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An Approach to Malignant Bone Tumors

An Approach to Malignant Bone Tumors. Dr.Suhas B MD Radio-Diagnosis. Introduction. Bone tumors are classified into: Primary bone tumors Secondary bone tumors ( Metastasis)

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An Approach to Malignant Bone Tumors

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  1. An Approach to Malignant Bone Tumors Dr.Suhas B MD Radio-Diagnosis

  2. Introduction Bone tumors are classified into: Primary bone tumors Secondary bone tumors ( Metastasis) Most are classified according to the normal cell of origin and apparent pattern of differentiation. Forms 0.2% of human tumor burden. Primary malignant bone tumors make 1% of all malignant tumors. Commonest bone tumour is secondaries from other sites. Commonest primary bone tumour is multiple myeloma, second osteosarcoma.

  3. Occurence

  4. Classification Bone-forming tumours Cartilage forming tumours Giant-cell tumour Marrow tumours Vascular tumours Other connective tissue tumours Other tumours Secondary malignant tumours of bone

  5. Bone-forming tumors (malignant) Osteosarcoma Central (medullary) Peripheral (surface) Paraosteal Periosteal High grade surface Cartilage-forming tumors (malignant) Chondrosarcoma Differentiated chondrosarcoma Juxta-cortical chondrosarcoma Mesenchymal chondrosarcoma Clear cell chondrosarcoma Marrow tumors (malignant) Ewing’s sarcoma Neuroectodermal tumour Malignant lymphoma of bone (Primary/secondary) Myeloma Vascular tumors (malignant) Angiosarcoma Malignant haemangio pericytoma Other tumors (malignant) Chordoma Adamantinoma

  6. Other connective tissue tumours (malignant) Fibrosarcoma Malignant fibrous histiocytoma Liposarcoma Malignant mesenchymoma Leiomyosarcoma Undifferentiated sarcoma Secondary malignant tumours of bone Osteoblastic Osteolytic Mixed Lesions

  7. Evaluation Age & Sex Symptomatology Pain Swelling History of trauma Neurological symptoms Restriction of movement Other constitutional sympotms (cough, chest pain, backache, loss of appetite etc) Pathological fracture Associated conditions Prior surgeries/investigations

  8. Age distribution of various bone tumors

  9. Imaging Plain radiography CT scan MRI Radionuclide scanning PET

  10. Plain Radiography Information yielded by radiography includes : Size Site of the Lesion Borders of the lesion/zone of transition Type of bone destruction Periosteal reaction Matrix of the lesion Nature and extent of soft tissue involvement Multiplicity

  11. Plain radiography (contd.) Size It helps us in pre treatment staging of the tumor. The larger the lesion the more likely to be aggressive or malignant.

  12. Plain radiography (contd.) Site Type of bone Long bone / Flat bone Intramedullary / Eccentric / Cortical lesion The epicenter of the tumor helps to determine the origin. Epiphysis / Metaphysis / Diaphysis

  13. Distribution of various bone tumors

  14. Distribution of various lesions in a long tubular bone before skeletal maturity Distribution of various lesions in a long tubular bone after skeletal maturity

  15. Distribution of various lesions in a vertebra Benign lesions predominate in its posterior elements. Osteoblastoma Osteoid osteoma Aneurysmal Bone cyst Osteochondroma Chondromyxoid fibroma Malignant lesions are seen predominantly in its anterior part (body) Lympohoma Myeloma Osteosarcoma Ewing Chondrosarcoma Metastases

  16. Zone of Transition The zone of transition is the most reliable indicator in determining whether an osteolytic lesion is benign or malignant. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. A small zone of transition results in a sharp, well-defined border and is a sign of slow growth. A sclerotic border especially indicates poor biological activity. An ill-defined border with a broad zone of transition is a sign of aggressive growth.

  17. Narrow zone of transition Wide zone of transition

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