- Primary bone tumours are rare
- Secondaries tumours are more common especially in the elderly
Classification
| Cell type |
Benign |
Malignant |
| Bone |
Osteoid osteoma |
Osteosarcoma |
| Cartilage |
Chondroma |
Chondrosarcoma |
|
Osteochondroma |
|
| Fibrous tissue |
Fibroma |
Fibrosarcoma |
| Bone marrow |
Eosinophilic granuloma |
Ewing's sarcoma |
|
|
Myeloma |
| Vascular |
Haemangioma |
Angiosarcoma |
| Uncertain |
Giant-cell tumour |
Malignant giant cell tumour |
Clinical features
- Most present with pain, swelling and localised tenderness
- Rapid growth and erythema are suggestive of malignancy
- May cause pathological fractures
- Diagnosis confirmed by:
- Plain x-ray
- CT scan
- Bone scan
- Carefully planned biopsy
Osteoid osteoma
- Benign bone tumour
- Usually less than 1 cm in diameter and surround by dense osteoid
- Occurs in young adults
- Tibia and femur are the commonest site
- Pain (relieved by aspirin) is presenting complaint
- Xray has characteristic appearance of a radiolucency surrounded by dense bone
- Local excision is curative
Osteochondroma
- Commonest bone tumour
- Lesions can be single or multiple
- Appears in adolescence as cartilaginous overgrowth at epiphyseal plate
- Grows with underlying bone
- Metaphyses of long bones are the commonest sites
- Presents as painless lump or occasionally joint pain
- Excision should be considered if causing significant symptoms
Chondroma
- Benign tumour of cartilage
- Lesions may be single or multiple (Ollier's disease)
- Appears in tubular bones of hands and feet
- Xray shows well defined osteopenic area in the medulla
- Lesion should excised and bone grafted
Giant-cell tumour (Osteoclastoma)
- Equal proportions are benign, locally invasive and metastatic
- Found in sub-articular cancellous region of long bones
- Only occurs after closure of epiphyses
- Patients are usually between 20 and 40 years
- Xray shows an asymmetric rarefied area at the end of a long bone
- Cortex is thinned or even perforated
- Treatment by local excision and grafting often leads to recurrence
- Wide excision and joint replacement is the treatment of choice
- Amputation if malignant or recurrent tumour
Osteosarcoma
- Occurs in the metaphyses of long bones
- Commonest sites are around the knee or proximal humerus
- Destroys bone and spreads into the surrounding tissue
- Rapidly metastasizes to the lung
- Usually occurs between 10 and 20 years
- In later life is seen associated with Paget's disease
- X-ray shows combination of bone destruction and formation
- Periosteum may be lifted (Codman's triangle)
- Soft tissue calcification produces a 'sunburst' appearance
- Treatment involves amputation and chemotherapy
- Amputations are often limited with prosthetic replacement
- 50% five years survival
- Worst prognosis seen with proximal and axial skeletal lesions
Picture provided by Sathar Thajam, Monkland's Hospital, Airdrie, Scotland
Chondrosarcoma
- Occurs in two forms
- 'Central' tumour in pelvis or proximal long bones
- 'Peripheral' tumour in the cartilaginous cap of an osteochondroma
- Tend to metastasise late
- Wide local excision is often possible
Bibliography
Ham S J, Schraffordt-Koops H, van der Graaf W T, van Horn J R, Postma L, Hoekstra H
J. Historical, current and future aspects of osteosarcoma treatment. Eur J Surg Oncol
1998; 24: 584-600.
Witt J. Management of osteoid osteoma. Hosp Med 2002; 63: 207-209.
|