Classification of Tumor Benign Osteoma Osteoid osteoma Osteoblastoma Gaint Cell Tumor Enchondroma Osteochondroma Chondromyxoid fibroma Chondroblastoma

Non fibrous corticol defect Non-ossifying fibroma Fibrous dysplasia Simple bone cyst Aneurysmal bone cysts Arising From «.. Bone Malignant Osteosarcoma

Cartilage

Chondrosarcoma

Fibrous tissues

Malignant fibrous histiocytoma

Tumor of uncertain origin

Ewing¶s sarcoma Adamantinoma

Comparison between benign and malignant tumor Benign Asymptomatic and Incidental Single lesion Slow growing with well define margin or with sclerotic margin. Low blood supply Thick well-orgenized periosteal (slow growing lesion) Very seldom involve the contex Less likely to involve the adjacent soft tissue Malignant Local pain, swelling, limp and pathological fracture, Multiple lesions suggesting of metastasis. Rapidly growing with Ill-defined margin and appear diffusely into the surrounding structure. Extensive blood supply via angiogenesis Thin layers of priosteal (rapidly growing malignant lesion) Cortex involvement suggesting of malignant lesion Extension to the adjacent tissue suggesting of aggressive lesion.

Clinical features Imaging Margin of the lesion Blood Supply Perisoteal reaction Breach of bone cortex Soft tissue mass

extracompartmental Stage IIA : HGT. extracompartmental Stage III : Any tumor with evidence of metastasis . intracompartmental Stage IIB : HGT. others may contain cartilage cells or fibroplastic tissue with little or no osteoid ‡ most common = around the knee/proximal humerus and femur PATHOPHYSIOLOGY STAGING ‡ Enneking staging system 1980 Stag e IA B IIA IIB Grad e G1 G1 G2 G2 G1 or G2 Tumor Metastasis ‡ ‡ ‡ T1 T2 T1 T2 T1 or T2 M0 M0 M0 M0 ‡ ‡ ‡ M1 ‡ ‡ ‡ ‡ ‡ ‡ HISTORY age : young adolescene paget¶s disease Rothmund-Thomson syndrome familial retinoblastoma syndrome Li-Fraumeni syndrome male>female c/o : worsening dull pain/progressive swelling hx of radiation family hx of cancer (genetic predispostn) cnsttnl sx : LOA. fever hx preceded by trauma/fracture pathology fracture limping III Stage IA : LGT.LOW. intracompartmental Stage IB : LGT.OSTEOSARCOMA DEFINITION/AETIOLOGY ‡ Highly malignant tumor ‡ Arise within the bone ‡ Spread rapidly outwards to the periosteum and surrounding soft tissues. ‡ Some areas may consist of characteristic spindle cells in an osteoid matrix. nightsweat. ‡ Histlogical = considerable variation.

ALP and LDH : y Elevated ALP indicates that there could be active bone formation occurring as ALP is a byproduct of osteoblast activity. INVESTIGATION Plain radiograph of the bone : y Entirely osteolytic. and it accumulates. Osteosaroma with sunburst periosteal reaction Lymphadenopathy: l unusual. When the osteoid becomes mineralized. ‡ ‡ ‡ ‡ MANAGEMENT Neoadjuvant Chemotherapy Surgical Resection Adjuvant Chemotherapy Local Radiotherapy l Decreased range of motion: l Involvement of a joint should be obvious on physical examination. Osteoid makes up about fifty percent of bone volume and twenty-five percent of bone weight. When there is insufficient mineral or osteoblast dysfunction.The cortex is breached and the tumour extends into the adjacent tissues streaks of bone appear. It is composed of fibers and ground substance. is termed rickets. Osteoblasts begin the process of forming bone tissue by secreting the osteoid as several specific proteins. spindle shaped stromal cells & atypical with irregularly shaped nuclei. Biopsy : y Presence of osteoid in the lesion. . when present in children. radiating outwards from the cortex. MRI : y To assess the extent of intramedullary disease as well as associated soft-tissue masses and skip lesions. metastases. Chest radiograph : y To detect presence of pulmonary metastases Radioisotopes : y To detect for the presence of metastatic disease y Reveal skip lesions (a ve scan does not exclude them) Ct scan : y Extend of the tumour y more sensitive than is plain film radiography for assessing pulmonary In histology. the osteoid does not mineralize properly. y Should always be performed before commencing treatment. y Codman¶s triangle ± the reactive new bone forms in the angle between periosteum and cortex. Respiratory findings: l Auscultation is usually uninformative unless the disease is extensive.PHYSICAL EXAMINATION Mass: l l l tender warm increased skin vascularity over the mass(dilated vein) Pulsations or a bruit may be detectable. osteoid is the unmineralized. The predominant fiber-type is Type I collagen. y µSunburst¶ effect . The ground substance is mostly made up of chondroitin sulfate and osteocalcin. y Margins are poorly defined. it and the adjacent bone cells have developed into new bone tissue. Osteomalacia. This process is called osteomalacia. others show alternating areas of lysis and increased bone density. organic portion of the bone matrix that forms prior to the maturation of bone tissue.

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