osteosarcoma & ewin's sarcoma
DESCRIPTION
PPT of Osteosarcoma & Ewing,s Sarcoma. Orthopedic Point of View.TRANSCRIPT
OSTEOSARCOMA
EWING’S TUMOR
PRESENTER: ABDUL MUSHIB IBRAHIM
COORDINATOR: DR MAREKO
Osteosarcoma
• DEFINITION:- is a malignant tumor of the bone.-there are 2 types:a)Primary Osteosarcomab)Secondary Osteosarcoma
CAUSE: Unknown.
a) Primary Osteosarcoma
• Arises in absence of underling bone disease or predisposing factors.
• Most common in 2nd decade of life.• Usually situated in central metaphyseal region
of long Tubular bones. * Proximal Humerus * Distal Femur * Proximal Tibia
Osteosarcoma of Humerus
Osteosarcoma of Humerus
Osteosarcoma of Humerus
Osteosarcoma of Femur
Osteosarcoma of Femur
b) Secondary Osteosarcoma
• Occurs as a background of some predisposing factor.
• Occurs in other locations (e.g Jaws).• Usually occurs later in Life.PREDISPOSING FACTORSPagets Disease (common)Irradiation (Uncommon)Fibrous Dysplasia (rare)Diaphyseal Aclasis (Very rare)
PATHOLOGY
• Tumor arises in the metaphseal region of the bone Extends in all directions.
Eventually eroding cortex, invading soft tissues. (Producing obvious extraosseous mass).
Codman’s Triangle: When penetrating the cortex, tumor lifts the periosteum. Angle betn outer surface of cortex & elevated periosteum radiologially.
Codman’s Triangle
PATHOLOGY
• Cut surface Grey-white areas of hemorrhages & necrosis.
• If untreated fungates to produce an infected malignant ulcer.
* Sometimes the ulcer overlies a Pathological fracture.
PATHOLOGY
• MICROSCOPIC FEATUREFormation of osteoid directly by tumor cells.
• SPREADMainly to the Lungs.
CLINICAL FEATURES
• SYMPTOMS1.Local Pain-Persistant ache or throb.2.Swelling of Bone.3.Pathological Fracture.4.Infected malignant Fracture.5.General Malaise, cachexia & Weight loss.6.Cough & Hemoptysis.
CLINICAL FEATURES
• SIGNSLOCAL SIGNS…..SWELLING -Usually in lower end of femur, upper end of
tibia & upper end of humerus. -Colour: affected skin may be reddened. -Tenderness: Slightly -Temp: Usually Raised -Shape: Asymmetrical. -Surface: Usually smooth but Infected M U -Composition: Firm & Not Bony Hard
DIAGNOSTIC INVESTIGATIONS
• 1-Radiology• 2-Histology
DIAGNOSTIC INVESTIGATIONS
1-Radiologya) Ostcolytic Lesions in bone with ill defined edges.b)Extension into soft tissues. Neoplastic bone tends
to be deposited as irregular spicules radiating away from the shaft to give a “sunray” appearance.
c) Codman’s Triangle.d)Pathological Fracture.e)Secondaries to Lung.
DIAGNOSTIC INVESTIGATIONS
2-Histologya)To confirm the diagnosis.b)Obtained by: Needle Biopsy or Open Biopsy
TRETMENT OPTIONS• OPERATIVEa) Amputationb)Wide Local resection with replacement of defect
by prosthesis or allograft.• ADJUVANT CHEMOTHERAPYGive Postop to control & prevent development of
metastasis.• TREATMENT OF PULMONARY 2°a) Solitary: Lobectomyb)Multiple: Chemo.
PROGNOSIS
• Prognosis is separated into 3 groups.A.STAGE I• Is rare.• Includes perosteal region• Prognosis > 90% with wide resection.
PROGNOSISB. STAGE II• Depends on site of tumor.• Size of tumor.• Degree of necrosis from Chemo.• Distant Metastatsis to lungs. (Length of time &
Number of Nodules spread over a time span).• 2-year survival after the metastases-50%, 5-
year-40% and 10 year -20% (2 yrs no spread + < 2 nodules)
PROGNOSIS
C. STAGE III• Metastasis to lungs• Depends on removing primary & lung
nodules.• survival prognosis is about 30%
ANY POINTS FOR DISCUSSION?????????????
EWING’S SARCOMA
DEFINITION
• Is a malignant round cell tumor.• Initially starts in the bones & may also include
the soft tissues.• Extraosseous Ewing's sarcoma. • Exact cell of origin for Ewing's sarcoma. (Oc).
CAUSE: UNKNOWN
• RISK FACTORS: Unknown• GENETIC FACTORS: Unknown• PREVENTION: Unknown
• male/female ratio of 1:6• Peak Age: 10-20 yrs
• affects the long bones, such as:• Pelvic Bone • Ribs• Clavicle• Femur• Humerus• Tibia
SYMPTOMS
• Pain• Swelling• tumor may be present for many months
before it becomes large enough to cause pain and swelling.
• bone weakened by disease may break after a minor injury.
DIAGNOSING
• Hx• Imaging: X-ray, CT, MRI, Bone Scan.• X-Ray will show “ONION SKIN” type periosteal
reaction• BIOPSY • Chromosomes #11 and #22 are affected.
X-ray
TREATMENT
• NON OPERATIVEChemotherapy: vincristine , dactinomycin,
cyclophosphamide and doxorubicin • OPERATIVESurgery• RADIATION Therapy
PROGNOSIS
• Five-year survival for localized disease is 70% to 80% when treated with chemotherapy.
• Long term survival for metastatic disease can be less than 10%
Any Points For DISCUSSION
THANK YOU FOR YOUR TIME