Bone Tumors

BONE TUMORS
What are bone tumors ?

Abnormal and uncontrollable neoplastic growth of the
bones that can form a mass or lump of tissue is known as
bone tumor.
 Bone tumors are classified into:
Primary bone tumors
Secondary bone tumors ( Metastasis)
 Mostare classified according to the normal cell of origin
and apparent pattern of differentiation
BONE TUMOR CLASSIFICATION
Bone-forming tumors
Cartilage-forming tumors
Miscellaneous tumors
BONE FORMING TUMORS COMMON LOCATIONS AGE (yr)
BENIGN
OSTEOMA Facial bones, skull. 40-50
OSTEOID OSTEOMA 10-20

Metaphysis of femur & tibia.
OSTEOBLASTOMA 10-20
Vertebral column
MALIGNANT
PRIMARY OSTEOSARCOMA Metaphysis of distal femur, 10-20

proximal tibia & humerus.
SECONDARY
OSTEOSARCOMA >40
Femur , humerus ,pelvis
CARTILAGINOUS TUMORS COMMON LOCATION AGE (yr)
BENIGN
OSTEOCHONDROMA Metaphysis of long tubular 10-30

bones.
CHONDROMA 30-50
Small bones of hands & feet.
MALIGNANT
CHONDROSARCOMA Bones of shoulder , pelvis, 40-60

proximal femur , ribs .
MISCELLANEOUS
GIANT CELL TUMOR Epiphysis of long bones. 20-40

(USUALLY BENIGN)
EWING TUMOR 10-20

(MALIGNANT ) Diaphysis & metaphysis.
BENIGN TUMORS
OSTEOMA
Osteomas are benign lesions of bone.
Most commonly present in the head , neck and paranasal
sinuses.
Most commonly occurs in middle age
OSTEOID OSTEOMA
arise during teenage years & 20s.
More common in males than females( 2:1)
arise most often in the proximal femur and tibia
less than 2cm
Imaging: sclerotic thickening of the shaft
Osteoblastoma:
bone-forming lesion that may be found within the cortex,
medullary canal, or periosteal tissues
arise most often in vertebral column
larger than 2.0 cm in diameter
TREATMENT
Chemotherapy.
Limb salvage therapy ( long term survival in 60-70%) .
CHONDROMA
Benign tumors of hyaline cartilage.
When they arise within the bone, termed as
enchondromas.
When they grow outwards from a bone, termed as
periosteal chondromas or ecchondroma.
Two syndromes are associated with chondromas;
Ollier disease (dyscondroplasia):
characterized by multiple chondromas preferentially
involving one side of the body.
Arise in the region of the growing epiphysial cartilages,
interfere with normal growth and may lead to shortening
or deformity
Maffucci syndrome is characterized by multiple
chondromas associated with benign soft tissue angiomas.
CLINICAL FEATURES
Pathological fractures.
Most common at spine (sacral region).
Periosteal chondroma – arise in hands or feet , or from
flat bones such as scapula or ilium
Painless lesions.
Progressive disorder.
Swelling of jaws.
RADIOLOGICAL FINDINGS
O-ring sign
Mineralization
Calcification
OSTEOCHONDROMA
Also known as osseocartilaginous exostosis
Usually present in 10 – 20 age group
Tumor originates from the growing epiphysial cartilage
plate
Diaphysial Aclasis (multiple exostosis) – involvement of
several bones
Clinical Features:
Hard swelling near a joint
Usually painless
May be painful if the pressure affects adjacent nerves or
vascular structures
Imaging:
Shows mushroom like
stalk of the bony tumor
Treatment:
Tumor should be
excised if it causes pain
or if it enlarges after
puberty
GIANT CELL TUMOR OF BONE
Also known as Osteoclastoma
type of benign tumor that grows at the ends of the body's
long bones
Tumors develop at the lower end of the femur and upper
end of the tibia , lower end of radius, and the upper end
of humerus
May also occur in spine and sacrum
Occurs in young adults in the 20-40 age group
Common in females.
CLINICAL FEATURES
Pathological fractures
Bone pain — pain tends to increase when active and
improve when the area is rested.
Swelling
A lump — with or without pain.
Tenderness.
Decreased mobility in the joint near to the tumor.
Build-up of fluid in a joint near to the tumor.
DIAGNOSTIC PROCEDURES
Xrays.
CT-scan
MRI
Bone scan.
Blood test.
TREATMENT
Radiation therapy
Embolization, minimally invasive surgical technique.
The purpose is to prevent blood flow to an area of the
body, which can effectively shrink a tumor or block an
aneurysm.
Amputation.
Wide resection.
Intralesional surgery.
MALIGNANT TUMORS
CHONDROSARCOMA
Tumor of cartilage
Second most common type of bone cancer (30-60 age group)
develop in the interior of the bone (central chondrosarcoma)
– commonly in the femur, tibia or humerus
upon its surface (peripheral chondrosarcoma) – affect a flat
bone such as innominate bone, sacrum or scapula
Rarely involves distal extremities.
Metastasize to lungs and skeleton.
CLINICAL FEATURES
Pain
Localized swelling
Pathological fracture
TREATMENT
Surgical excision.
Chemotherapy.
OSTEOSARCOMA
Osteosarcoma is a bone producing malignant tumor.
Occurs most commonly in 10-25 age group
Accounts for 20% of primary bone cancers.
Often occurs as a complication of paget’s disease
Tumors arise in the metaphyseal region of long bones of
the extremities
Common sites are:
Lower end of femur, upper end of tibia, and the upper
end of humerus
CLINICAL FEATURES
Pathologicalfractures
Local bone pain with gradually increased swelling
Thickness near the end of bone
Overlying skin is warmer than normal
Imaging:
triangular shadow on x-ray between the cortex and
raised periosteum (Codman triangle) .
10-20% patients have pulmonary metastasis.
Treatment:
Chemotherapy
Drugs currently used include:
Methotrexate, doxorubicin, cisplatin, ifosfamide
EWING SARCOMA
Also known as endothelial sarcoma of bone
This is the most common cancer among children, it is rare in adults.
Ewing’s sarcoma is a very rare type of cancerous tumor that grows
in bones or the soft tissue around bones, such as cartilage or the
nerves.
Common in shaft of femur, tibia or humerus
Unlike osteosarcoma, it arises in diaphysis rather than the
metaphysis of bone
It usually affects people from the ages of 5 to 20
Males are more prone .
CLINICAL FEATURES
A lump near skin that feels warm and soft to the touch
Constant low fever
Limited range of motion
Bone pain that gets worse when you exercise or during the
night
Broken bones without an obvious cause
Weight loss
Always being tired
 Paralysis or loss of bladder control if the tumor is near spine.
WORK UP / DIAGNOSIS
X-rays
Bone scan
Magnetic resonance imaging (MRI)
CT scan
Positron emission tomography scan ( PET scan)
Biopsy
Bone marrow aspiration and biopsy
X-rays shows destruction of bone (onion-peel
appearance)
TREATMENT
Chemotherapy (drugs – vincristine, cyclophosphamide,

dactinomycin, doxorubicin)
Surgery: remove the tumor to stop its spread. In some
cases, amputation of an arm or leg is done if the tumor
has spread a lot.
Radiation
MYELOMA
Also known as myelomatosis or plasmacytoma
Arises from the plasma cells of bone marrow, in 50-70
age group
Spreads to many parts of the skeleton through blood
stream
CLINICAL FEATURES:
Pathological fractures
Local pain
Patient is pale from associated anemia
Local tenderness over affected bones
Prone to develop infections due to suppression of normal
antibody production
ESR and serum globulin increased
Imaging:
X-rays show lytic lesions
especially in bones containing
red marrow
such as ribs, vertebral bodies,
pelvic bones, skull and proximal
ends of femur and humerus
Treatment:
Radiotherapy
Chemotherapy (drugs – thalidomide, dexamethasone,
proteasome inhibitor, bortezomib)

Bone Tumors

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BONE TUMORS

What are bone tumors ?

OSTEOMA Facial bones, skull. 40-50

OSTEOID OSTEOMA 10-20

PRIMARY OSTEOSARCOMA Metaphysis of distal femur, 10-20

OSTEOCHONDROMA Metaphysis of long tubular 10-30

CHONDROSARCOMA Bones of shoulder , pelvis, 40-60

GIANT CELL TUMOR Epiphysis of long bones. 20-40

EWING TUMOR 10-20

Chemotherapy (drugs – vincristine, cyclophosphamide,

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