10. Dr. Karuniawan - Bone Tumor, 2012 November (English)
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Transcript of 10. Dr. Karuniawan - Bone Tumor, 2012 November (English)
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Bone TumorKaruniawan Purwantono
Head of Surgery Dept Christian University of Indonesia
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Approach to Bone Tumor diagnosis - Back to Basics
a. General considerationsb. Relevant clinical information
1.Table-Age Groupsc. Radiological correlation
1.Table-Skeletal Site2.Table-Long Bone Site3.Table-Growth Patterns4.Table-Types of Periosteal Reaction 5.Table-Types of Tumor Matrix
d. General histologic assessment of the lesion.
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General considerations
Bone Tumors can be divided into
• Primary Tumor
• Secondary Tumor
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Secondary Tumor
subdivided• Metastatic tumors• Tumors resulting from contiguous spread of
adjacent soft tissue neoplasms• Tumors representing malignant
transformation of the pre-existing benign lesions.
most frequent malignant tumors found in bone
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Secondary Tumor
Most common malignancies producing skeletal metastases
Adult> 40 years
carcinomas of the prostate, breast, kidney, lung and melanoma
Chilfren < 10 years
Neuroblastoma, rhabdomyosarcoma, andretinoblastoma
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Secondary Tumor
Radiographic appearance of the metastatic tumors
• Purely lytic (kidney, lung, colon, and melanoma)
• Purely blastic (prostate and breast carcinoma)• Mixed lytic and blastic (most common
appearance)
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Primary bone
Primary bone tumors are characterized by
• Predominant occurrence in the first 3 decades of life, The commonest sites for many primary tumors, both benign and malignant, are in the distal femur and proximal tibia
• specific radiographic presentations.
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Primary bone
• Benign tumors > malignant(osteochondroma, non-ossifying fibroma, andenchondroma)• difficult to classify as benign or malignant• highest incidence : osteosarcoma and
multiple myeloma , followed by chondrosarcoma and Ewing's sarcoma.
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Approach to Bone Tumor Diagnosis Relevant clinical information
• AGE
• PAIN
• MULTIPLE LESIONS
• SKELETAL LOCATION
• SITE OF LONG BONE INVOLVEMENT
• TYPES OF PERIOSTEAL REACTION
• TYPES OF PERIOSTEAL REACTION
• PATTERNS OF MATRIX MINERALIZATION
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Primary bone
Two important features of bone tumors:• The ability of some to dedifferentiate (eg.,
enchondroma or a low-grade chondrosarcoma transforming into a high-grade sarcoma)
• Tendency of high-grade sarcomas to arise in damaged bone, at the sites of bone infarcts, radiation osteitis and Paget's disease
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Primary bone Relevant clinical information
• Age • most important
clinical clue
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Primary bone Relevant clinical information
pain• Growing lesions. This category includes locally
aggressive lesions (eg., aggressive osteoblastoma and GCT), and malignant tumors
• Pathologic fracture complicating either benign or malignant tumor
• Significant local tissue reaction to the tumor
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Primary bone Relevant clinical information
MULTIPLE LESIONS• Radiological
Correlation
• PLAIN RADIOGRAPH• COMPUTER
TOMOGRAPHY• MRI is a method of
choice for local staging.
• BONE SCINTIGRAPHY is a highly sensitive but relatively non-specific technique
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Primary bone Relevant clinical information
• SKELETAL LOCATION
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Primary bone Relevant clinical information
• SITE OF LONG BONE INVOLVEMENT
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PATTERNS OF GROWTH and BONEDESTRUCTION
geographic pattern Cortical expansion.
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PATTERNS OF GROWTH and BONEDESTRUCTION
"Moth-eaten" pattern Permeative pattern
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TYPES OF PERIOSTEAL REACTION
Focal cortical thickening Codman's triangle
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TYPES OF PERIOSTEAL REACTION
"onion-skinning" andspiculated "hair-on-end" types
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PATTERNS OF MATRIX MINERALIZATION
Osteoid• Malignant osteoid • cloudlike• Or• ill-defined amorphous• densities with haphazard• mineralization.
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PATTERNS OF MATRIX MINERALIZATION
Osteoid Chondroid
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Contoh kasus
Solitary Bone Cyst (SBC) Eosinophilic Granuloma (EG)
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Non-Ossifying Fibroma (NOF) Fibrous Dysplasia
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Chondroblastoma Giant Cell Tumor of Bone
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Surgical staging
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Surgical staging
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treatment
Non surgical • Radioterapy • brachytherapy• Chemotherapy • Adjunavt Chemoth/• Neo adjuvant chemoth/
• Cryosurgery
Surgical • Excisional • Curetage • Amputation • Resection + bone
replacement /graft • Resection + arthroplasty
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Surgical procedure
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Bone excision Curetage
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Treatment
Non surgical Surgical • Excisional
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And soft tissue