04.management of tumours
DESCRIPTION
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Management of bone tumours
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Neoplasms of bone
Osteoblast origin
Benign
Osteoma
Osteoid osteoma
Osteoblastoma
Malignant
Osteosarcoma
Chondroblast origin
Benign
Chondroma
Osteochondroma*
Chondroblastoma
Malignant
Chondrosarcoma
Unknown cell of origin
Giant cell tumour (Osteoclastoma)
Ewing’s tumour
Connective tissue tumours :
(Vascular , Neural, etc)
Metastases
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Tumour – like conditions• Fibrosseous lesions
– Fibrous dysplasia– Osteofibrous dysplasia ( Ossifying fibroma)– Metaphyseal fibrous defect (non ossifying
fibroma)• Cysts
– Solitary bone cyst (unicameral bone cyst)– Aneurysmal bone cyst– Ganglion cyst
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Modes of presentation
• Lump• Pathological fracture• Pain• Pressure effects• Incidental finding• Secondaries
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Exostosis
• Osteochondroma (actually a hamartoma)• Growing end of long bones• Problems – lump. Malignant change rare• Multiple (diaphyseal aclasis) – can interfere
with growth
• Excise if single, causing problems – tumour is larger than it appears on X-ray
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Exostosis
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Exostosis
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Chondromata
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Others
Fibrous cortical defect
Aneurysmal bone cyst
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Fibrous dysplasia
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Osteoclastoma• Giant cell tumour• Expands the bone• Classically asymmetrical• Occurs at the site of epiphysis• Lytic. Septate• ‘Egg shell crackling’
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Osteoclastoma
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Osteoclastoma - treatment
• Curettage and bone grafting• Pamidronate• Allograft / autograft bone• Bone cement• Prostheses
• NO radiotherapy
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Ewing’s tumour
Classically mid shaft
Onion peel appearance
Respond to RT
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Osteosarcoma• Common at growing end of long bones• Occur in the second decade (2nd peak –due
to Paget’s disease)• Warm swelling• X-ray – Codman’s triangle, sunray spicules,
bone destruction, cortex breached• CT-scan for extent. Also CT chest• Biopsy – incision or true-cut
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Osteosarcoma
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Osteosarcoma -treatment
• Excision, DXRT, Chemo
• Excision – amputation, limb conserving
• Custom made prostheses, allograft
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Chondrosarcoma
• Occur in older patients• Affect the axial skeleton
• Treatment – Surgical (not responsive to Chemo, DXRT)
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Chondrosarcoma
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Secondaries in bone• Commonly lytic• Common primaries – lung, thyroid, breast,
kidney, prostate• Multiple myeloma• Sclerotic – prostate, breast, colon• 50% of bone must be destroyed to be seen
on X-ray• CT, Bone scan – seen as hot spots.
Myeloma is cold
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Ca- Breast
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Multiple myeloma
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Secondaries -treatment
• Wherever possible –fix.• Use bone cement.• Aim is to get early mobilization
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Soft tissue sarcomas
• Can occur anywhere• Limbs, abdominal
wall, retro-peritoneum• Radical excision + RT
+ CT