NEOPLASMA of MUSCULOSKELETAL TISSUES

(bone)
ANDRI R. WINOTO
dr. SpOT(K) Hand and Microsurgery Reconstruction

Sub Department of Orthopedic and Traumatology

dr. Kariadi General Hospital

Medical School of Diponegoro University

Classification (Aegerter,1975)
I.Reactive Bone Lesion II.Hamartomas Affecting Bone III.True Neoplasms of Bone A. Osteogenic 1. Osteosarcoma 2. Parosteal sarc B. Chondrgenic 1. Benignchondroblasto ma 2. Chondromyxoid fobroma 3. Chondrosarcoma C. Collagenic 1. Fibrosarcoma 2. Angiosarcoma D. Myelogenic 1. Ewings tumor 2. Reticulum cell sarc 3. Hodgkins disease E. Osteoclastoma (GCT)

A.Osteogenic 1. Osteoid osteoma 2. Osteoblastoma

A. Oteogenic 1. Osteoma 2. Osteochondroma

B. Chondrgenic 1. Enchondroma C. Collagenic 1. Angioma 2. Aneurysmal bone cyst

B.Collagenic 1. Subperiosteal cortical defect 2. Non-osteogenic fibroma

Diagnosis
Clinical history Physical signs Biochemical findings (lab) Radiographic features Scintigraphy (bone scan)

Computed tomograpphy
Arteriography (angiography) MRI Biopsy Microscopic appearance

Primary Neoplasms and Neoplasma-like Lesions of Bone

Classifications:

World Health Organization, Lichtenstein, Aegerter. 1% of all age groups

Primary neoplasms

Secondary neoplasms Types of Specialists:

Orthopaedic surgeon Radiologist Patologist Medical oncologist

incidence, pathogenesis, clinical features, diagnosis, treatment

Incidence: osteosarc-during childhood GCT- during adult life Site incidence metaphyseal regions
Neoplastic cells do not destroy bone, their presence incites local osteoclastic resorption of bone

General Considerations

I. Reactive Bone Lesion

II.Hamartomas Affecting Bone A.Oteogenic Osteoma osteochondroma

osteochondroma

RATE OF GROWTH (Lodwick)

Grade 1 1a. Sclerotic margin without complete cortical penetration 1b. Sharp margin, non-sclerotic margin without total cortical penetration 1c. Poorly defined margin, totally penetrated the cortex Grade 2 geographic lesion + moth-eaten and/or permeative destruction
Grade 3 motheaten and/or permeative destruction only

PERIOSTEAL REACTIONS

Radiographic Features

Osteosarcoma

Osteolysis: bone resorption Osteosclerosis: bone deposition Expansion Codmans triangle Onion skin Sunburst appearance Pathological fracture

chondrosarcoma

D. Myelogenic
Ewings tumor

SURGICAL STAGES

Stage IA
Stage IB Stage IIA Stage IIB Stage IIIA Stage IIIB

G1, T1, M0
G1, T2, M0 G2, T1, M0 G2, T2, M0

Low grade, intracompartmental lesion, without metastasis

Low grade, extracompartmental lesion, without metastasis High-grade, intracompartmental lesion, without metastasis High-grade, extracompartmental lesion, without metastasis

G1 or G2, T1, Intracompartmental lesion with metastasis M1 G1 or G2, T2, Extracompartmental lesion with metastasis M2

SurgicalStaging System (SSS) William F. Enneking

Stage I: (G1,T1,Mo)

Low-grade, intracompartmental, metastase (-) low-grade, extracompartmental, metastase (-) High-grade,intracompartement. Metastase (-) High-grade,extracompartment. Metastase (-) Intracompartment, metastase (+) Extracompartment, metastase(+)

Stage IB:(G1,T2,Mo)

Stage IIA:(G2,T1,Mo)

Stage IIB:(G2,T2,Mo)

Stage IIIA: (G1 or G2,T1,M1)

Stage IIIB:(G1 or G2,T2,M2)

Principles of Treatment
Accurate diagnosis Benign neoplasms and non-malignant lesion: surgically (excision, curettement, bone grafting) Malignant primary neoplasms: surgical ablation, eradication, with or without radiotherapy and adjuvant chemotherapy Ennekings staging system Limb-sparing, extremity saving, Limb-salvaging

Types of Specialists: Orthopaedic surgeon Radiologist Patologist Medical oncologist

CONCLUSION
EARLY DETECTION (VERY EXPENSIVE) LATE must be AMPUTATION (paliative treatmant) SO

PREVENTION
HEREDITARY SOSIAL PROBLEM