TUMORS AND TUMOR LIKE

AFFECTATIONS OF THE BONE

DEFINITION

Bone tumor -
neoplastic (abnormal
and uncontrolled)
growth of bone tissue
 OBJECTIVES AND OUTLINE
• To be able to understand tumor,
common signs and symptoms and
diagnostic work ups
• To be familiar with the types of
tumors based on classification of
tissue and whether benign or
malignant
• To know the epidemiology, signs
and symptoms, radiologic and
histology of the tumors as well as
treatment
• Define tumor
• Common signs and symptoms
• Classification of tumor (based on
tissue)
• Classification of benign vs
malignant
• Discussion of the different
tumors affecting the bone and
other structures
 TUMORS

• 3 most common manifestations of

tumors
• Pain
• A mass
• A pathologic fracture
 CLINICAL
PRESENTATION

• consult due to localized pain

or swelling of a few weeks’
or months’ duration
• benign tumors are often
asymptomatic
• malignant tumors
are often
accompanied by
pain
• mild pain at first
—> aggravated
by exercise,
worse at night
• minor trauma may be the
initiating event
 DIAGNOSTIC AND
STAGING WORK-UP

• Goals of diagnostic evaluation

• establish tissue diagnosis
• evaluate disease extent
• assess feasibility of surgical resection
using principles of limb-sparing surgery
• Xrays - can often predict potentially
malignant bone lesion
• MRI - for better definition of tumor size,
local intra-osseous or extra-osseous extent
• CT scan - less useful than MRI for assessing
primary bone tumors
• best method to evaluate thorax for
metastasis
 X-RAYS

Most useful
examination for
differentiating lesions
in the bone
XRAY FINDINGS

• Periosteum is a
labile, sensitive
structure capable
of responding to
traumatic stimuli
or pressure from
the growth of an
underlying tumor
by depositing new
bone
 XRAY FINDINGS

• Solid Buttress
• Slow-growing tumors on the
cortical surface provoke a solid
buttress at their borders under the
periosteum
 XRAY FINDINGS

• Onion-skin
• More rapid growth
penetrating through an eroded
cortex
 XRAY FINDINGS

• Spiculated
• Very aggressive tumor growth
• Perpendicular to the cortical
surface
• Sunburst appearance
 XRAY FINDINGS

• Codman’s triangle
• Rapidly advancing neoplastic processes
• cortical destruction and periosteal elevation of
significant degree
• separation of the periosteum from the
still-intact cortex forms an acute angle with
an open end toward the tumor’s epicenter
XRAY FINDINGS
 BONE SCAN

• Technetium 99 MDP radioisotope

• Indicates bone formation/ turn-over
• Screening for focal bone or multiple
skeletal involvement
• Look for distant metastases
 BIOPSY

• Indications for Biopsy

• when there is significant doubt
as to the diagnosis of a benign or
malignant lesion
• when histologic distinction
among possible diagnoses could
alter the planned course of
treatment
• when definitive confirmation of
the diagnosis is required before
undertaking a hazardous,costly,
or potentially disfiguring
treatment
 BIOPSY

• Biopsy Techniques:
• Needle biopsy
• Advantage:
• no need for general anesthesia or operating
room
• readily scheduled
• can be directed to the lesion and document
its location with image-guidance
• Disadvantage:
• limited amount of tissue for diagnostic
studies
• sampling
 • Biopsy Techniques:
• Open (Operative biopsy):
• incisional biopsy - only a
sample of the mass/tumor is
cut
BIOPSY
• Excisional biopsy - for small
tumors involving soft tissues
(e.g. lipomas)
• removal of the entire
lesion/tumor
 BIOPSY

Incisional biopsy Excisional biopsy

 DIAGNOSIS

• Systematic approach to tumor

• Age
• Periosteal reaction
• Zone of transition
• Cortical destruction
• Location (epiphysis, metaphysis, diaphysis) and bone involved
• single or multiple
 DIAGNOSIS

• Zone of transition

Small zone of transition wide zone of transition

 DIAGNOSIS

• Periosteal reaction -
periosteal reaction is
a non-specific
reaction and will
occur whenever the
periosteum is
irritated by a
malignant tumor,
benign tumor,
infection or trauma
 CORTIC AL DESTRUCTION

• Cortical destruction is a common finding, and not very

useful in distinguishing between malignant and benign
lesions.
LOCATION

The location of a
bone lesion within
the skeleton can be
a clue in the
differential diagnosis
 LOC ATION

• Aneurysmal Bone Cyst - tibia, femur, fibula, spine, humerus

• Adamantinoma - tibia shaft, mandible
• Chondroblastoma - femur, humerus, tibia, tarsal bone (calc), patella
• Chondromyxoid fibroma - tibia, femur, tarsal bone, phalanx foot, fibula
• Chondrosarcoma - femur, rib, iliac bone, humerus, tibia
• Chordoma - sacrococcygeal, spheno-occipital, cervical, lumbar, thoracic
• Eosinophilic Granuloma - femur, skull, iliac bone, rib, vertebra
• Enchondroma - phalanges of hands and feet, femur, humerus, metacarpals,
rib
• Ewing's sarcoma - femur, iliac bone, fibula, rib, tibia
• Fibrous dysplasia - femur, tibia, rib, skull, humerus
 LOC ATION

• Hemangioma - Giant Cell Tumor - femur, tibia, fibula, humerus, distal radius
• pine, ribs, craniofacial bones, femur, tibia
• Lymphoma - femur, tibia, humerus, iliac bone, vertebra
• Metastases - vertebrae, ribs, pelvis, femur, humerus
• Non Ossifying Fibroma - tibia, femur, fibula, humerus
• Osteoid osteoma - femur, tibia, spine, tarsal bone, phalanx
• Osteoblastoma - spine, tarsal bone (calc), femur, tibia, humerus
• Osteochondroma - femur, humerus, tibia, fibula, pelvis
• Osteomyelitis - femur, tibia, humerus, fibula, radius
• Osteosarcoma - femur, tibia, humerus, fibula, iliac bone
• Solitary Bone Cyst - proximal humerus, proximal femur, calcaneal bone, iliac
bone
 LOC ATION
EPIPHYSIS, METAPHYSIS, DIAPHYSIS
• Epiphysis
• Only a few lesions are located in
the epiphysis
• In young patients it is likely to be
either a chondroblastoma or an
infection.
• In patients over 20, a giant cell
tumor has to be included in the
differential diagnosis.
• In older patients - degenerative
subchondral bone cyst
• Diaphysis
• Ewing's sarcoma, Simple bone
cyst, Aneurysmal bone cyst,
Enchondroma, Fibrous dysplasia
and Osteoblastoma.
• Metaphysis
• Non ossifying fibroma, Simple
bone cyst, Chondomyxiod
fibroma, Osteosarcoma,
Chondrosarcoma, Enchondroma
and infections
LOCATION
EPIPHYSIS,
METAPHYSIS,
DIAPHYSIS
CLASSIFICATION
 • Benign - lacking the ability
to invade neighboring
tissue or metastasize
TYPES OF
TUMORS • Malignant - cancers
• ability to invade
neighboring tissue or
metastasize
 BENIGN

• Chondroma
• Chondroblastoma (Codman’s tumor)
• Osteochondroma
• Osteoid osteoma
• Nonosteogenic fibroma
• Giant cell tumor
• Bone cyst
• Aneurysmal bone cyst
 MALIGNANT

• Osteogenic sarcoma (osteosarcoma)

• Parosteal osteogenic sarcoma
• Chondrosarcoma
• Ewing’s sarcoma
• Reticulum cell sarcoma (histiocytic lymphoma of bone)
• Plasma cell myeloma (multiple myeloma)
• Tumors metastasizing to bone
 • Bone • Marrow element
• Osteoid osteoma • Lipoma
• Osteoblastoma
• Vascular tissue
BENIGN • Osteoma • Neruofibroma
TUMORS • Glomus tumor
• Cartilage
AND • Osteochondroma
• Uncertain
THEIR • Giant cell tumor
• Chondroma • Solitary bone cyst
TISSUE OF • Chondroblastoma
ORIGIN • Neural tissue
• Neurofibroma
• Fibrous tissue
• Fibroma
• Fibrous dysplasia
 • Bone • Vascular tissue
• Osteogenic sarcoma • Hemangioendothelioma
• Cartilage • Uncertain
• Malignant Giant cell
MALIGNANT • Chondrosarcoma
tumor
TUMORS • adamantinoma
AND • Fibrous tissue
THEIR • Fibrosarcoma • Neural tissue
TISSUE OF • Chondroma
ORIGIN • Marrow element
• Metastatic
• Liposarcoma • Breast, lung, prostate,
• Ewing’s sarcoma kidney, thyroid cancer
• Multiple myeloma
• Malignant lymphoma
 STAGING OF TUMORS

ENNEKING SYSTEM
• characterizes non-metastatic malignant bone tumors by grade and further
subdivided according to local anatomic extent

STAGE Description

IA Low-grade
Intra-compartmental

IB Low-grade
Extra-compartmental

IIA High-grade
Intra-compartmental

IIB High-grade
Extra-compartmental

III Metastatic
 • Goals of Surgery
• Complete
SURGERY FOR PRIMARY removal of tumor
MUSCULOSKELETAL
TUMORS • Preservation/
restoration of
limb function
 SURGERY FOR
PRIMARY
MUSCULOSKELETAL
TUMORS

• EXCISION
• Intralesional:
• benign tumors
• Plane of dissection
is within the
tumor
• Marginal: benign, low-
grade malignant
tumors
• plane of dissection
is through the
pseudo‐capsule
 SURGERY FOR
PRIMARY
MUSCULOSKELETAL
TUMORS

• Wide: Low/ high-grade

tumors
• Plane of dissection
is in normal tissue
• Entire tumour
surrounded by
cuff normal tissue
• Radical: High-grade
tumors
• All the
compartments
that contain
tumour is
resected
 SURGERY FOR PRIMARY
MUSCULOSKELETAL TUMORS

• AMPUTATION
• Through-bone (BKA, AKA, AEA, BEA)
• Disarticulation (Hip, forequarter,
hemipelvectomy)
• LIMB SALVAGE
• preservation of limb function through
conservative excision/ resection of
tumor
 PRINCIPLES OF LIMB
SALVAGE
• Pre-conditions • Requisites

• No compromise to local tumor • Accurate tumor staging available

control
• Adequate margins of resection
• No compromise to long-term attainable
survival
• Resection defect reconstructible
• Resulting function better than
an amputated limb • Painless function attainable with
rehabilitation
 PRINCIPLES OF LIMB
SALVAGE
Fixed joint: Arthrodesis

Mobile joint: Arthroplasty

Arthrodesis Arthroplasty
PRINCIPLES OF LIMB
SALVAGE

Van Ness
Rotationplasty
 Chemotherapy

Radiotherapy
ADJUVANT/ALLIED
THERAPY
Pain Management

Rehabilitation
BENIGN TUMORS
 CHONDROMA

• slowly growing tumor composed of cartilage

• arise within the medullary cavity and are called
Enchondromas
• most common sites:
• phalanges
• metacarpals and metatarsals
• also humerus and femur
• Age: 20-30 yo
• Symptom – slow growing tumor with slight discomfort
• Xrays:
• rounded area of decreased density with smooth outline
expanding beneath a narrow shell of cortical bone
• scooped-out periosteum seen in periosteal chondroma
CHONDROMA

• may undergo malignant

degeneration to
Chondrosarcoma
especially enchondromas
of large tubular bones
• Treatment:
• Thorough curettage
or excision
• Packing the resulting
cavity with small bone
grafts
 CHONDROBLASTOMA

• Codman’s tumor
• seen in epiphyseal region of large
bones
• adolescents, males
• most common sites Usually in the
epiphyseal region of large bone
• femur
• tibia
• humerus
CHONDROBLASTOMA

• Histology:
• Closely packed round or
polyhedral cells with distinct
cell membranes and large
nuclei
• Focal calcification
throughout tumor tissue
together with cellular
degeneration and necrosis
• Clinical features:
• Gradual pain on motion
(knee, hip or shoulder)
• Swelling, palpable mass and
tenderness
 CHONDROBLASTOMA

• X-ray:
• Round or ovoid indistinctly mottled
area of radiolucency with thin margin
of sclerotic bone in the epiphyseal
region
• Treatment:
• Curettage and packing of resulting
bony cavity with cancellous bone
graft results in PERMANENT CURE
 OSTEOCHONDROMA

• Most common benign bone tumor

• May result to skeletal deformity
• Epidemiology
• 10 – 25 years old
• Found at ends of long bones forming pedunculate bony
overgrowth
• Often found in the femur and tibia and upper end of the
humerus, scapula
• Symptoms
• Swelling or palpable lump
• Slight discomfort
• Treatment
• No need for surgery, but if it is traumatized easily
(location) it may be removed
 OSTEOID OSTEOMA

• small solitary lesion in cancellous or

cortical bone
• Reactive bone lesion of unknown cause
rather than a neoplasm
• Age: 10-25 yo, males
• Most common sites: femur and tibia, also
in the carpal, tarsal and posterior
elements of vertebrae
• Lesion - oval nidus not more than 1.5cm
surrounded by extensive and dense
reactive bone
 OSTEOID OSTEOMA

• Clinical features:
• Aching local pain for several months
• Pain may cause stiffness and weakness in
the adjacent muscle and limp
• Usually considered as a reactive bone
lesion
• Pain worst at night
• Relieved by ASPIRIN
• Xrays:
• nidus - small, round or oval, radiolucent
well-circumscribed area with a central
area of increased density
 OSTEOID
OSTEOMA

• Treatment and
prognosis:
• Complete
excision with
bone graft - best
treatment,
permanent relief
of pain
• If not excised —
> regresses but
pain may persist
for years
• AKA Osteoclastoma
• solitary slow growing tumor,
seen at epiphyseal-metaphyseal GIANT CELL TUMOR
region of long bones
• Most common sites:
• lower end of femur, upper end
tibia, lower end of radius and
sacrum
• vary in clinical course - some
slow growing, others aggressive
growth and destruction or
become malignant
• Age: young adults 20-35 yo

• Clinical features:
• swelling and mild pain (most
common)
• Severe pain associated with
pathologic fracture
 GIANT CELL TUMOR

• Grossly: brownish red appearance

with areas of fibrosis and
hemorrhage
• Microscopically: vascularized
network of fusiform and ovoid
stromal cells of fibroblastic or
histiocytic type
• many multinucleated giant cells
similar to osteoclasts
 GIANT CELL TUMOR

• Xrays:
• eccentric area of bone
destruction
• radiolucency in the epiphyseal
and metaphyseal areas with
expansion and thinning of
cortex
• lesion is expansile with minimal
periosteal reaction
 GIANT CELL
TUMOR

• Treatment and prognosis:

• Biopsy needed to establish
diagnosis
• complete resection of lesion -
high success
• curettage + destruction of
remaining tumor cells with
liquid nitrogen or phenol or
bone cement packing of the
lesion - more successful than
simple curettage
• curettage and bone graft has
high recurrence rates
• amputation for malignant
GCT
 SIMPLE BONE
CYST

• AKA Solitary bone cyst

• slowly growing fluid
filled lesion
• metaphysis of a long
bone
• proximal metaphysis
humerus - most
common
• femur, tibia and fibula
• unilocular containing
amber fluid
 SIMPLE BONE CYST

• Clinical features:
• boys
• asymptomatic until pathologic fracture
develops

• Xrays:
• single or multilocular central bone defect at
or near the metaphysis with a smooth, intact
outline formed by thinned slightly expanded
coritcal bone
SIMPLE BONE
CYST

• Treatment and
prognosis:
• >10 years old -
curettage and
bone grafting
• intralesional
corticosteroid
injection - 90%
healing
 ANEURYSMAL BONE CYST

• uncommon
• solitary benign
• unknown etiology
• probably a disorder of local vasculature of bone marrow
• Cyst is filled with soft tissue and cavernous vascular spaces
• Most common sites:
• Vertebrae (posterior element involvement)
• Long bones
• Grossly: rounded protrusion consisting of a thin shell of
bone filled with spongy soft tissue, vascular channels and
bloody fluid
 ANEURYSMAL
BONE CYST

• Clinical features:
• Most common in adolescents
• Localized pain
• May lead to paralytic symptoms
when located in the vertebra
• Xrays:
• Ovoid radiolucent area bulging
eccentrically giving it an aneurysmal
or blowout appearance
• Treatment and prognosis:
• If untreated - enlarge
• Curettage and bone graft
• Excision if surgically accessible
• Irradiation for inaccessible areas
MALIGNANT TUMORS
 OSTEOGENIC SARCOMA

• Most common malignant primary bone tumor

• Age: 10-20 years old, males > females
• Aggressive tumor with rapid growth and early
pulmonary metastasis
• Etiology: unknown
• irradiation can induce osteogenic sarcomas
• malignant degeneration of Paget’s disease and
certain irradiated benign tumors
• Most common sites:
• Metaphysis of long bone
• proximal tibia, distal femur and proximal
humerus - where most rapid bone growth
occurs
 OSTEOGENIC SARCOMA

• Microscopically - large, bizarre and hyperchromatic

nuclei with high levels of alkaline phosphatase
(signifying increased osteoblastic activity)
• osteoid matrix - hallmark of osteogenic
osteosarcoma
• Clinical features:
• dull, constant, aching pain interferes with sleep
• tender bony enlargement just above or below the
knee or shoulder
• LOM, limp
• superficial venous distention, elevation of skin
temperature over the lesion
 OSTEOGENIC SARCOMA

• Xrays:
• Sunburst appearance - small spicules
of bone radiating at right angles to
the shaft
• Codman’s triangle - small triangule
of reactive bone
• Treatment and prognosis:
• 15-20% 5 year survival rate
• pulmonary mets are found within
a year after diagnosis
OSTEOGENIC SARCOMA

• Surgery:
• Wide resection
• Amputation
• Limb salvage - Van ness rotationplasty,
tumor resection with limb
reconstruction using tumor prosthesis
• Chemotherapy:
• Adjuvant - destroys microscopic foci
of tumor metastases
• after surgery
 • Chemotherapy:
methotrexate,
vincristine,
cyclophosphamide,
adriamycin and cis-platin
• destroys
microscopic foci
of tumor
metastases
• Adjuvant - given after
OSTEOGENIC SARCOMA surgery
• Neo-adjuvant -
chemotherapy given
prior to planned
surgery
• Close follow-up after
surgery and chemo to
detect as early as
possible pulmonary
metastases
CH ONDROSAR COMA

• Malignant tumor from cartilage

cells
• May result from malignant
degeneration of a benign lesion
• Central chondrosarcoma -
develop from interior of the
bone
• Peripheral chondrosarcoma -
develop from surface of the
bone
• Age: 5th and 6th decade
• Most common sites:
• Pelvis
• Proximal part of femur
 CHONDROSARCOMA

• Clinical features:
• Slow growing tumor and provoke mild
symptoms
• Slow to metastasize
• Not obvious in early stages due to
their site of involvement (pelvis)
• Xrays:
• Bulky area of soft tissue density with
irregular blotches of more opaque
calcification
CHONDROSARCOMA

• Treatment and
prognosis:
• better prognosis
than osteosarcoma
due to slow growth
and metastatic
potential
• Surgical treatment
• Amputation
• Wide resection
• Not chemo nor
radiosensitive
EWING’S SARCOMA

• Malignant tumor arising from

marrow cavity and destroys and
penetrates the cortex producing
extra-osseous mass
• Simulates low grade
osteomyelitis
• Involve metaphyseal or
diaphyseal area
• Ages: 10-25 yo
• Microscopically - closely packed,
small round cells with scant
cytoplasm and dense round or
oval nuclei
 EWING’S SARCOMA

• Clinical features:
• Pain, fever, leukocytosis
• Palpable soft tissue mass
which may be larger than
tumor seen on xrays
• Metastasis to the lungs and
other bones
 EWING’S SARCOMA

Xrays:
• Similar to acute or chronic
osteomyelitis
• Onion skin pattern - widening of shaft
from reactive endosteal and
subperiosteal bone in layers parallel to
its long axis

Treatment and prognosis:

• Metastasis become clinically evident
within 6-12 months after diagnosis
• Combined chemotherapy and
radiotherapy followed by wide
exicison
 PLASMA CELL
MYELOMA

• Multiple myeloma
• Highly malignant tumor from
bone marrow
• Age: 50-60 yo
• Most common sites:
• Axial skeleton
• Ribs, sternum, skull,
vertebrae
• Proliferation of cells producing
immunoglobulins
• Results in over production of
monoclonal immunoglobulins
or free monoclonal light
chains (Bence Jones protein)
 • Clinical features:
• Does not produce early
symptoms
• Insidious vague pain, swelling
PLASMA • pathologic fracture of rib or
CELL vertebra - first manifestation
MYELOMA • Back pain - first complaint
• Susceptibility to recurrent
bacterial infections due to
impaired production of
normal antibodies
 PLASMA CELL
MYELOMA

• Laboratory findings:
• Sternal or iliac bone biopsy -
myeloma cells
• Bence Jones proteinuria -
confirmatory finding
• Reversed Albumin-Globulin
ratio due to elevation of
globulins
• High narrow M spike on serum
electrophoresis
• Hypercalcemia
• Hyperurecemia
• Elevated Erythrocyte
sedementation rate
• Anemia
 PLASMA CELL
MYELOMA

• Xrays:
• Multiple punched out
appearance
• Generalized osteopenia
• Bone scans are negative
• Treatment and prognosis:
• Palliative
• Radiotherapy - best
treatment for solitary
myeloma
• Immobilization by brace, cast,
or traction to prevent
pathologic fractures
• Surgical treatment - for relief
of cord compression,
pathologic fractures
 Most common primary tumors
metastasizing to bone:
• Breast
• Lungs
• Prostate
• Kidney
• Thyroid

Usually multiple in number

TUMORS
METASTASIZING
Most are osteolytic causing
TO BONE extensive bone destruction

Breast and prostate tumors are

osteoblastic

Most common sites:

• Vertebrae and pelvis followed by femur, skull

and humerus
 • Clinical features:
• Deep aching night pains
or pathologic fracture -
most common
presenting symptoms
TUMORS • Anemia and elevated
METASTASIZING ESR
TO BONE
• Hypercalcemia due to
extensive bone
destruction
• Elevated acid
phosphatase in prostate
cancer
 TUMORS
METASTASIZING
TO BONE

• Xrays:
• Variable
• Located at metaphysis
or diaphysis, diffused in
flat bones
• Punched out/mottled
appearance
• Isotope bone scans -
most helpful in detecting
additional skeletal
metastases
• Angiography - for highly
vascular lesions (kidney
or thyroid cancers)
 • Treatment and prognosis:
• Biopsy should verify the diagnosis of metastatic
cancer
• Surgical fixation of weakened bone (IM nailing
or plates and scres) augmented with bone
cement

T UMOR S • For stabilization and pain relief

ME TASTASI Z ING • Radiation therapy - for pain relief
TO BONE
• Endocrine therapy - for breast or prostate
cancers
• Prognosis depends on type and aggressiveness
of tumor, but generally poor prognosis
• Life span: Breast cancer 2 years after
metastasis
• Lung cancer - few months after metastasis
 TUMORS OF
JOINTS

• Synovial chondromatosis:
• Knee most common
• Multiple loose bodies
• Synovial sarcoma:
• The only primary
malignant tumor that
arises within the joints
• Radical excision or
amputation + local
radiotherapy
 TUMOR OF
MUSCLE

• Benign muscle tumors are uncommon

outside of the abdomen
• Leiomyosarcoma - malignant tumor
arising from smooth muscle
• Abdominal and pelvic viscera
• Rhabdomyosarcoma - malignant tumor
arising from striated muscle
• Embryonal form - most common
in children
• Face and neck and genito-
urinal tracts
• Pleomorphic type - in adults
• Metastasis to lungs or lymph nodes
occur early
• Radical resection - for limb tumors
of the adult type
• Radiotherapy reduces recurrence
 TUMOR OF
FATTY TISSUE

• Lipoma - may occur in any

part of the body
• Common benign fatty
tumor
• Excision - for cosmesis or
for definitive diagnosis
• Liposarcoma - occurs in adults
• Buttocks or thigh - most
common sites
• Wide local excision or
amputation
• Recurrence is common
• Metastasis to the lungs
 TUMOR OF VASCULAR
ORIGIN

• Hemangiomas - arise in almost any tissue

• benign vascular lesions and never
become malignant but may be invasive
• Glomus tumor - small localized painful
lesions consisting of small vessels lined by
round cells and unmyelinated nerve fibers
• seen beneath the nails of hands and feet
• Excision cures the lesion
 TUMOR OF
PERIPHERAL
NERVE

• Neurilemoma or
Schwannoma
• solitary encapsulated
benign tumor arising
from Schwann cells
• Malignant Schwannoma
• malignant
neurilemoma
• most commonly seen
in patients with von
Recklinghausen’s
disease
 TUMOR OF PERIPHERAL
NERVE

• Neurofibroma - solitary non-encapsulated

tumors arising from endoneural fibrous
connective tissue
• firm, non-tender slowly growing tumor
on the skin or subcutaneous tissue
• maybe attached to larger nerves
• Surgical excision indicated when lesion
becomes malignant, rapid growth or
nerve irritation or block appears
• amputation in advanced
neurofiborsarcoma
 TUMOR OF
PERIPHERAL
NERVE

• Neurofibromatosis:
• slowly growing, non
tender found in skin
and subcutaneous
tissue
• symptoms from local
mechanical pressure
• tendency for malignant
degeneration
• Excision may be done
for deforming and
disabling lesion but
malignant recurrence
may develop
 TUMOR OF PERIPHERAL NERVE

• Neurofibromatosis:
• von Recklinghausen’s disease
• inherited (autosomal dominant) defect in tissues of ectodermal origin
• numerous pedunculated soft tissue tumors
• Cafe au lait spots - small scattered areas of skin pigmentation with smooth edges
 TUMOR OF PERIPHERAL
NERVE

• Neurofibromatosis:
• large diffuse mass may develop
about the head or neck forming
an unsightly drooping fold of skin
and soft tissue
• attached to large nerves like
sciatic nerve
• scoliosis and limb deformities are
common findings
THANK YOU!