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)

8. AGE

9. AGE

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.

20. BENIGN BONE TUMOURS ABC GCT SBC
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
OSTEOSARCOMA

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

31. METASTATIC BONE DISEASE
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)