BONE TUMOURS

Primary tumours are less common than metastases to bone Primary tumours occur in paediatrics All share similar clinical features and red flags: o Persistent skeletal pain o Localized tenderness o Spontaneous non-injury fracture o Enlarging mass

Benign 1. Osteoid osteoma Teenage years to 20s Male Proximal femur and tibia Night pain, relieved by aspirin (classic feature) Radiograph: Central radiolucent area (nidus) surrounded by dense bone 2. Osteoblastoma Very similar to osteoid osteoma Vertebral column Doesnt respond to aspirin Osteochondroma 45% of all benign bone tumors Teens to 20s Metaphysis of long bones (femur/humerus) Like a polyp Radiograph: Cartilage-capped bony spur on radiograph Very slow growing -> impinges on nerves Malignancy in 1-2% Treatment: Resection Chondroma Tumor of hyaline cartilage Enchondromas: Arise from within medulla Juxtacortical chondromas: Arise from bone surface Age 20-50 Radiograph: Oval lucencies (O-ring sign) Ollier disease multiple chondromas Maffucci syndrome multiple chondromas + soft tissue angiomas

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Cystic Lesions Includes solitary bone cysts and fibrous cortical defects (very common developmental defect in up to 30-50% of all children) Local pain, pathological fracture Radiograph: Lytic, translucent area on metaphyseal side of growth plate Benign but Aggressive 1. Giant Cell Tumors Multinucleated osteoclast-type giant cells 4.5% of all primary bone tumors Age 20-40 Epiphyseal ends of long bones (knee, radius, humerus) Radiograph: Well-defined lytic lesion, cortical expansion + thin subperiosteal new bone

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Differentials: ABC, hyperparathyroidism, Browns tumor Increased uptake on bone scan Treatment: Excision and reconstruction Aneurysmal Bone Cyst 2.5% of all primary bone tumours Most before 20 Pain and swelling Thin rim of cortex + big ballooning lytic area Periosteal new bone formation -> buttress effect High recurrence rate Excision and reconstruction

Malignant Age <1: Neuroblastoma Age 1-10: Ewings sarcoma (tubular bones) Age 10-30: Osteosarcoma, Ewings sarcoma (flat bones) Age >40: Metastatic, multiple myeloma, chondrosarcoma 1. Osteosarcoma Most common primary malignancy of bone Bone-producing mesenchymal tumour Bimodal distribution: 75% younger than 20, 25% elderly Predisposition: Retinoblastoma + irradiation Men > Women Long bones of extremities (Distal femur, proximal tibia, proximal humerus) Painful enlarging mass Radiograph: Codmans triangle i. Periosteal elevation ii. Triangular shadow between periosteum and cortex iii. Sunburst sign Ewings sarcoma Second most common primary malignancy of bone 5-20 year olds Radiograph: Moth-eaten appearance with periosteal onion-skinning pattern Mild fever, anemia, leucocytosis, raised ESR/LDH Chemo + excision Chondrosarcoma

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