Bone Tumours
last authored:
last reviewed:
Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
Metastatic bone tumours
most common cause of cancer in the bone. Most common in the red marrow of axial and proximal appendicular skeleton. It is often multifocal due to carcinoma spread.
most often lytic or destructive.
radioisotope bone scan is best screening modality.
can present with pain or fracutre, but can also be asymptomatic.
osteosarcoma
favours the metaphyseal area of large limb bones - about 50% occurring around the knee. Most affect people from 12-25 years, though a second small peak is seen in older folks with Paget's disease.
Most arise inside the bone and are poorly differentiated. Production of bone matrix is characteristic. Osteosarcomas spread hematogenously, mostly to the lungs. Five year survival is 60-70%.
osteoid sarcoma
distinctive benign bone-forming tumour with prominent pain presentation, often relieved with ASA. They are almost always small and occur in young adults, with excellent prognosis.
osteochondroma
the commonest benign bone tumour - arises near the growth plate and grows outwards by endochondral ossification with a muschroom shape. They present as a lump or result in pressure on adjacent structures.
endochondroma
benign cartilage tumour - prediliction for small bones of hands.
chondrosarcoma
usually a well-differentiated tumour, with a long history of achy pain and slowly growing mass. Treatment is wide surgical excision. The main problem is local recurrence, as they rarely metastasize. High grade tumours are the exception.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- biopsy
- diagnostic imaging
Biopsy
Biopsy
open surgical biopsy is preferred for primary tumours, though increasingly image-guided core biopsies are being used.
FNA for cytological evaluation is not useful for mesenchymal neoplasm, but can be sueful for metastatic cacncer
molecular diagnosis is increasingly being used.
Diagnostic Imaging
X ray is the first line, but there are many false negatives.
Bone scans
CT and MRI
Differential Diagnosis
Treatments
Consequences and Course
Resources and References
Topic Development
authors:
reviewers:
 |