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BONE TUMORS

Assoc. Prof. Melih Güven Yeditepe University Hospital Department of Orthopaedics and Traumatology. BONE TUMORS. Learning Objectives. Classification of benign bone tumors Charasteristic clinical and radiological features of most common benign bone tumors Definition of tumor like lesions

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BONE TUMORS

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  1. Assoc. Prof. Melih Güven Yeditepe University Hospital Department of Orthopaedics and Traumatology BONE TUMORS

  2. Learning Objectives • Classification of benign bone tumors • Charasteristic clinical and radiological features of most common benign bone tumors • Definition of tumor like lesions • Classification of malign bone tumors • Charasteristic clinical and radiological features of most common malign bone tumors • Charasteristic features of metastatic bone tumors • Surgical applications in benign and malign bone tumors

  3. Bone tumors • General knowledge • Benign tumors • Tumor like lesions • Malign tumors • Metastatic bone tumors

  4. General approaches • Initial referral • Pain • Deeply, sharp and increased over time • Localized sensitivity and rush • Pathologic fracture • Deformity • Incidental finding

  5. General approaches • First stage evaluation • Anamnesis • Duration and level of pain, number and duration of the lesions, age, loss in weight, fever, weakness • Physical examination • Site and size of the lesion, mobility, sensitivity,LAP • Radiological evaluation • Codman triangle, onion skin view, sunrise view • Laboratory findings • ALP, serum Ca level, ESR, LDH, protein electrophoresis

  6. Bone Tumors Imaging • Solitary or multiple lesions? • What type of bone is involved? • Which part of the bone is involved? • Are the margins of the lesion well defined? • Is there any bony reaction? • Does the lesion contain calcification?

  7. General approaches • Second stage evaluation • CT • Bone scintigraphy – Tc 99m • Anjiography • MRI • PET – CT

  8. General approaches • Second stage evaluation • Biopsy • Closed • Fine needle aspiration biopsy • Trochar biopsy • Needle biopsy under CT control • Open • Incisional biopsy • Excisional biopsy • Frozen section biopsy (intraoperative)

  9. Staging • Staging of benign bone tumors (Enneking) • Stage I: Latent • Dense capsule, no reactive zone • Spontaneous healing • Stage II: Active • Dense capsule, adhesions between capsule and surrounding soft tissue; reactive zone present • No spontaneous healing

  10. Staging • Staging of benign bone tumors (Enneking) • Stage III: Agressive • Irregularity is present at the border of the tumor, thin capsule • Dense reactive zone and edema • Tumor can grow up quickly, no restriction

  11. Staging • Staging of malign bone tumors (Enneking) • G :G1: Low potential of metastasis , G2: High potential of metastasis • T : Intracompartmantal (T1) or extracompartmantal (T2) • M : M0: No metastasis, M1: Metastasis present IA G1 T1 M0 IB G1 T2 M0 IIA G2 T1 M0 IIB G2 T2 M0 IIIA G1-G2 T1 M1 IIIB G1-G2 T2 M1

  12. General classification • Tumors with osseous origin a-Benign:  Osteoma, Osteoid osteoma, Osteoblastoma b-Malign:   Osteosarcoma • Tumors with cartilaginous origins a- Benign :Chondroma, Osteochondroma, Chondroblastoma, Chondromyxoidfibroma b- Malign :  Chondrosarcoma

  13. General classification • Tumors with bone marrow origins Ewing’s sarcoma Reticulumcellsarcoma Lymphosarcoma Multiple myeloma • Gaint cell tumors Gaint cell bone tumors (osteoclastoma)

  14. General classification • Tumor like lesions (Fibrous, cystic) Simple bone cyst Aneurysmal Bone Cyst Fibrouscorticaldefect (Non-ossifyingfibroma) Eosinophilicgranuloma FibrousDysplasia Desmoplasticfibroma

  15. Treatment • If possible, extremity preserving surgery • Functional extremity • External body view • Psychological copmpliance • Sociocultural compliance

  16. Surgical treatment 1.Intracapsular excision: - Benign, latent lesions 2.Marginal excision: - Surgical borders contain also reactive zone of the tumor - Benign, active lesions

  17. Surgical treatment 3.Wide resection: - Surgical borders contain surrounding healthy tissue - Benign, agressive lesions; malignant low grade lesions 4.Radical resection: - Tumor resection with whole compartment contents - Malignant high grade lesions 5. Amputation

  18. Adjuvanttherapies • Chemotheraphy • Neoadjuvant (8-12 weeks) • Adjuvant (6-12 months) • Radiotheraphy • Local adjuvants: • Fenol, hydrogen peroxid, liquid nytrogene, bone cement, alcohol, coterisation, hot water (80°C)

  19. BENIGN BONE TUMORS

  20. Osteochondroma

  21. Enchondroma

  22. Enchondroma • Ollier disease • Maffuci syndr.

  23. Osteoid osteoma

  24. Osteoblastoma

  25. GiantCellTumor(Osteoklastoma)

  26. Chondroblastoma

  27. Benign bone tumors • Osteochondroma • Multiple herediter osteochondromatisis • Enchondroma • Osteoid osteoma • Osteoblastoma • Giant cell tumor • Chondroblastoma

  28. TUMOR LIKE LESIONS

  29. Simple Bone Cyst

  30. Aneurysmal Bone Cyst

  31. Eosinophilicgranuloma

  32. Fibrouscorticaldefect (Non-ossifyingfibroma)

  33. Fibrousdysplasia mlgn 5 yıl sonra

  34. Tumorlikelesions • Simple bone cyst • Aneurysmal bone cyst • Eosinophilic granuloma • Fibrous cortical defect (Non-ossifying fibroma) • Fibrous dysplasia

  35. MALIGNANT BONE TUMORS

  36. Osteosarcoma Birkaç ay sonra

  37. Chondrosarcoma

  38. Ewing’ssarcoma

  39. Multiple myeloma

  40. Chordoma

  41. Malignant Bone Tumors • Osteosarcoma • Chondrosarcoma • Ewing’s sarcoma • Multiple myeloma • Chordoma

  42. METASTATIC BONE TUMORS

  43. Metastatic Bone Tumors • Most common malignancy of the skeleton • Pain (most common), limitation of movement, pathologic fracture, spinal cord compression, hypercalcemia • Breast most common in woman, prostate and lung most common in man

  44. Metastatic Bone Tumors • Spreading; • Direct • Indirect • Lenfogenous • Hematogenous • Location of metastasis; - vertebra % 69 - pelvis %41 - femur % 25 - cranium %14 Batson venous plexus

  45. Breast met. Kidney met. Prostat met. Prostate met. ob ol Lung met.

  46. Metastatic Bone Tumors • Diagnosis; • Bone scintigraphy (Tecnesium 99m) • Radiographs • Computarised tomography (CT) • MRI • PET-CT (F-18 PET) • Biopsy Standart methods

  47. Metastatic Bone Tumors • Treatment • Chemotherapy • Radiotherapy • Tumor excision ? • Limb salvage surgery • Preventive surgery for pathologic fracture

  48. ThankYou …

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