Vous êtes sur la page 1sur 56

Dr. Andre Sihombing.

SpOT
Orthopaedics surgeon
Christian University of Indonesia

Etiology
Usually no obvious cause
Ionising radiation
Predisposing conditions:

Pagets disease
fibrous dysplasia
retinoblastoma (genetic)
syndromes eg. Olliers disease

Introduction & Incidence:


Rare - 0.5% of cancer deaths.
40% Malignant.
Primary & Secondary/metastatic.
Primary in Young. (Osteosarcoma)
Secondary in the old. (Breast, Kidney, thyroid,

lung, prostate)
Marrow neoplasms (hemopoietic) myeloma,
leukemia, lymphoma etc.

Bone-producing tumors
Osteoma, osteoid osteoma, osteoblastoma
Osteosarcoma*
Cartilage-producing tumors
Osteochondroma, chondroma (enchondroma)
chondromyxoid fibroma
chondroblastoma
Chondrosarcoma*
Miscellaneous tumors
Ewings sarcoma*
Giant cell tumor of bone

PRIMARY TUMORS OF
BONE

Tumour-like conditions of
bone
Bone cysts
Simple bone cyst
Aneurysmal bone cyst

Fibrous-osseous lesions
Fibrous dysplasia
Eosinophilic granuloma (Langerhans
histiocytosis)
Osteochondroma - ?hamartoma

OSTEOMA
Benign, Often craniofacial in location
Hamartomatous / reactive not true tumor.
Histologically are woven and lamellar bone (closely

resemble normal bone).


Gardner Syndrome: multiple, Osteoma,
osteochondroma, GIT polyps, skin tumors.
Autosomal Dominant, Colon Cancer.

OSTEOID OSTEOMA
Benign, second decade; males (3:1)
1-2 cm lesion in cortex of femur or tibia
Painful (high prostaglandin levels in lesion)
Central nidus of vascular spaces surrounded by

interlacing reactive trabecular bone.


Therapy - Resection of nidus - bone graft.

OSTEOBLASTOMA
Clinically similar to osteoid osteoma (large)
Also known as giant osteoid osteoma.
Common location -- vertebral column
Histology similar but rare nidus.
Can be locally aggressive
Therapy - curettage/resection with bone graft.

OSTEOSARCOMA
Common primary cancer of bone
Young adults - 10 and 25 years
Rare in later age Secondary to previous irradiation

or Pagets disease
genetic (retinoblastoma gene)
Metaphysis of a long bone (Knee)
Tenderness / pain / Mass.

OSTEOSARCOMA

Malignant mesenchymal cells that produce

Irregular lace like osteoid matrix.


May or may not be calcified.
pre-operative chemotherapy with surgical
resection.
The five-year survival ~ 60%

Osteosarcoma gross

Osteosarcoma gross

Osteosarcoma X-ray

Osteosarcoma Microscopy:
Malignant
cells
Osteoid
matrix

OSTEOCHONDROMATOSIS
Hereditary (multiple) or sporadic (single)
mushroom-shaped bony projections
Lateral aspects of cartilage joints.
Chondrosarcoma in hereditary type.

Osteochondroma:

Osteochondroma

Osteochondroma microscopy:

CHONDROMA (ENCHONDROMA)
Benign, Any age
Single or multiple sites
Often involves small bones of hands and feet.
Well demarcated, mature cartilage.

CHONDROMA (ENCHONDROMA)
Hereditary multiple enchondromatosis. Usually

over one side of the body. (Olliers disease).


Maffucci's syndrome - multiple bone chondromas
and hemangiomas of soft tissue
Increased risk for chondrosarcoma

CHONDROSARCOMA
Next common to Osteosarcoma.
Older adults 30 to 60 years.
Location - axial skeleton (pelvis & pectoral girdles,

ribs & spine)


Aggressive, erodes & invades soft tissue,
Metastases to lungs, liver, kidney & brain.

CHRONDROSARCOMA
Malignant cartilage with anaplastic chondrocytes in

spaces with focal enchondral ossification and


calcification

Resistant to chemo Surgical

resection
Grade I tumors have 5-year survival
rates of 90%, while high grade tumors
have poor prognosis.
Clear cell chondrosarcoma is a
histologic variant that is associated with
a better prognosis.

Chondrosarcoma - gross

Chondrosarcoma of Pelvis

nodules of white to bluish-white cartilagenous tumor


tissue eroding and extending outward from the bone at
the lower right.

Cartilage in chondrosarcoma:

OSTEOSARCOMA

CHRONDROSARCOMA
>40 years of age

10-25 years of age


affects long bones
sensitive to

chemotherapy

affects axial

skeleton
not sensitive to
chemotherapy

EWINGS SARCOMA:
Rare, young, 10-20 years, Males 2:1
Diaphysis of long bones, pelvis
Histopath : sheets uniform round cells

cytoplasmic glycogen, extensive necrosis;


11/22 translocation
Prognosis: very poor, <10% 5-year survival
with surgery and radiotherapy, 40% with
adjuvant chemotherapy

Ewings Sarcoma:

FIBROUS DYSPLASIA
Etiology is unknown.
Dysplastic proliferation of fibrous tissue & bone

tissue in localized area(s) of skeletal bone


Three Types:
monostotic,
polyostotic,
polyostotic with endocrinopathies.

Polyostotic with endocrinopathies


3 to 5% of cases
caf au lait spots and precocious sexual

development (McCune-Albright syndrome)


Associated with other endocrine disorders.

Metastatic tumors:

Osteoblastic Metastasis: Prostate

Osteoblastic Metastasis: Prostate

Osteolytic Metastasis: Breast ca

Osteolytic Metastasis: Breast ca