Classification of Tumor

Benign Arising From ….. Malignant

Osteoma Bone Osteosarcoma
Osteoid osteoma
Osteoblastoma
Gaint Cell Tumor
Enchondroma Cartilage Chondrosarcoma
Osteochondroma
Chondromyxoid fibroma
Chondroblastoma
Non fibrous corticol defect Fibrous tissues Malignant fibrous histiocytoma
Non-ossifying fibroma
Fibrous dysplasia
Simple bone cyst Tumor of uncertain origin Ewing’s sarcoma
Aneurysmal bone cysts Adamantinoma

Comparison between benign and malignant tumor

Benign Malignant
Clinical features Asymptomatic and Incidental Local pain, swelling, limp and pathological
fracture,
Imaging Single lesion Multiple lesions suggesting of metastasis.
Margin of the Slow growing with well define margin or Rapidly growing with Ill-defined margin and
lesion with sclerotic margin. appear diffusely into the surrounding structure.
Blood Supply Low blood supply Extensive blood supply via angiogenesis
Perisoteal Thick well-orgenized periosteal (slow Thin layers of priosteal (rapidly growing
reaction growing lesion) malignant lesion)
Breach of bone Very seldom involve the contex Cortex involvement suggesting of malignant
cortex lesion
Soft tissue mass Less likely to involve the adjacent soft Extension to the adjacent tissue suggesting of
tissue aggressive lesion.
 OSTEOSARCOMA

DEFINITION/AETIOLOGY PATHOPHYSIOLOGY STAGING HISTORY

• Highly malignant tumor Stag Grad • age : young
• Arise within the bone Tumor Metastasis adolescene
e e
• Spread rapidly • paget’s disease
outwards to the • Rothmund-Thomson
IA G1 T1 M0
periosteum and syndrome
surrounding soft • familial retinoblastoma
tissues. B G1 T2 M0 syndrome
• Histlogical = • Li-Fraumeni syndrome
considerable variation. IIA G2 T1 M0 • male>female
• Some areas may • c/o : worsening dull
consist of characteristic IIB G2 T2 M0 pain/progressive
spindle cells in an swelling
osteoid matrix; others • hx of radiation
G1 or T1 or
may contain cartilage III M1 • family hx of cancer
G2 T2
cells or fibroplastic (genetic predispostn)
tissue with little or no • cnsttnl sx : LOA,LOW,
osteoid nightsweat, fever
Enneking staging system 1980
• most common = around • hx preceded by
the knee/proximal trauma/fracture
Stage IA : LGT, intracompartmental
humerus and femur • pathology fracture
Stage IB : LGT, extracompartmental
• limping
Stage IIA : HGT, intracompartmental
Stage IIB : HGT, extracompartmental
Stage III : Any tumor with evidence of
metastasis

PHYSICAL EXAMINATION INVESTIGATION MANAGEMENT

Mass:
 tender
 warm
 increased skin
vascularity over the
mass(dilated vein)
 Pulsations or a bruit
may be detectable.
Decreased range of
motion:
 Involvement of a joint
should be obvious on
physical examination.
Lymphadenopathy:
 unusual.
Respiratory findings:
 Auscultation is usually
uninformative unless
the disease is
extensive.
Plain radiograph of the bone : • Neoadjuvant Chemotherapy
 Entirely osteolytic, others show alternating areas of lysis and increased • Surgical Resection
bone density. • Adjuvant Chemotherapy
 Margins are poorly defined. • Local Radiotherapy
 ‘Sunburst’ effect - The cortex is breached and the tumour extends into
the adjacent tissues  streaks of bone appear, radiating outwards from
the cortex.
 Codman’s triangle – the reactive new bone forms in the angle between
periosteum and cortex.
In histology, osteoid is the unmineralized,
organic portion of the bone matrix that forms
Osteosaroma with
sunburst
prior to the maturation of bone tissue.
periosteal reaction Osteoblasts begin the process of forming
bone tissue by secreting the osteoid as
several specific proteins. When the osteoid
becomes mineralized, it and the adjacent
Chest radiograph :
bone cells have developed into new bone
 To detect presence of pulmonary metastases
tissue.
Radioisotopes :
 To detect for the presence of metastatic disease Osteoid makes up about fifty percent of bone
 Reveal skip lesions (a –ve scan does not exclude them) volume and twenty-five percent of bone
Ct scan : weight. It is composed of fibers and ground
 Extend of the tumour substance. The predominant fiber-type is
 more sensitive than is plain film radiography for assessing pulmonary Type I collagen. The ground substance is
metastases. mostly made up of chondroitin sulfate and
MRI : osteocalcin.
 To assess the extent of intramedullary disease as well as associated
soft-tissue masses and skip lesions.
When there is insufficient mineral or
Biopsy :
 Presence of osteoid in the lesion, spindle shaped stromal cells & atypical osteoblast dysfunction, the osteoid does
with irregularly shaped nuclei. not mineralize properly, and it
 Should always be performed before commencing treatment. accumulates. This process is called
ALP and LDH :
 Elevated ALP indicates that there could be active bone formation osteomalacia. Osteomalacia, when present
occurring as ALP is a byproduct of osteoblast activity. in children, is termed rickets.