Sandbox: foreverbones

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Diagnosis

Staging | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies | Biopsy Template:Tumors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [4]

Overview

Tumors of the bone (also known as "Bone and cartilage tumors") are generally defined as the neoplastic growth of tissue in the bone and cartilage. Abnormal growths found in the bone or cartilage can be benign or malignant. These tumors may be classified as "primary tumors", which originate in bone or from bone-derived cells and tissues, and "secondary tumors" which originate in other sites and metastasize to the skeleton. Carcinomas of the prostate, breasts, lungs, thyroid, and kidneys are the carcinomas that most commonly metastasize to bone. Secondary malignant bone tumors are more common than primary bone cancers. The most common symptom of bone tumors is pain, which will gradually increase over time. The pain increases with the growth of the tumor. Additional symptoms may include fatigue, fever, weight loss, anemia, and/or sudden bone fractures. In some cases, bone tumors may be asymptomatic. Bone tumors may weaken the structure of the bone, causing pathologic fractures.

Classification

According to World Health Organization, bone tumors can be divided into primary and secondary. Primitive bone tumors are classified using histo-genetic criteria and malignancy anatomic-clinical criteria. The table below summarizes the findings that differentiate bone tumors according to location, age, histological features, imaging features, and tumor origin.

Primary tumors

• Primary tumors of bone can be divided into benign and malignant tumors.
• Common benign bone tumors, include:

• Osteoma
• Osteoid osteoma
• Osteochondroma
• Aneurysmal bone cyst
• Fibrous dysplasia.

• Common malignant bone tumors, include:

• Osteosarcoma
• Chondrosarcoma
• Ewing's sarcoma

Secondary tumors

Secondary bone tumors include metastatic tumors which have spread from other organs (usually, adenocarcinomas). In general, metastatic tumors frequently involve the axial skeleton and the appendicular skeleton.

• Common secondary bone tumors, include:

• Breast cancer
• Lung cancer
• Prostate cancer.

For more details about each specific type of bone tumor, click on the links in blue in the table below.

Type of tumor	Age	Location	Histological features	Imaging features	Origin	Bone/Cartilage
Osteoma	40-50 years	Skull bones	Matured lamellar bone	Sclerotic	Benign	Bone
Osteoid osteoma	10-20 years	Short and long bone diaphysis	Osteiod outlined by osteoblasts, incorporated in a fibrous stroma	Sclerotic	Benign	Bone
Osteosarcoma	11-40 years	Long bones metaphysis	Osteoid and bone formed of malignant osteoblasts and fibroblasts	Sclerotic	Malignant	Bone
Chondroma	30-60 years	Small tubular bones of the hands and feet	Maturated hyaline cartilage (enchondroma/ecchondroma), preserving lobulation	Well-defined	Malignant	Cartilage
Chondrosarcoma	30-60 years	Long bones metaphysis, axial skeleton	Immature cartilage, no preserving lobulation, cells arranged in groups of two or four, with atypia and mitosis	Well-defined	Malignant	Cartilage
Ewing sarcoma	5-25 years	Long bones diaphysis	Small, round, undifferentiated cells, no stroma, a lot of capillary arrangement.	Ill-defined	Malignant	Bone
Giant cell tumor	20-40 years	Knee	Multinucleated giant cells, fusiform cells, mononuclear cells.	Well-defined	Malignant	Bone
Metastases	50-90 years	No site predilection	Frequently adenocarcinomas. Metastases can be blastic or lytic depending on the tumor origin	Sclerotic	Malignant	Bone

Diagnosis

Symptoms

• Bone tumors are generally asymptomatic.
• The majority of patients may develop non-specific symptoms, such as:
• Dull pain

• Worse at nights

• Adjacent muscle soreness

Physical Examination

Physical examination findings of bone tumors, may include:

• Painless mass
• Weight loss
• Limited range of motion
• Fever
• Tenderness
• Swelling

Treatment

• The treatment of choice for bone tumors is dependent on the histological type of tumor.
• Chemotherapy and radiotherapy are effective in certain bone tumors (such as Ewing's sarcoma).
• Treatment for some bone tumors may involve surgery, such as:

• Limb amputation
• Limb-sparing surgery (often in combination with chemotherapy and radiation therapy).
• Limb sparing or limb salvage surgery
• Van-ness rotation or rotationplasty

Surgery

• The mainstray of choice for the majority of bone tumors is surgery.
• Common surgical procedures may include:

• Amputations (conservative or radical)
• Radical amputation, is called hemicorporectomy (translumbar or waist amputation) which removes the legs, the pelvis, urinary system, excretory system and the genital area (penis/testes in males and vagina/vulva in females).

Acknowledgements

The content on this page was first contributed by: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]