Bone TumorKaruniawan Purwantono

Head of Surgery Dept Christian University of Indonesia

Approach to Bone Tumor diagnosis - Back to Basics

a. General considerationsb. Relevant clinical information

1.Table-Age Groupsc. Radiological correlation

1.Table-Skeletal Site2.Table-Long Bone Site3.Table-Growth Patterns4.Table-Types of Periosteal Reaction 5.Table-Types of Tumor Matrix

d. General histologic assessment of the lesion.

General considerations

Bone Tumors can be divided into

• Primary Tumor

• Secondary Tumor

Secondary Tumor

subdivided• Metastatic tumors• Tumors resulting from contiguous spread of

adjacent soft tissue neoplasms• Tumors representing malignant

transformation of the pre-existing benign lesions.

most frequent malignant tumors found in bone

Secondary Tumor

Most common malignancies producing skeletal metastases

Adult> 40 years

carcinomas of the prostate, breast, kidney, lung and melanoma

Chilfren < 10 years

Neuroblastoma, rhabdomyosarcoma, andretinoblastoma

Secondary Tumor

Radiographic appearance of the metastatic tumors

• Purely lytic (kidney, lung, colon, and melanoma)

• Purely blastic (prostate and breast carcinoma)• Mixed lytic and blastic (most common

appearance)

Primary bone

Primary bone tumors are characterized by

• Predominant occurrence in the first 3 decades of life, The commonest sites for many primary tumors, both benign and malignant, are in the distal femur and proximal tibia

• specific radiographic presentations.

Primary bone

• Benign tumors > malignant(osteochondroma, non-ossifying fibroma, andenchondroma)• difficult to classify as benign or malignant• highest incidence : osteosarcoma and

multiple myeloma , followed by chondrosarcoma and Ewing's sarcoma.

Approach to Bone Tumor Diagnosis Relevant clinical information

• AGE

• PAIN

• MULTIPLE LESIONS

• SKELETAL LOCATION

• SITE OF LONG BONE INVOLVEMENT

• TYPES OF PERIOSTEAL REACTION

• TYPES OF PERIOSTEAL REACTION

• PATTERNS OF MATRIX MINERALIZATION

Primary bone

Two important features of bone tumors:• The ability of some to dedifferentiate (eg.,

enchondroma or a low-grade chondrosarcoma transforming into a high-grade sarcoma)

• Tendency of high-grade sarcomas to arise in damaged bone, at the sites of bone infarcts, radiation osteitis and Paget's disease

Primary bone Relevant clinical information

• Age • most important

clinical clue

Primary bone Relevant clinical information

pain• Growing lesions. This category includes locally

aggressive lesions (eg., aggressive osteoblastoma and GCT), and malignant tumors

• Pathologic fracture complicating either benign or malignant tumor

• Significant local tissue reaction to the tumor

Primary bone Relevant clinical information

MULTIPLE LESIONS• Radiological

Correlation

• PLAIN RADIOGRAPH• COMPUTER

TOMOGRAPHY• MRI is a method of

choice for local staging.

• BONE SCINTIGRAPHY is a highly sensitive but relatively non-specific technique

Primary bone Relevant clinical information

• SKELETAL LOCATION

Primary bone Relevant clinical information

• SITE OF LONG BONE INVOLVEMENT

PATTERNS OF GROWTH and BONEDESTRUCTION

geographic pattern Cortical expansion.

PATTERNS OF GROWTH and BONEDESTRUCTION

"Moth-eaten" pattern Permeative pattern

TYPES OF PERIOSTEAL REACTION

Focal cortical thickening Codman's triangle

TYPES OF PERIOSTEAL REACTION

"onion-skinning" andspiculated "hair-on-end" types

PATTERNS OF MATRIX MINERALIZATION

Osteoid• Malignant osteoid • cloudlike• Or• ill-defined amorphous• densities with haphazard• mineralization.

PATTERNS OF MATRIX MINERALIZATION

Osteoid Chondroid

Contoh kasus

Solitary Bone Cyst (SBC) Eosinophilic Granuloma (EG)

Non-Ossifying Fibroma (NOF) Fibrous Dysplasia

Chondroblastoma Giant Cell Tumor of Bone

Surgical staging

Surgical staging

treatment

Non surgical • Radioterapy • brachytherapy• Chemotherapy • Adjunavt Chemoth/• Neo adjuvant chemoth/

• Cryosurgery

Surgical • Excisional • Curetage • Amputation • Resection + bone

replacement /graft • Resection + arthroplasty

Surgical procedure

Bone excision Curetage

Treatment

Non surgical Surgical • Excisional

And soft tissue