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)