Bone Tumors

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most common malignant tumors of bone?

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metastatic tumor; mets outnumber primary bone tumors by ratio of 10:1

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most common met to bone?

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carcinoma: breast, prostate, lung, kidney, thyroid

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main categories of bone tumors

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hematopoietic (40), chondrogenic (22), osteogeneic (19), fibrogenic, unknown origin (10)

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osteochondroma

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aka exostosis; cartilage capped outgrowth attached to underlying skeleton; metaphysis; most common benign tumor; males <20 yo; 3:1; can be asymptomatic; 40% around knee; bony projections with cartilaginous cap; thickened hyaline cart cap; slow growing, stop at time of plate closure; no treatment if no symptoms; resection; can become chondrosarcoma esp if have multiple hereditary exostosis

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two neoplasms arising from epiphysis

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chondroblastoma, and giant cell tumor

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two from metaphysis

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osteochondroma and osteosarcoma

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chondroma

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benign; tumor of hyaline cart; within bone (most common), on surface, in soft tissue, or enchondromatosis; solitary; 10-30 yo; 1:1;usually asymptomatic; maybe pathological fracture; hands and feet; Ollier disease or Maffucci syndrome; well circumscribed, pale blue; lytic on xray and thin sclerotic rim; hypocellular; resection, curettage, internal fixation; can be hard to tell from chondrosarcoma;

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Olliers

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multiple endochondromas; present early in life; bony deformity, limb length inequal, short; metaphyseal and unilateral; risk of malignant transformation

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Maffucci's syndrome

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rare; enchondromatosis with multiple soft tissue hemangiomas; malignant transform 40% of the time; greater degree of cellularity

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chondroblastoma

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benign chondroid neoplasm; second decade male; bone pain and synovitis, joint effusion; epiphyseal lesion common in humerus tibia and femur; well circumscribed; mix of mononuc cells and osteoclast-like giant cells; chicken wire calcification; low mitotic figures; may recur locally; resect, curettage, chemical therapy

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chondrosarcoma

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malignant; broad spectrum of findings; tumor cells from cartilage; 3rd most common malignant bone neo; 30-60 yo; 3:1 male; local swelling and pain and tenderness; metaphyseal or diaphyseal; central portion of skeleton, usually pelvis; white or light blue appearance of cart; myxoid changes and cystic formation; mitotic figures are rare; permeating marrow space; entrapping trabecular bone; mxyoid change; enchondroma looks like grade 1 chondrosarcoma; permeation through cortex to soft tissue; wide resection is treatment; 5 yr survival low if high grade; clear cell, mesenchymal, dedifferentiated types.

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osteoid osteoma

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neoplastic prolif of osteoid and fibrous tissue; 10-30, 2:1; long bones and cortex of metaphysis; less than 1.5 to 2 cm in diameter; pain worse at night and relieved by aspirin; nidus; softer than surrounding; well circumscribed lesion with anastamosing trabeculae rimmed by osteoblasts; NSAIDS, RFA, resection for treatment

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osteoblastoma

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same as osteoid osteoma, except diameter is over 1.5 to 2 cm and it does not respond to aspirin treatment; may appear malignant b/c of cortical expansion

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osteoma

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dense, mature, laminar bones of skull and face lesion; 40-50 yo 2:1; asymptomatic; flat bone of skull,f ace, mandible, jaw pain,sinusitis; smooth well defined border with no evidence of bone destruction

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osteosarcoma

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malignant neoplastic cells produce osteoid matrix; most common after myeloma; 20% of primary bone cancers; 10-25, 3:2; pain swelling soft tissue mass; metaphysis of long bone**; 50% around knee; xtends into soft tissue; lesion may be soft, gritty, fleshy; epiphyseal plate is barrier; bony destruction and penetration; subperiosteal elevation (cadman's triangle), high grade spindle cell tumor producing matrix unassoc with cartilage; common bizarre tumor giant cells; mitoses common;painful and progressively enlarging;

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GCT

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locally aggressive; large numbers of osteoclastic like giant cells; osteoclastoma; 20-40 yo 4:5; pain tenderness swelling; epiphyseal primarily, also metaphyseal; 55% around knee; spinal lesions can extend; lytic expansile lesion; curettage, resection, cyrosurgery; benign but potentially malignant; 50% recurs, 10% mets; 4% mets to lung

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lipoma

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most common soft tissue tumor; benign tumor of mature adipose tissue surrounded by fibrous capsule; usually painless;

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MFH

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most common soft tissue sarcoma; diagnosis of exclusion; 50-70 yo 2:1; painless enlarging mass; lower extremities common; wide resection, chemo, maybe radiation; storiform pattern of growth