Dr. Andre Sihombing.

SpOT
Orthopaedics surgeon
Christian University of Indonesia
Etiology
Usually no obvious cause
Ionising radiation
Predisposing conditions:
Pagets disease
fibrous dysplasia
retinoblastoma (genetic)
syndromes eg. Olliers disease
Introduction & Incidence:
Rare - 0.5% of cancer deaths.
40% Malignant.
Primary & Secondary/metastatic.
Primary in Young. (Osteosarcoma)
Secondary in the old. (Breast, Kidney, thyroid,
lung, prostate)
Marrow neoplasms (hemopoietic) myeloma,
leukemia, lymphoma etc.
Bone-producing tumors
Osteoma, osteoid osteoma, osteoblastoma
PRIMARY TUMORS OF BONE
Osteosarcoma*
Cartilage-producing tumors
Osteochondroma, chondroma (enchondroma)
chondromyxoid fibroma
chondroblastoma
Chondrosarcoma*
Miscellaneous tumors
Ewings sarcoma*
Giant cell tumor of bone
Tumour-like conditions of
bone
Bone cysts
Simple bone cyst
Aneurysmal bone cyst
Fibrous-osseous lesions
Fibrous dysplasia
Eosinophilic granuloma (Langerhans
histiocytosis)
Osteochondroma - ?hamartoma
OSTEOMA
Benign, Often craniofacial in location
Hamartomatous / reactive not true tumor.
Histologically are woven and lamellar bone (closely
resemble normal bone).
Gardner Syndrome: multiple, Osteoma,
osteochondroma, GIT polyps, skin tumors.
Autosomal Dominant, Colon Cancer.
OSTEOID OSTEOMA
Benign, second decade; males (3:1)
1-2 cm lesion in cortex of femur or tibia
Painful (high prostaglandin levels in lesion)
Central nidus of vascular spaces surrounded by
interlacing reactive trabecular bone.
Therapy - Resection of nidus - bone graft.
OSTEOBLASTOMA
Clinically similar to osteoid osteoma (large)
Also known as giant osteoid osteoma.
Common location -- vertebral column
Histology similar but rare nidus.
Can be locally aggressive
Therapy - curettage/resection with bone graft.
OSTEOSARCOMA

Common primary cancer of bone

Young adults - 10 and 25 years
Rare in later age Secondary to previous irradiation
or Pagets disease
genetic (retinoblastoma gene)
Metaphysis of a long bone (Knee)
Tenderness / pain / Mass.
OSTEOSARCOMA
Malignant mesenchymal cells that produce
Irregular lace like osteoid matrix.
May or may not be calcified.
pre-operative chemotherapy with surgical
resection.
The five-year survival ~ 60%
Osteosarcoma gross
Osteosarcoma gross
Osteosarcoma X-ray
Osteosarcoma Microscopy:
Malignant
cells
Osteoid
matrix
OSTEOCHONDROMATOSIS
Hereditary (multiple) or sporadic (single)
mushroom-shaped bony projections
Lateral aspects of cartilage joints.
Chondrosarcoma in hereditary type.
Osteochondroma:
Osteochondroma
Osteochondroma microscopy:
CHONDROMA (ENCHONDROMA)
Benign, Any age
Single or multiple sites
Often involves small bones of hands and feet.
Well demarcated, mature cartilage.
CHONDROMA (ENCHONDROMA)
Hereditary multiple enchondromatosis. Usually
over one side of the body. (Olliers disease).
Maffucci's syndrome - multiple bone chondromas
and hemangiomas of soft tissue
Increased risk for chondrosarcoma
CHONDROSARCOMA
Next common to Osteosarcoma.
Older adults 30 to 60 years.
Location - axial skeleton (pelvis & pectoral girdles,
ribs & spine)
Aggressive, erodes & invades soft tissue,
Metastases to lungs, liver, kidney & brain.
CHRONDROSARCOMA
Malignant cartilage with anaplastic chondrocytes in
spaces with focal enchondral ossification and
calcification
Resistant to chemo Surgical
resection
Grade I tumors have 5-year survival
rates of 90%, while high grade tumors
have poor prognosis.
Clear cell chondrosarcoma is a
histologic variant that is associated with
a better prognosis.
Chondrosarcoma - gross
Chondrosarcoma of Pelvis

nodules of white to bluish-white cartilagenous tumor

tissue eroding and extending outward from the bone at
the lower right.
Cartilage in chondrosarcoma:
OSTEOSARCOMA CHRONDROSARCOMA
10-25 years of age >40 years of age
affects long bones affects axial
skeleton
sensitive to
not sensitive to
chemotherapy
chemotherapy
EWINGS SARCOMA:

Rare, young, 10-20 years, Males 2:1

Diaphysis of long bones, pelvis
Histopath : sheets uniform round cells
cytoplasmic glycogen, extensive necrosis;
11/22 translocation
Prognosis: very poor, <10% 5-year survival
with surgery and radiotherapy, 40% with
adjuvant chemotherapy
Ewings Sarcoma:
FIBROUS DYSPLASIA
Etiology is unknown.
Dysplastic proliferation of fibrous tissue & bone
tissue in localized area(s) of skeletal bone
Three Types:
monostotic,
polyostotic,
polyostotic with endocrinopathies.
Polyostotic with endocrinopathies
3 to 5% of cases
caf au lait spots and precocious sexual
development (McCune-Albright syndrome)
Associated with other endocrine disorders.
Metastatic tumors:
Osteoblastic Metastasis: Prostate
Osteoblastic Metastasis: Prostate
Osteolytic Metastasis: Breast ca
Osteolytic Metastasis: Breast ca