kuliah s1 uniba bone.ppt

8/18/2019 kuliah s1 UNIBA BONE.ppt

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Diagnosis of Bone Tumours

1. Age of patient

2. Location of tumour

3. Radiological appearance

4. Histological features


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Age group Most common benign lesions Most common malignant tumors

0-20

non-ossifying fibroma

fibrous dysplasiasimple bone cystaneurysmal bone cystosteochondroma (exostosis)osteoid osteomaosteoblastomachondroblastomachondromyxoid fibromaeosinophilic granuloma

Ewing's sarcomaleukemic involvementmetastatic neuroblastomaosteosarcomaEwing's sarcoma

2!-"0enchondromagiant cell tumor chondrosarcoma

#"0 osteoma

metastatic tumorsmyelomaleukemic involvementchondrosarcomaosteosarcoma ($aget's associated)%&

chordoma


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SITE OF LONG BONE INVOLVEMENT (most primary bone tumors have favored sites within long bones this may provide a clue todiagnosis)

Diaphyseal intramedullary lesions:Ewing's sarcoma, lymphoma, myeloma. *ommon for i!ro"s #ysplasia andenchon#roma

Metaphyseal lesions centered in thecortex:$lassic loca%ion or a non&ossi ying

i!roma NOF(. +lso a common site forosteoid osteoma

Epiphyseal lesions:$hon#ro!las%oma $h( an# Gian%$ell T"mor G$T( are almost

invariably centered in the epiphysis*hondroblastoma is a rare tumorseen in children and adolescents withopen growth plates ,* is the mostcommon tumor of epiphyses inskeletally mature individuals withclosed growth plates ,* oftenshows metaphyseal extension

Metaphyseal exostosis:Os%eochon#roma

Metaphyseal intramedullary lesions:Os%eosarcoma is usually centered in themetaphysis *hondrosarcoma and

fibrosarcoma often present as metaphyseallesions .steoblastoma enchondromafibrous dysplasia simple bone cyst andaneurysmal bone cyst are common in thislocation

Diaphyseal lesions centered inthe cortex:Os%eoi# os%eoma


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Radiological Features


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PRIMARY !M"R# "F $"%&

' Bone-producing tumors ( "steoma) osteoid osteoma) osteo*lastoma ( "steosarcoma+

' Cartilage-producing tumors ( "steoc,ondroma) c,ondroma -enc,ondroma ( c,ondrom/0oid fi*roma ( c,ondro*lastoma

( ,ondrosarcoma+

' Miscellaneous tumors ( & ing s sarcoma +

( iant cell tumor of *one


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umour5li6e conditions of *one

' $one c/sts ( #imple *one c/st ( Aneur/smal *one c/st

' Fi*rous5osseous lesions ( Fi*rous d/splasia

' &osinop,ilic granuloma -Langer,ans ,istioc/tosis


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Benign TumoursOsteochondroma

Also 6no n as an e0ostosis) is a cartilage (cappedout gro t,.

Men are affected t,ree times more oftent,an omen

7e8elop in *ones of endoc,ondral origin and arise fromt,e metap,/sis near t,e gro t, plate of long *onesespeciall/ a*out t,e 6nee


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7e8elopment o8er time of an osteoc,ondroma*eginning it, an outgro t, from t,e epip,/sealcartilage


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linicall/ present as slo gro ing masses

an *e painful if t,e/ impinge on a ner8eor if stal6 is fractured.

In man/ cases) t,e/ are detected as anincidental finding.

Rarel/ t,e/ gi8e rise to c,ondrosarcoma

Osteochondroma


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Osteochondromaof femur

The white arrows point to a mushroom-shaped, peduculatedbony excresence arising from the anteromedial aspect of thedistal femoral metaphysis, attached to the parent bone andpointing away from the metaphyisis


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Osteochondroma


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Chondroma$enign tumours of ,/aline cartilage

Ma/ arise it,in t,e medullar/ ca8it/5enc,ondroma

Ma/ arise on t,e surface of *one ( su*periosteal c,ondroma

&nc,ondromas are t,e most common

Located in t,e metap,/seal region of tu*ular *ones

Most enc,ondromas are as/mptomatic and detectedas incidental finding


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Enchondroma of the phalanx witha pathological fracture


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&nc,ondroma it, a nodule of ,/aline cartilage encased*/ a t,in la/er of reacti8e *one.


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"llier s 7isease9 Multipleenc,ondroma.


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Chondroblastoma' Rare *enign tumor ' Most common primar/ epip,/seal tumor in

c,ildren

' #igns:#/mptoms9' Local pain and s elling; tumors 1.< to =.< cm' Age9

' 2 nd decade of life

' #e09' M > F' Anatomic 7istri*ution9

' &pip,/sis of long *ones' 4


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L/tic lesion of epip,/sis it,t,in sclerotic rim; t,inningit,out destruction of corte0

Chondroblastoma


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ellular lesion it,pol/,edral c,ondro*lasts;

giant cells and areas ofcalcification ma/ *e seen;

mitoses common


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Osteoid osteoma and Osteoblastoma

Ha8e identical ,istolog/

"steo*lastoma larger t,an osteoidosteoma


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Osteoid osteoma

@ 2 cm in greatest dimension

Affects teenagers and adolescents

= ? of patients @ 2 /ears

Affects corte0 of femur or ti*ia

Painful lesion

Relie8ed */ salic/late


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"steoid osteoma of Femoral nec6


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Osteoid osteoma


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"# &"$LA# "MA

' linicall/ similar to osteoid osteoma -large' Also 6no n as giant osteoid osteoma.' ommon location 55 8erte*ral column

' Histolog/ similar ( *ut rare nidus.' an *e locall/ aggressi8e' ,erap/ 5 curettage:resection it, *one graft.


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Osteosarcoma O!"

Most common primar/ malignanttumor of t,e *one

Mesenc,/mal tumor

ancerous cells produce *one matri0

= ? occur in patients /ounger t,an 2</ears of age


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Primar/ osteosarcoma arise in t,e

metap,/sis of long *ones of t,ee0tremities

#econdar/ osteosarcomas occur in olderpatients it, Paget s disease

More common in men t,an omen

ommon sites are distal end of femur or pro0imal ti*ia

Osteosarcoma O!"


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Patients it, Mutation of R* gene arepredisposed to osteosarcoma

oncurrent trauma to *ones and Boints

In t,e elderl/ "# often arises from pree0isting *one diseases eg9 Paget s

disease of *one

Osteosarcoma O!"


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Clinical #resentation

Painful and progressi8el/ enlarging masses

#pread t,roug, *lood stream

,e tumour *rea6s t,roug, t,e corte0and lifts t,e periosteum

"ften metastasiCes to t,e lungs

Osteosarcoma O!"


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Osteosarcomaon distal end offemur

Cortex isdestroyed


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$eoplastic osteoblasts forming osteoid


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$eoplastic osteoblasts forming osteoid


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Chondrosarcoma

FreDuenc/ is a*out ,alf ofosteosarcoma

#econd most common malignant matri0producing tumor

Mean age for c,ondrosarcoma is 43/ears

Men are affected more t,an omen


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Chondrosarcomas

ommonl/ arise in t,e centralportions of t,e s6eletonincluding Pel8is) pro0imal femur) ri*s)sternum and s,oulder girdle


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Present as painful progressi8el/enlarging masses

Prognosis depends on siCe of tumor

#preads to lungs and s6eleton

Chondrosarcoma


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Chondrosarcoma


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umor ,as de8eloped in t,e pro0imalfemur

%ot destro/ed t,e corte0

Has a *luis,) glass/ appearance )reminiscent of cartilage

Chondrosarcoma

Malignant neoplastic cells produce a chondroid matrix


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g p p


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The aggressi)eness o chon#rosarcomas can !e pre#ic%e# ! %heir his%ologic gra#e rading system is based on three parameters/ cellularity


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The aggressi)eness o chon#rosarcomas can !e pre#ic%e# !y %heir his%ologic gra#e. ,rading system is based on three parameters/ cellularitydegree of nuclear atypia and mitotic activity

Gra#e * low&gra#e(ery similar to enchondroma owever the cellularity is

higher and there is mild cellular pleomorphism he nuclei aresmall but often show open chromatin pattern and smallnucleoli 1inucleated cells are fre uent %itoses are very rare,rade ! chondrosarcomas are locally aggressive and prone torecurrences but usually do not metastasi3e

Gra#e + low&gra#e(he cellularity is higher than in ,rade ! tumors *haracteristic

findings are moderate cellular pleomorphism plump nucleifre uent bi-nucleated cells and occasional bi3arre cells %itosesare rare &oci of myxoid change may be seen 4nlike ,rade !tumors about !05 to !65 of ,rade 2 chondrosarcomas

produce metastases

Gra#e high&gra#e(*haracteristic findings are high cellularitymarked cellular pleomorphism high 78*ratio many bi3arre cells and fre uentmitoses (more than ! per hpf) hese arehigh grade tumors with significantmetastatic potential


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O!TEO!%&COM% C'&O$D&O!%&COM%

' 1


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In8ol8e *ot, epip,/sis and metap,/sis

In adolescents limited to metap,/sis

ommon sites are distal femur andpro0imal ti*ia

(iant cell tumour of bone (CT"


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Ewing sarcoma E!"

Primar/ malignant small round cell tumour

& ing sarcoma ,as t,e /oungest

a8erage age at presentations -1


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Pel8is is t,e most common siteusuall/ arises in t,e diap,/sis of

long *ones especiall/ femurfollo ed */ ti*ia and ,umerus

Ewing sarcoma E!"


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Ewing sarcoma

of tibia from achild


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The ollowing s%"#ies are re-"ire# %o s"ppor% %he #iagnosis o ES an# NET /

Demonstration of t(11;22) or EWS- !"-1 fusion transcript (present in both E9 and $7E ) "mmunostains (both E9 and $7E are positive for *:;;8.!< =n addition $7E shows positive stainingwith neural markers)

EM (E9 cells are undifferentiated and show prominent glycogen deposits $7E shows neuraldifferentiation)

Ewing sarcoma E!"


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,e pat, a/s of spread include

7irect e0tension

L/mp,atic or 8ascular dissemination

Intraspinal seeding

Ewing sarcoma E!


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!econdary tumours of bone

Metastatic cancer to *one ismore common t,an primar/

cancer of *one


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)*+ of bone metastasis originate from

ancers of prostate *reast 6idne/ lung

t,/roid

Metastatic lesions are multifocal

Produce a l/tic and or *lastic reaction

Bone metastasis


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Bone metastasis


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#rostatic carcinoma metastatic to bone


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kuliah s1 uniba bone.ppt

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