BONE METASTSASIS

AND TUMOUR LIKE

CONDITIONS
ARAVINDA NARASIMHAN.V
ROLL NO 21
METASTASIS IN BONE
 Commoner than primary bone tumour
 Common tumours
 Breast
 Lung
 Prostate
 Renal
 Gastro-intestinal
 thyroid
CLINICAL FEATURES
 Known case of primary tumour
 Not known case of primary tumour
 Known case
 Bone pain – spine,ribs and extremities
 Pathological fracture – spine

 Not known case

 Bone pain – due to destructive lesion
 Pathological fracture – weakened bone
 Eg. Ca Thyroid , renal cell carcinoma , Ca
bladder
INVESTIGATIONS
 RADIOLOGY
 BLOOD
 OTHER INVESTIGATIONS
RADIOLOGY
 X-RAY
 Osteolytic
 Osteoblastic – isotope bone scan
 Sclerotic lesions – Ca breast , Ca prostate
 Common sites
 Spine
 Ribs
 Pelvis
 Humerus
 femur
 CT
 Bone metastases to the finger. Radiograph
shows a destructive expanded osteolytic
lesion in the metacarpal of the thumb in a
55-year-old man with lung carcinoma.
 Pathologic fracture. Radiograph shows a
displaced fracture through an osteolytic
lesion in the distal femur of a 53-year-old
woman with lung carcinoma.
 Lateral radiograph shows sclerotic metastasis
of the L2 vertebra in a 54-year-old man with
prostatic carcinoma.
 Axial computed tomography scan shows 2
rounded, mixed osteolytic-sclerotic lesions in
the thoracic vertebral body of a 44-year-old
woman with lung carcinoma.
BLOOD
 Full blood count
 ESR
 Serum calcium
 Serum phosphate
 Alkaline phophatase
 PSA
TREATMENT
 NSAIDS
 Radiotherapy
 Reossification
 Breast,lung,prostate
 Chemotherapy
 Smallcell ca lung , ewings sarcoma , thyroid ,
breast,neuroblastoma
 Surgery
TUMOUR LIKE CONDITIONS OF
BONE
 OSTEOCHONDROMA
 ENCHONDROMA
 SIMPLE BONE CYST
 ANEURYSMAL BONE CYST
 FIBROUS DYSPLASIA
OSTEOCHONDROMA
 Benign
 Metaphyseal
 Growth plate abnormality
 Tip of lump-cartilage
 Remaining-mature bone
CLINICAL PRESENTATION
 Adolescence
 Painless swelling
 Usually around knee
 Sessile or pedunculated

 complications
COMPLICATIONS
 Pain
 Bursitis
 Fracture of exostosis
 Compression of neuro-vascular bundle
 Limitation of joint movement
 Malignant transformation
 Rapid growth
 pain
INVESTIGATION & TREATMENT
 X-ray
 excision
Radiograph of 24-year-old woman who presented with a hard,
palpable mass on the medial aspect of the upper calf. A
bulbous, pedunculated osteochondroma arising from the medial
side of the upper tibial diaphysis and pointing away from the
metaphysis is noted. The patient reported no history of
hereditary multiple exostoses.
ENCHONDROMA
 Benign
 Cartilage with fibrous capsule
 20-30yrs
 Short bones of hand and feet
 Painless swelling with gradual increase in
size
 X-ray shows expanding lytic lesion
 Treatment – curettage and bone grafting
radiograph of the left hand demonstrates an expansile lytic lesion
in the proximal phalanx of the fifth digit with a distinct zone of
transition, thinning of the cortex, and a pathologic fracture. The
lesion involves the diaphysis and approaches the end of the bone
near the metacarpophalangeal joint.
UNCOMMON PRESENTATIONS
 OLLIER’S DISEASE
 Non hereditary
 Childhood
 Persisting of unossified cartilage in metaphyses of
long bones
 Usually multiple
 Shortening and deformities

 MAFUCCI SYNDROME
 HEREDITARY
 MULTIPLE
ENCHONDROMAS & CAVERNOUS
HEMANGIOMAS
SOLITARY LESIONS OF BONE
 SIMPLE BONE CYST
 Cavityin bone lined by thin membrane with
serous fluid
 ANEURYSMAL BONE CYST
 blood filled space enclosed in a shell
 FIBROUS DYSPLASIA
 Normal bone replaced by fibrous tissue
 Albright’s syndrome
 FEATURES SIMPLE BONE ANEURYSMAL FIBROUS
CYST BONE CYST DYSPLASIA

AGE <20 10-40 20-30

COMMON BONES UPPER HUMERUS* TIBIA NECK OF FEMUR

UPPER FEMUR HUMERUS TIBIA

LOCATION METAPHYSIS METAPHYSES METAPHYSES

X-RAY MAXIMUM WIDTH DISTENDING MULTI LOCULATED

LESS THAN WIDTH LESION BALLONING GROUND GLASS
OF GROWTH PLATE THE BONE APPEARANCE
TRABECULATIONS+
+
TREATMENT CURETTAGE AND SAME SAME
BONE GRAFT
SIMPLE BONE CYST
A 7-year-old boy with a simple
bone cyst in the upper
metaphyseal region of the right
humerus. The cyst has a
multilocular appearance.
ANEURYSMAL BONE CYST
FIBROUS DYSPLASIA
Image shows homogeneous loss of the
normal trabecular pattern in the shaft of
the humerus, with a ground-glass
appearance caused by fibrous dysplasia.
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