1. BONE TUMORS Pamela Gregory-Fernandez RPA-C

2. Benign Primary Bone Tumors Definition = tumors that arise from cells of mesenchymal origin –Bone; cartilage; fibrous tissue; round cells –Bone cyst; fibrous lesion; osteochondrome; giant cell tumor; chondroma; osteoid osteoma

3. Diagnosis 1. H & P 2. Three age groups: children; young adults; older adults = > 40 yo 3. How was the tumor discovered ? Incidental finding on x-ray Mass Pain Pathological fracture 4. BEWARE masses in the KNEE, SHOULDER, BUTTOCK

4. 5. Plain x-rays : A. Location of the tumor in the bone B. Reaction of the tumor/bone complex 6. MRI : A. Anatomic location and extent of tumor B. Soft tissue involvement C. Bone marrow involvement 7. Bone Scan: A. Multiple lesions 8. CAT Scan 9. Special Imaging 10. Blood testing: Multiple Myeloma 11. Biopsy: open; needle

5. Problems 1. Pathological fracture 2. Deformity 3. Growth plate involvement 4. Pain 5. Tenderness 6. Neurovascular compromise 7. Joint motion restriction

6. Treatment 1. Excision 2. Curettge and bone grafting

7. Malignant Primary Bone Tumors Sarcoma: a malignant tumor arising from cells of mesenchymal origin –1. metastasizes by the blood stream –2. very aggressive –3. poor response to radio or chemotherapy Examples: osteosarcoma (most common) Fibrosarcoma; Ewings sarcoma; multiple myelome; chondrosarcoma

8. Clinical Features / Diagnosis 1.Younger age group 1.Except myeloma 2.Pain 1.Night 2.Progressive 3.Mass 4.Pathological fracture 5.Bone not deformed 1. Staging –A. CT; MRI; arteriograms; scans; clinical –B. Grade I; II; III = distant mets –C. Intra vs. Extracompartmental 2. Biopsy

9. Treatment 1. Wide margin excision, may mean amputation, with adjunctive RT and/or chemotherapy 2. Limb salvage with adjunctive RT and/or chemotherapy –Custom made total joints –Large bone allografts

10. Osteosarcoma 1. MOST COMMON 2. males 3. second decade 4. metaphysis 5. distal femur, proximal tibia, humerus 6. Spindle cell sarcoma 7. x-ray = CODMAN’S TRIANGLE 8. pain 9. soft tissue mass

11. Ewings Sarcoma 1.5-30 years old 2.Second most common 3.Pain of involved extremity 4.May follow trauma 5.FEVER, FATIGUE, MALAISE, WEIGHT LOSS 6.Micromets at presentation

12. Nonossifying Fibroma Pathologic fxcurretageBone graft asymptomatic Found incidentally childrenmetaphyseal X-ray = sclerotic riml Serial x-rays Benign Tumors