1 / 80

Bone & Joint Tumors

Bone & Joint Tumors. Periostal reactions Response to RAPIDLY growing lesions. Spiculated "hair-on-end" Onion-skinning. Codman's triangle. Periostal reactions Response to SLOW growing lesions. focal cortical thickening. I. Cartilaginous Tumors Osteochondroma Solitary Enchondroma

celestek
Download Presentation

Bone & Joint Tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Bone & JointTumors

  2. Periostal reactionsResponse to RAPIDLY growing lesions • Spiculated "hair-on-end" • Onion-skinning

  3. Codman's triangle

  4. Periostal reactionsResponse to SLOW growing lesions focal cortical thickening

  5. I. Cartilaginous Tumors • Osteochondroma • Solitary Enchondroma • Chondrosarcoma

  6. Osteochondroma • Osteocartilaginous exostosis • Most common benign tumors or tumorlike lesions of bone, • In almost any bone preformed in cartilage, particularly long tubular bones, • Presents as a solitary cartilage-capped bony outgrowth protruding from the bone surface near the metaphysis.

  7. The most common location of an osteochondroma is in the region of the knee, • particularly the lower metaphysis of the femur or the upper metaphysis of the tibia. • occasionally in a flat bone • such as a rib, clavicle, ilium, or vertebra.

  8. Pathology • A sessile or stalked, cartilage-capped, bony protusion which extends from the metaphysial region • Microscopically • bony protusion • a cap of mature cartilage

  9. bony protusion • a cap of mature cartilage

  10. Solitary Enchondroma • Central Chondroma • Composed of mature hyaline cartilage • Develops in the medullary cavity of a single bone • Third to sixth decades of life • average age : between 30 and 40 years.

  11. The most common location is in the bones of the hand: • About one-third of all cases occur in the phalanges. • Sometimes: • the bones of the foot • long tubular bone (the humerus or femur) • pelvic bones • shoulder girdles.

  12. Radiology: • A central, or slightly eccentric, well-circumscribed or "bubbly" radiolucent lesion, • finely or densely stippled with calcification.

  13. Pathology: • Microscopically, small neoplastic cartilage cells with single small nuclei • May form lobules or facets • May be partially calcified

  14. - lobules or facets • - partially calcified

  15. Enchondromatosis (Ollier’s Disease)

  16. Chondrosarcoma • A malignant cartilaginous tumor • The third to sixth decades of life (average age of 45 years) • Slightly more common in males than females

  17. Chondrosarcoma may originate in the medullary cavity (central chondrosarcoma) • about 75% of cases or by malignant transformation of a preexisting enchondroma particularly in patients withenchondromatosis, • May originate in a juxtacortical location (peripheral chondrosarcoma) by sarcomatous change in the cartilage cap of an osteochondroma.

  18. Location: • flat bones of the pelvis • the large limb bones • femur  25% • humerus • the ribs

  19. Radiology: • Radiolucencies (irregular or circular or bubbly) • Calcification (granular or lobular radiopaque areas) • Destruction of the inner cortex, • Enlargement of bone contours, • Focal periosteal reaction, • Penetration of the cortex.

  20. Chondrosarcoma

  21. Chondrosarcoma

  22. Chondrosarcoma

  23. Microscopy • a lobular cartilaginous architecture, • highly cellular, • more than one nucleated cell per lacuna, • occasionally reveals tumor giant cells or clear cells, • with increasing grades of malignancy, has marked variation in nuclear and cellular size and shape.

  24. Chondrosarcoma

  25. II. Bone-Forming Tumors - Osteoid Osteoma - Osteoblastoma - Osteogenic Sarcoma

  26. Osteoid Osteoma • A distinctive, small (<2 cm), solitary, benign, tumorlike lesion of bone • It is composed of osteoid tissue intermixed with woven bone and surrounded by reactive bony sclerosis. • Osteoid osteoma most often occurs in children and young adults. • A frequent presenting symptom of this condition is night pain, often relieved by aspirin, with localized tenderness in the painful area.

  27. Osteoid osteoma is commonly located in a femur or tibia, • Radiology: • A representative x-ray picture • An osteoid osteoma shows a well circumscribed, small, round or oval, radioluscent or radiodense lesion (the nidus) • May be located in or near the cortex and surrounded by densely sclerotic bone.

  28. Osteoid Osteoma

  29. Microscopy • The nidus: • narrow trabeculae of osteoid or newly formed bone produced by osteoblasts + vascularized stroma • surrounded by a sclerotic mature bone.

  30. Osteoid Osteoma

  31. Osteoblastoma • Osteoblastomas are larger (> 2 cm) than osteoid osteomas • Mainly osteolytic • do not evoke reactive bone sclerosis • Higher recurrence rate (~10%) • Characterised by immature osteoid production • Commonly in the cancellous bone of the spine (posterior elements) and skull

  32. Osteogenic Sarcoma • Osteosarcoma: a malignant tumor of bone • Most common primary bone tumor after myeloma

  33. In young people under 20 years of age • Male / Female : 2/1 • Peak beyond 40 years of age: • Secondary to preexisting disease • Paget's disease (Paget's sarcoma) • Previous radiation (irradiation sarcoma) • Other conditions

  34. Osteosarcoma may occur in any bone • The most frequent location is near the knee (~50-60% of cases) • most commonly in the distal end of the femur • the upper end of the tibia, • upper end of the humerus, • pelvis, • upper end of the femur. • Bone-forming cells produce alkaline phosphatase • The serum alkaline phosphatase is markedly elevated in many patients with osteosarcoma.

  35. Radiology of a long bone usually show a large, ill-defined tumor. • The bone-producing (osteoblastic) lesion is located in the medulla near the metaphysis • Lifts up the periosteum (periostal reaction) • often producing "Codman's triangle", an angle between the outer cortex and the elevated periosteum, • Sun-rays pattern • Less common : • destructive (osteolytic) lesions with a "moth eaten" appearance of the cortex.

  36. Osteosarcoma

  37. Osteosarcoma Osteosarcoma

  38. Osteosarcoma

  39. Osteosarcoma: Lung mets

  40. Microscopy • Proliferating malignant spindle- cell stroma • Osteoid or immature bone

  41. Osteosarcoma

  42. Osteosarcoma

  43. III.Tumors of Other or Unknown Histogenesis • Ewing’s sarcoma • Giant Cell Tumor

  44. Ewing's Sarcoma • A malignant, small, round-cell tumor of bone • Composed of uniform, densely packed, tumor cells with round nuclei and indistinct cellular borders • The histogenesis of Ewing's sarcoma remains controversial

More Related