Presentation is loading. Please wait.

Presentation is loading. Please wait.

DR Valentine Mandizvidza

Similar presentations

Presentation on theme: "DR Valentine Mandizvidza"— Presentation transcript:

1 DR Valentine Mandizvidza
BONE TUMOURS DR Valentine Mandizvidza

2 BONE TUMOURS 1. Benign tumours 2. Malignant tumours
Further classified as 1.Primary 2.Secondary

3 Bone Tumours Further classified according to tissue of origin - bone-forming(osteogenic) - cartilage-forming (chondrogenic) - fibrous (fibrogenic) -vascular

4 Role of Imaging Detection 2. Diagnosis 3. Surgical staging
4. follow-up

5 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

6 Clinical History and Examination
DIAGNOSIS OF BONE TUMOURS Clinical History and Examination Used in conjuction with radiographic findings to come up with differential diagnoses

7 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)



10 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? Cartilage tumours-hand and feet Chordoma- clivus and sacrum Burkitt’s Lymphoma- mandible and maxilla Spine- anterior(malignant), posterior(benign)

11 Radiographic Assessment PATTERN OF BONE DESTRUCTION
Fast/ Slow growth Permeative or moth eaten/ well defined margins Lytic, expansile & well defined ABC

12 Radiographic Assessment

13 Radiographic Assessment PERIOSTEAL REACTION
Shell Lamellar Interrupted Combined Interrupted-CODMAN TRIANGLE- ddx OS/ Osteomyelitis

14 Radiographic Assessment

15 Radiographic Assessment MATRIX
Osteiod, cloud to ivory-like Cartilage is stippled, popcorn in appearance

16 Enneking Classification of Benign Bone Tumours
STAGE DESCRIPTION TUMOUR EXAMPLES 1 Inactive NOF, Enchondroma 2 Active GCT, ABC, UBC, Chondroblastoma 3 Aggressive GCT, ABC

17 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

18 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 T2 II A G3-G4 II B III Any T3 IV A N 1 IV B Any Nodal Status M 1 Grade G1-well differentiated, G2- moderately differentiated, G3-poorly differentiated, G4-Undifferentiated Size: T1≤ 8cm; T2> 8cm Nodal Status: N 0= No nodal metastasis, N 1= nodal metastasis Metastasis: M 0=no distant metastasis, M 1=distant metastasis

19 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 Myeloma lymphoma Nerve neurilemmoma Malignant peripheral nerve-sheath tumor Lipogenic lipoma liposarcoma Notochordal Notochordal rest chordoma Unknown Giant cell tumor, ABC,SBC Ewing sarcoma, Adamantinoma Based on the type of proliferating cell and whether the lesion is benign or malignant.

Simple bone cyst..fallen fragments, most common in proximal humerus metaphysis. Symetrical expansion less than width of growth plate Aneurysmal bone cyst..long bones,expansile lytic, metaphysis, multiple blood filled cavities, septated appearance. Can expand wider than growth plate. Giant cell tumour..lytic, expansile, epiphyseal and metaphysis. i.e subarticular

21 BENIGN BONE TUMOURS Osteoid osteoma..diaphysis of long bone, 5-15mm, self limited, night pain,relieved by ASA Well circumscribed intracortical lesion with radiolucent nidus

22 Osteoblastoma……posterior spine elements, >1
Osteoblastoma……posterior spine elements, >1.5CM, progressive, dull ache Radiolucent lesion, with ocasional intralesional densities, cortically based.

23 OSTEOCHONDROMA Osteochondroma (bone and cartilage)..most common benign bone tumor..common around the knee, Medullary cavity of lesion is continuous with the femur Cartilage cape

24 ENCHONDROMA Enchondroma..comprised of mature hyaline cartilage located in the medullary cavity Ollier disease/ maffuci syndrome(+soft tissue angiomas)

25 Malignant bone forming tumours


27 . CHONDROSARCOMA Central or peripheral, metadiaphysis
If it exceeds 5cm in length a chondrosarcoma is more likely than an enchondroma

28 EWING’S SARCOMA Usually in the diaphysis of long bone...frequently metadiaphyseal Permeative bone destruction, onion skin periosteal reaction, cortical destruction, soft tissue extension Unlike osteosarcoma there is no matrix mineralisation DDX osteomyelitis


30 MULTIPLE MYELOMA Neoplastic proliferation of plasma cells producing a monoclonal protein

OSTEOLYTIC OSTEOBLASTIC MIXED (osteolytic/osteoblastic) Lung Prostate Breast Thyroid Bladder Kidney Gastrointestinal

32 breast lung prostate

33 Mixed lytic and sclerotic

34 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)

Download ppt "DR Valentine Mandizvidza"

Similar presentations

Ads by Google