1. 1. DR. HAIFA MUSTFA EL MILUDI Burn and plastic surgery hospital
2. 2. HAND BONY TUMORS Abstract Bone tumors develop when cells in the bone divide without control, forming a mass of tissue. Most bone tumors are benign, not cancer and cannot spread. However, they may still weaken bone and lead to fractures or cause other problems. Bone cancer destroys normal bone tissue and may spread to other parts of the body (called metastasis).
3. 3. CLASSIFICATION bone tumour is neo-plastic growth of tissue in bone abnormal growth found in the bone benign (noncancerous ) or malignant (cancerous ) bone tumours may be classified as 1-primary tumours which originate in bone or from bone 2- secondary tumours which originate in other sites and spread metastasies to the Skelton as carcinoma of the prostate, breasts, lung, thyroid and kidneys Primary bone tumours divided into benign tumours and malignant tumours .
4. 4. CLASSIFICATION The benign tumours 1-EnChondroma 2- Osteochondroma 3- Osteoid osteoma 4- unicameral bone cysts ( cystic lesion ) 5- Giant cell bone tumor 6- chondroblastoma
5. 5. CARTILAGINOUS TUMORS EnCHONDROMA Most common primary hand btumor 3rd and 4th decades common in adult M=F most commonly site in the phalanges usually in the proximal and middle phalanx and in shaft of metacarpal bone as solitary enchondroma ,multiple enchondroma ollier disease ( enchondromatosis )
6. 6. Solitary Enchondroma
7. 7. Multiple enchondroma(ollier disease)
8. 8. ENCHONDROMA PRESENTION Asymptomatic with local edema sudden onset of pain swelling and pathological fracture . rapid growth concern for malignant degeneration . DIAGNOSIS plain radiographs On an X-RAY they appear as dark hole in the bone but usually they have calcification or white spots in the hole
9. 9. TREATMENT Surgical treatment (curettage of lesion ) &bone graft Multiple enchondromatoses Deformities treated by osteotomy
10. 10. OSTEOCHONDROMA osteochondroma (exostosis )primary benign hand tumor more commone in young Presentation 1- Mass, may be painful secondary to irritation of soft tissue and structures. 2-angular deformities becous inhibition of longitudinal growth and mechanical blockage of joint 3-pathological fructure
11. 11. DIAGNOSIS Radiographic scattered calcification within the cartilaginous cap Treatment : Observation if asymptomati if symptomatic surgical , removal of the cartilage cap. OSTEOCHONDROMA
12. 12. OSTEOID OSTEOMA benign osseous tumor usually less than 1.5 cm in diameter no cases of malignant transformation . Common in 2nd and 3rd decad M;f 3;1 common sites phalanges metacarpls &carpal bone (scaphoid capitate ) presention typical pain worse at night relieved NSAIDS
13. 13. OSTEOID OSTEOMA Diagnosis 1-Radiographs :the lesion is seen as small round lucency (the nidus )situated within the cortex ,surrounded by sclerotic , reactive bone treatment 1 -symptomatic treatment with NSAIDs 2- surgical treatment (curettage &bone grafting ) complicaion 1-fracture 2- recurrence .
14. 14. CYSTIC LESIONS UNICAMERAL BONE CYST membrane lined cavity containing a clear yellow fluid. occurrs most often in children 4-10 years of age. Most common sites (metacarpal &metaphysis of bone) they enlarge during skeletal growth and become inactive,, after skeletal maturity.(heal spontaneously at maturity)
15. 15. UNICAMERAL BONE CYST Presention 1-Asymptomatic unless pathological fracture diagnosis Radiologically : Centrally located, purely radiolucent lesion . No cortical destruction Treatment 1- observation 2-aspiration 3-injection of steroid 4- curretage of bone
16. 16. GIANT CELL TUMOR (GCT) a common benign but locally aggressive lesion of unknown etiology; occurs chiefly in men between 20-50 yrs (after epiphyseal closure). Presention: 1-pain and swelling 2-pathological fracture.
17. 17. GIANT CELL TUMOR (GCT) DIAGNOSIS 1-PLAIN radiographs lytic with cortical expansion. 2- staging for GCT of bone (radiographs) - STAGE I no perforation of cortex . - STAGE II perforation of cortex without soft tissue involvement . - STAGE III perforation of the cortex with extension into soft tissues . 3-incisional biopsy .
18. 18. GIANT CELL TUMOR (GCT) TREATMENT surgical phalanges &metacarpal 1- stage I and II curettage and cavity packed with bone graft 2-Stage III amputation with reconstruction .
19. 19. GIANT CELL TUMOR (GCT) COMPLICATION 1- stiffness 2- infection 3- joint collapse 4-neurapraxia 5- recurrence
20. 20. CHONDROBLASTOMA Chondroblastoma is benign tumor derived from germ cell its rare bone tumor. patient usually present with pain associated with limited motion of affected joint and soft tissue swelling . Clinical presentation : painful - motion limiting, benign tumor arising during adolescence.
21. 21. CHONDROBLASTOMA Diagnosis : Radiographs: - oval osteolysis located in the epiphysis; - slight bone expansion of cortex; - tumor is usually bordered by a well defined margin Treatment curettage with possible use of liquid nitrogen or phenol
22. 22. MALIGNANT BONE TUMORS & CARTILAGE TUMORS 1- CHONDROSARCOMA 2- OSTEOSARCOMA 3- EWING S SARCOMA
23. 23. CHONDROSARCOMA Most common primary malignant bone tumor of the hand in the 4th and 6th decade of life. COMMON SITE Proximal phalanx and metacarpals but rare in carpus bone . PRESENTION 1- slowly enlarged firm mass often painful 2- symptoms could be present in more than 10 years .
24. 24. CHONDROSARCOMA diagnosis 1- RADIOGRAPHS (cortical expansion and destruction , endosteal erosion mineralization and pathological fracture ). 2- histopathology (incisonal biopsy ) correlate to improve sensitivity. 3- staging chest CT .
25. 25. CHONDROSARCOMA TREATMENT 1- wide en bloc resection limp sparing or amputation and reconstruction . COMPLICATION 1- infection 2- recurrence
26. 26. OSTEOSARCOMA Osteosarcoma less than 1% presented in the hand . 4th to 7th decad of life usally arise de novo from the bone may be secandary to pagets disease and ionizing radiation . metastasis from hand tumors less common .
27. 27. OSTEOSARCOMA COMMON site 1 - metacarpals and phalanges 2- carpal bone tumor rare . PRESENTION 1- palpable soft tissue mass with localized tenderness. 2- pain and swelling . 3- pathological fracture . 4- average duration before presention is 3 months .
28. 28. OSTEOSARCOMA DIAGNOSIS 1- bone scan plain films and CT scan of the chest for staging . 2- MRI of involved hand for surgical planning 3- incisional biopsy .
29. 29. OSTEOSARCOMA TREATMENT 1.chemotherapy 2.limb sparing wide en bloc excision and reconstruction or ampution . 3. radiation after induction chemotherapy. COMPLICATION 1-wound healing difficulties. 2-recurrence.
30. 30. EWINGS SARCOMA Ewing sarcoma 10% of all primary malignant bone tumors .rare in the hand . in patients less 20 years male more than femle common site metacarpals and proximal phalanges . PRESENTION 1-swelling pain and erythema may present with fever.
31. 31. EWINGS SARCOMA 2-may show leukocytosis and elevated sedimention rate nonspecific . DIAGNOSIS 1- MRI for diagnosios local staging and surgical planning 2-incisional biopsy . 3-chest X ray and CT , bone scan ,bone marrow aspirate for oncological workup .
32. 32. EWING S SARCOMA TREATMENT 1-chemotherapy to decrease tumor size . 2- wide en bloc resection and reconstruction 3- radiation if poor response to chemotherapy . COMPLICATION 1-recurrence .