1. BONE TUMOURS

2. introduction In general bone tumours can be classified into :
A- primary .
B- secondary .
Primary bone tumours classification :
Most classification of bone tum.are based on the recognition of the dominant tissue in the various lesion ; e.g. bone forming tum. Or cartilage forming tum. Etc.

3. Cell type benign malignant
Bone osteoid osteoma osteosarcoma
Cartilage chondroma chondrosarcoma
Fibrous t. Fibroma fibrosarcoma
b. Marrow eosinophilic Ewing sarcoma,
granuloma myeloma
Vascular haemangioma angiosarcoma
Uncertain giant cell tumor malignant giant
cell tumor
Tumor-like lesions: bone cysts , fibrous dysplasia , brown
tumor

4. Surgical staging Sarcoma are divided into :
Stage 1 :all low grade sarcoma .
Stage 2 :all high grade sarcoma .
Stage 3 : all metastatic tumors .
Enneking”s classification :
Type A : all the intracompartmental tumors .
Type B : all the extracompartmental tumors .

5. Radiological investigation
A- plain x- ray.
1- site of the lesion .
2- size of the lesion .
3- shape of the lesion .
4- density of the lesion .
5- homogenous or non homogenous lesion .
6- boundary of the tumor and the transitional
zone .
7- presence or absence of periosteal reaction .

6. Signs of aggressive lesions in x-ray
1- rapidly enlarged tumor .
2- wide transitional zone .
3- destruction of the cortex .
4- periosteal reaction .

7. B- bone scan e.g Tc99. C- C.T scan. D- MRI

8. Principles of treatment
1- benign asymptomatic lesion need no
treatment ; if the diagnosis is not 100%
sure then biopsy is indicated .
2- benign symptomatic :painful or continue
grow after arresting of growth : it require
biopsy and marginal excision .
3- suspected malignant :it need detailed
investigation for knowing the type and the
staging to decide the way of treatment .

10. Benign bone tumor

11. Osteochondroma (bone exostosis)
This is one of the commonest benign bone tumor ; it is developmental tumor start as small over growth of cartilage at the edge of the physeal plate , and grow to boney protuberance covered by cap of cartilage.
The commonest sites are the fast growing ends of the long bones , and it continue to grow until the bone stop growing at the end of the growth period .
Any further increase in size after this period is mean malignant changes .

12. The patient is usually teenager or young adult presented with a lump near the end of the long bones , some time there is pain .
Multiple lesions can be present as part of heritable disorder (multiple exostosis) called diaphyseal acalasis.
X-ray : boney projection from the metaphysis
of the long bone, large lesion may have cauliflower – like lesion .
Treatment : excision .

15. Osteoid osteoma
Small tumor of bone cause symptoms out of all proportion to its size .
Patient usually under 30 years old , male more than female , it can affect all bones except the skull and mainly the femur and tibia .
The patient complain from persistent pain which typically revealed by salicylate .

17. X-ray :plain x-ray show small radiolucent
area (nidus) in the diaphysis
surrounded by area of sclerosis and cortical thickening .
Tc99 : show localized increased activity .
Treatment : by complete excision of the
nidus

18. enchondroma
It is benign tumor of the cartilage , it seen in young people and it affect the tubular bone of the hand and feet (inside the bone) .
The tumor is usually asymptomatic and discovered incidentally by x-ray or after pathological fracture .
X-ray show well defined centrally located ,
radiolucent area and there is flecks of calcification within the lucent area (this is a path gnomonic feature of the tumor) .

20. Enchondroma cont. Treatment : removal of the tumor by
curettage and bone graft .
The tumor has a possibility of 2% to change to malignant

21. Bone cysts We have two main types of bone cysts :
1- simple bone cyst (solitary bone cyst) .
2- aneurysmal bone cyst .

22. Simple bone cyst
It is also called solitary or unicameral bone cyst .it appear during the childhood , typically in the metaphysis of the long bones and mostly in the metaphysis of the humerous or femur .
It is regarded as tumor – like lesion and it may heal spontaneously .
The condition discovered incidentally or after pathological fracture .

23. Simple bone cyst cont. X-ray : show well defined homogenous
radiolucent area in the metaphysis ,
centrally located , the cortex is thin .
By aspiration by wide bore needle , it contain straw - colour fluid (yellow ) .

25. treatment Small lesion can be treated conservatively
By continuous follow up and advice the patient not to exposed to trauma to avoid path. Fracture . If no progression of healing occur or the cyst tend to be larger , we can do aspiration of the fluid and injection of methylprednisolone mg inside the cyst this may induce healing .
If no improvement then surgical curettage and bone graft . This lesion is carry considerable risk of recurrence .