bone tumours dr valentine mandizvidza. bone tumours 1. benign tumours 2. malignant tumours further...

BONE TUMOURS

DR Valentine Mandizvidza

BONE TUMOURS

1. Benign tumours2. Malignant tumours

Further classified as

1.Primary2.Secondary

Bone Tumours

Further classified according to tissue of origin

- bone-forming(osteogenic)- cartilage-forming (chondrogenic)- fibrous (fibrogenic)-vascular

Role of Imaging

1. Detection

2. Diagnosis

3. Surgical staging

4. follow-up

Imaging

40-50% trabecular bone distraction before an area of lucency is demonstrated

Cortical destruction is far more easily seen

Difficult to detect in areas such as the spine and pelvis

Clinical History and Examination

Used in conjuction with radiographic findings to come up with differential diagnoses

DIAGNOSIS OF BONE TUMOURS

Clinical History and Examination

Age

Previous medical history

Family history– Ollier’s disease (multiple enchondromas)

Ethnic/ geographic origin– KS(HIV), Burkitt’s lymphoma(tropical Africa)

AGE

AGE

Radiographic Assessment

1. Site in skeleton WHICH BONE IS AFFECTED?

2. Location in bone WHERE IN THE BONE IS THE LESION?– OS (metaphysis or metadiaphysis– ES (metaphysis or diaphysis)– Epiphyseal lesion in a child (chondroblastoma, langerhans cell histiocytosis,

abcess)

3. Pattern of bone destruction WHAT IS THE TUMOUR DOING TO THE BONE?

4. Periosteal reaction WHAT FORM IF ANY IS PRESENT?

5. Matrix WHAT TYPE OF MATRIX MINERALIZATION?

Radiographic AssessmentPATTERN OF BONE DESTRUCTION

• Fast/ Slow growth• Permeative or moth eaten/ well defined

margins

Lytic, expansile & well defined ABC

Radiographic Assessment

Radiographic Assessment

PERIOSTEAL REACTION

ShellLamellarInterruptedCombined

Radiographic Assessment

Radiographic Assessment MATRIX

Osteiod, cloud to ivory-like Cartilage is stippled, popcorn in appearance

Enneking Classification of Benign Bone Tumours

STAGE DESCRIPTION TUMOUR EXAMPLES

1 Inactive NOF, Enchondroma

2 Active GCT, ABC, UBC, Chondroblastoma

3 Aggressive GCT, ABC

Enneking Classification of Malignant Bone Tumors

Stage Description

I A Low grade, intracompartmental

I B Low grade, extracompartmental

II A High grade, intracompartmental

II B High grade extracompartmental

III Metastatic disease

American Joint Commission for Cancer (AJCC)Classification System for Bone Tumours

Stage Grade Size of Tumour Regional Nodes

Metaatasis

I A G1-G2 T1 N 0 M 0

I B G1-G2 T2 N 0 M 0

II A G3-G4 T1 N 0 M 0

II B G3-G4 T2 N 0 M 0

III Any T3 N 0 M 0

IV A Any Any N 1 M 0

IV B Any Any Any Nodal Status

M 1

Dahlin Modification of Lichtenstein Classification System

Cell Type Benign Malignant

Bone Osteoid osteoma, osteoblastoma Osteosarcoma

Cartilage Enchondroma, osteochondroma,chondroblastoma, chondromyxoid fibroma, periosteal chondroma

chondrosarcoma,

Fibrous Nonossifying fibroma Fibrosarcoma, Malignant fibrous histiocytoma

Vascular Hemangioma Hemangioendothelioma, Hemangiopericytoma

hematopoietic Myelomalymphoma

Nerve neurilemmoma Malignant peripheral nerve-sheath tumor

Lipogenic lipoma liposarcoma

Notochordal Notochordal rest chordoma

Unknown Giant cell tumor, ABC,SBC Ewing sarcoma, Adamantinoma

BENIGN BONE TUMOURS

SBC

ABC GCT

BENIGN BONE TUMOURS

OSTEOCHONDROMA

ENCHONDROMA

Malignant bone forming tumoursOSTEOSARCOMA

.

CHONDROSARCOMA

EWING’S SARCOMA

MULTIPLE MYELOMA

METASTATIC BONE DISEASE

OSTEOLYTIC OSTEOBLASTIC MIXED (osteolytic/osteoblastic)

Lung Prostate Breast

Thyroid Bladder

Kidney

Gastrointestinal

lung

prostate

breast

Tumours occurring in the vertebrae

Anterior (vertebral Body) Posterior elements

Giant cell tumour Osteoid osteoma

Metastatic disease Osteoblastoma

Multiple myeloma Aneurysmal bone cyst

Ependymoma

Chordoma

Lymphoma

Primary bone tumours (chondrosarcoma, osteosarcoma)