Term
| malignant vs benign tumors |
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Definition
| Rapid growth, warmth, tenderness, and ill defined edges are suggestive of malignancy. |
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Term
| Classification of malignant tumors of bone: (types) |
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Definition
• Osteosarcoma (Osteogenic sarcoma)
• Chondrosarcoma
• Ewing’s sarcoma
• Multiple myeloma- covered in hematology |
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Term
| Osteosarcoma (Osteogenic sarcoma) info, who gets it |
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Definition
• It is a malignant mesenchymal tumor in which cancerous cell produce bone matrix.
• Most common primary malignant tumor of bone
• Occurs in all age group but has bimodal age distribution
• 75% occur in person younger than 20 years of age
• Second peak occur in elderly who have predisposing condition – Paget disease, bone infarct, prior irradiation
– Males> females
• Usually arise from metaphysis of long bones of extremities, and almost 50% occur about the knee.
• Beyond the age of 25 years incidence in flat bones and long bones is almost equal. |
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Term
| Osteosarcoma (Osteogenic sarcoma) pathogenesis |
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Definition
• Approx. 70% have acquired genetic abnormalities such as ploidy changes and chromosomal aberrations, none of which is specific for this tumor.
• Mutation of RB gene (cell cycle regulator) and p53 gene (gene whose product regulate DNA repair and cellular metabolism) frequently associated with osteosarcoma.
• Germline mutation in RB gene roughly 1000-fold increase the risk of osteosarcoma
• Patient with Li-Fraumeni syndrome (germline p53 mutation) greatly elevate the incidence of osteosarcoma. |
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Term
| Several subtypes of osteosarcoma |
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Definition
• are grouped according to
– Site of origin (intramedullary, intracortical or surface)
– Degree of differentiation
– Primary (underlying bone is unremarkable)or secondary to preexisting disorders.
– Histological features (osteoblastic, chondroblastic, fibroblastic, telangiectatic, small cell and giant cell).
• The most common subtype arises in metaphysis of long bones and is primary, solitary, intramedullary and poorly differentiated.
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Term
| Osteosarcoma (Osteogenic sarcoma) gross appearance |
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Definition
| Grossly, Osteosarcoma are big bulky tumors that are gritty, grey-white, and often certain areas of hemorrhage and cystic degeneration. |
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Term
| Osteosarcoma (Osteogenic sarcoma) clinical features |
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Definition
• Localized pain and swelling
• Fast growing tumor
• Progressive weakness and weight loss
• Skin over the tumor is shiny and stretched with prominent veins
• Warm, tender and ill defined margins.
• Pulsatile tumor
• Movement of adjacent joint restricted due to mechanical obstruction and effusion.
• Regional lymph node enlarged only in 25-30% cases.
• If distal neurovascular deficit present strongly suggest malignancy.
• Lung metastasis occur in 10-12 months if left untreated. |
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Term
| Osteosarcoma (Osteogenic sarcoma) classic xray findings |
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Definition
• Codman's triangle (periosteal elevation) • Sunburst pattern/Sunrays appearance
• Bone destruction
• Ill-defined margins
[image] |
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Term
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Definition
• Occurs in old people
• Associated with Paget’s disease or chronic osteomyelitis
• Highly aggressive |
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Term
| Differential diagnosis for Osteosarcoma (Osteogenic sarcoma) |
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Definition
• Among primary and secondary bone tumors
• Sub acute and chronic osteomyelitis |
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Term
| treatment for Osteosarcoma (Osteogenic sarcoma) |
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Definition
M- Methotrexate
C- Cyclophosphamide
D- Doxorubicin |
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Term
| surgery for Osteosarcoma (Osteogenic sarcoma) |
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Definition
• Disarticulation
• Amputation
• Resection with reconstruction/endoprosthesis
• Limb salvage surgery
• Resection of metastatic lesion (lobectomy in lung) |
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Term
| limb salvage surgery (Osteosarcoma (Osteogenic sarcoma) |
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Definition
• Principle is to eradicate the bone tumor, retain integrity of skeletal system and preserve the limb with useful function.
• After resection, skeletal reconstruction done by bone grafting(auto or allograft) or by endoprosthesis (modular or custom made).
• Prosthetic reconstruction is more effective
• As compared to the radical amputation and external prosthetic fitting or limb sparing surgery with bone grafting this treatment is more effective in early mobilization. |
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Term
| Chondrosarcoma info, who gets |
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Definition
• Definition:
– Malignant tumor of chondroblasts cells
– Second most common malignant matrix producing tumor
• Etiology:
–The tumor may arise de novo (primary) or secondary to preexisting enchondroma, exostosis (osteochondromas) or Paget’s disease
– Primary chodrosarcoma is very uncommon, arises centrally in the bone and found in children |
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Term
| Chondrosarcoma most common findings |
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Definition
• Occur more commonly after 40 years of age
• Clear cell and especially mesenchymal variant occur in younger patients in their 20s.
• Male > female
• It is most common in the femur, humerus, ribs and on the surface of the pelvis
• Patients with Ollier's disease (multiple enchondromatosis) or Maffucci's syndrome (multiple enchondromas and hemangiomas) are at much higher risk of chondrosarcoma than the normal population. |
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Term
| Chondrosarcoma sub classified according to |
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Definition
– Site
• Central (intramedullary)
• Peripheral (juxtacortical and surface)
– Histologically
• Conventional (hyaline/myxoid) – Make up 90% of chondrosarcoma
• Clear cell
• Dedifferentiated
• Mesenchymal |
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Term
| Clinical Features of Chondrosarcoma |
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Definition
• Presentation of chondrosarcoma depends on the grade of the tumor.
• A high-grade, fast growing tumor can present with excruciating pain.
• A low grade, more indolent tumor is more likely to present as an older patient complaining of hip pain and swelling.
• Pelvic tumors present with urinary frequency or obstruction or may masquerade as "groin muscle pulls". |
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Term
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Definition
– Chondrosarcoma is a fusiform, lucent defect with scalloping of the inner cortex and periosteal reaction.
– Extension into the soft tissue may be present as well as punctate or stippled calcification of the cartilage matrix.
[image] |
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Term
| ct scan and xray of chondrosarcoma |
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Definition
CT scan
-Helpful in defining the integrity of the cortex and distribution of calcification.
• MRI
– Surgical planning as it demonstrates the intraosseus and soft tissue involvement of the tumor.
– Also helpful in evaluating possible malignant degeneration of osteochondromas by allowing accurate measurements of the cartilage cap |
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Term
| biopsy and gross examination of chondrosarcoma |
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Definition
• Biopsy
– Incisional biopsy done
• Gross examination
– A grayish-white, lobulated mass.
– May have focal calcification, mucoid degeneration, or necrosis |
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Term
| treatment of chondrosarcoma |
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Definition
• Treatment of chondrosarcoma is wide surgical excision.
• There is a very limited role for chemotherapy or radiation.
• Low grade tumor
– Limb salvage surgery(WLE)
• High grade tumor – Amputation |
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Term
| Ewing’s sarcoma info, seen in |
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Definition
• Malignant neoplasm of undifferentiated cells arising within the bone marrow cavity
• Ewing's sarcoma is a highly malignant tumor that is a type of peripheral primitive neuroectodermal tumor
• Found in the lower extremity more than the upper extremity, but any long tubular bone may be affected.
• Most common sites are the diaphysis and metaphysis of the femur followed by the tibia and humerus.
• Most common in the first and second decade
• Ratioofmaletofemaleis3:2. |
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Term
| ewing's sarcoma clinical features |
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Definition
• Presented with pain, swelling and tenderness
• Erythema and warmth of the local area are sometimes seen
• Osteomyelitis is often the initial diagnosis based on intermittent fevers, leukocytosis, anemia and an increased ESR.
• Contain glycogen granule so can cause hyperglycemia |
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Term
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Definition
– Concentric, onion-skin layering of new periosteal bone
– This appearance is caused by and splitting and thickening of the cortex by tumor cells.
– The lesion is usually lytic and central.
[image] |
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Term
| ewing's sarcoma ct and mri |
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Definition
• CT is helpful in defining bone destruction.
• MRI is essential to elucidate the soft tissue involvement |
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Term
| ewing's sarcoma Differential Diagnosis |
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Definition
• Infection
• Neuroblastoma metastasis
• Lymphoma
• Leukemia |
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Term
| ewing's sarcoma biopsy and gross appearance |
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Definition
• Open biopsy for bone lesions
• Gross appearance
– Tumor is gray to white in color and poorly demarcated.
– The consistency is soft and gray and sometimes semi- liquid especially after breaking through the cortex.
– Areas of hemorrhage and necrosis are common. |
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Term
| ewing's sarcoma treatment |
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Definition
• Chemotherapy
– A: Actinomycin D
– B: Bleomycin
– C: Cylophosphamide – D: Doxirubicin
• Surgery followed by adjuvant chemotherapy.
• Radiotherapy |
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Term
| ewing's sarcoma poor prognostic factors |
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Definition
• High grade tumour
• Age>12yrs
• Male
• H/O fever and increase TLC • Proximal lesion
• Larger lesion
• Metastasis
• Chemoresistant |
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Term
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Definition
• It is catastrophic complication for most patient of cancer.
• Usually occur in elderly age group
• Clinical features
– Pain
– Metastatic destruction of bone reduces load bearing capacity.
– Usually manifests as complication like pathological fracture, paraplegia (medullary compression), pressure symptoms. |
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