Dr. Andre Sihombing. SpOTOrthopaedics surgeonChristian University of Indonesia

Etiology Usually no obvious cause Ionising radiation Predisposing conditions: Pagets diseasefibrous dysplasiaretinoblastoma (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.

PRIMARY TUMORS OF BONEBone-producing tumorsOsteoma, osteoid osteoma, osteoblastomaOsteosarcoma*Cartilage-producing tumorsOsteochondroma, chondroma (enchondroma)chondromyxoid fibromachondroblastomaChondrosarcoma*Miscellaneous tumorsEwings sarcoma*Giant cell tumor of bone

Tumour-like conditions of boneBone cystsSimple bone cystAneurysmal bone cystFibrous-osseous lesionsFibrous dysplasiaEosinophilic granuloma (Langerhans histiocytosis)Osteochondroma - ?hamartoma

OSTEOMABenign, Often craniofacial in locationHamartomatous / 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 OSTEOMABenign, second decade; males (3:1)1-2 cm lesion in cortex of femur or tibiaPainful (high prostaglandin levels in lesion)Central nidus of vascular spaces surrounded by interlacing reactive trabecular bone.Therapy - Resection of nidus - bone graft.

OSTEOBLASTOMAClinically similar to osteoid osteoma (large)Also known as giant osteoid osteoma.Common location -- vertebral columnHistology similar but rare nidus.Can be locally aggressiveTherapy - curettage/resection with bone graft.

OSTEOSARCOMACommon primary cancer of boneYoung adults - 10 and 25 yearsRare in later age Secondary to previous irradiation or Pagets diseasegenetic (retinoblastoma gene)Metaphysis of a long bone (Knee)Tenderness / pain / Mass.

OSTEOSARCOMAMalignant 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 cellsOsteoid matrix

OSTEOCHONDROMATOSISHereditary (multiple) or sporadic (single)mushroom-shaped bony projectionsLateral aspects of cartilage joints. Chondrosarcoma in hereditary type.

Osteochondroma:

Osteochondroma

Osteochondroma microscopy:

CHONDROMA (ENCHONDROMA)Benign, Any ageSingle or multiple sitesOften 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

CHONDROSARCOMANext 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.

CHRONDROSARCOMAMalignant cartilage with anaplastic chondrocytes in spaces with focal enchondral ossification and calcificationResistant to chemo Surgical resectionGrade 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 CHRONDROSARCOMA10-25 years of ageaffects long bonessensitive to chemotherapy>40 years of ageaffects axial skeletonnot sensitive to chemotherapy

EWINGS SARCOMA:Rare, young, 10-20 years, Males 2:1Diaphysis of long bones, pelvisHistopath : sheets uniform round cells cytoplasmic glycogen, extensive necrosis; 11/22 translocationPrognosis: very poor,

Ewings Sarcoma:

FIBROUS DYSPLASIAEtiology is unknown.Dysplastic proliferation of fibrous tissue & bone tissue in localized area(s) of skeletal boneThree Types: monostotic, polyostotic, polyostotic with endocrinopathies.

Polyostotic with endocrinopathies3 to 5% of casescaf 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

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