- tissue mass with
concentric layers of new bone
formation (“onion-peel” sign)
 t: 11-22 present
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 chemiotherapy, resection and limb
salvage surgery or radiotherapy cures
about half
 poor prognosis due to large volume or
metastatic disease at presentation
Osteosarcoma
 adolescents
 arises towards the end of long bones
(typically the knee) in the metaphysis
 secondary osteosarcomas may arise in
bone affected by Paget’s disease or
after irradiation
 X Ray: bone destruction or new bone
formation with periosteal elevation
 treatment: chemiotherapy followed by
surgical resection
 vigorous treatment of metastatic
disease is worthwhile
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Chondrosarcoma
 may arise de novo from malignant
transformation of chondromas
 middle age
 slowly icresing mass occasionally
causing pressure symptoms
 X Ray: “cotton wool” calcification
 treatment: only surgery- no response
to chemiotherapy, radiotherapy
 inadequate surgery=> not only local
recurrence but often a higher grade of
malignancy
Malignant fibrous histiocytoma
 rarest of all primary bone tumours
 middle age
 often the site of previous bone
abnormality (eg. bone infarcts)
 tratment: as for Osteosarcoma
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Chordomas
 arise from notochord remnants in the
spine
 most common in sacrum
 often large size before diagnosis
 may present with neurological signs
(bladder, bowels)
 treatment: radical surgical excision is
mandatory for cure
Osteoid osteoma
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males 10-25 years
most common in long bones
X ray: local cortical sclerosis
treatment: local excision
Chondroma
 cartilaginous tumour, may arise from
bone surfaces or within the medulla
(enchondromata)
 present with local swelling or fracture
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Osteochondroma (autosomal dominant)
 the commonest of benign tumours
 arises from the metaphyseal areas of
bone as rounded swelling
Both chondromata and
osteochondromata rarely
undergo malignant change so
treatment is rarely indicated.
Suspect malignancy if pain
develops!
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