Overview of musculo-skeletal

tumors

Musculoskeletal Education Program

RCSI Professorial Unit
Cappagh National Orthopaedic Hospital

Learning Objectives

Recognise symptoms (Red Flags) associated with

Tumours
Differentiate between lesions that resemble
neoplasms, benign neoplasm and malignant
neoplasms
Describe common benign tumours
Describe common malignant tumours
Recognise what tumours commonly metastasize to
Bone

Musculo-skeletal tumours & some lesions that resemble

tumors, present exceptionally difficult diagnostic and
treatment problems.
- any region of the musculoskeletal system involve any tissue
- great variety in tissue origin, composition, response to treatment & natural hx
- many have similar clinical presentations and appearances ( imaging )
Lesions that resemble neoplasms
Benign neoplasms
Malignant neoplasms

Clinical Presentation
Pain

- often the first symptom

- wide range in intensity
- not all tumors cause pain metastasize before

often associated with an enlarging mass

dull ache
Often referred pain ( !! )
night pain ( keeps them awake ) , interferes with daily activities
often does not relieve with rest

Clinical Presentation
Swelling or a mass

- diffuse or firm, discrete

- wide range in size / growth rate

may be erythema increase in temp., could ulcerate through the skin

could be mistaken for abscesses ( !!! )
if deep ( thigh , hip ) not always palpable ( detectable )

Lack of a palpable mass or a measurable swelling does not exclude the

possibility of msk neoplasm and the presence of a well defined mass does
not necessarily indicate the presence of a neoplasm

Clinical Presentation
Loss of function

- occasional presentation

neurological deficit may be subtle , may de sudden

pathological fracture after minor trauma ( ?! )
restriction of ROM

Look carefully at X-Ray for subtle changes => if any suspicion

ask someone who knows

Clinical Presentation
Incidental discovery
routine clinical examination
incidental X-Rays / CT / MRI

Initial Evaluation

Detailed History and Clinical Examination

Plain X-Rays
Bone scan
CT Scan best for bone tissue
MRI - best method of evaluating soft tissue tumors

Decide if biopsy needed by experts in treatment

( surgery of needed )

Classification
1. Lesions that resemble bone & soft tissue neoplasms
- occur more frequently than neoplasms
- presentation may be similar to neoplasms
Stress fractures

Hematomas

Osteomyelitis

Ganglia

Simple bone cysts

Abscesses

Aneurysmal bone cysts

Aneurysms

Bone islands

Myositis ossificans

Fibrous dysplasia

Nodular fasciitis

Metabolic bone disease

Classification
2. Benign bone and soft tissue neoplasms
- occur more commonly than malignant neoplasms
- variable behavior
Osteoid osteoma

Lipoma

Osteoma

Hemangioma

Osteoblastoma

Lymphangioma

Osteochondroma

Neurofibroma

Enchondroma

Intramuscular myxoma

Periosteal chondroma

Elastofibroma

Chondroblastoma

Giant cell tumor of tendon sheath

Hemangioma
Giant cell tumor of bone

Classification
1. Malignant bone and soft-tissue neoplasms
A. Primary
- frequently cause disseminated disease and death
- sometimes near pre-existing benign processes ( chronic osteomyelitis )
Bone

- myeloma
- osteosarcoma
- chondrosarcoma
- Ewings sarcoma

Soft tissue

- Liposarcoma
- Fibrosarcoma
- Malignant fibrous histiocytoma

Classification
1. Malignant bone and soft-tissue neoplasms
B. Metastatic disease
- occurs > 20 times more frequently than primary
- nearly all malignant tumors metastases to bone

Breast
Lung

> 80 %

Prostate

Can cause pain & pathological fractures

Most frequently : vertebrae, pelvis, ribs and proximal limbs

Look for primary disease ( History & Clinical Exam )

Investigations : X-Rays, CT, MRI, Bone Scan, PET scan

Summary
- can involve all parts of musculo-skeletal system
- various clinical behavior ( benign highly malignant )
- occur rarely => often missed by physicians / non-specialists
- when suspicious always consider malignant until proven otherwise
- try to confirm suspicion before making the final diagnosis
- refer to specialist for biopsy / further treatment / multidisciplinary
Current treatment offers the possibility of cure for many patients
with primary malignancies of bone and soft-tissue, and improved
quality of life for others and for patients with metastatic disease.