Bone or cartilage mass overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
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 can be benign or malignant. Bone and cartilage tumors may be classified according to the WHO histological classification system into 5 sub-types: cartilage tumors, osteogenic tumors, fibrohistiocytic tumors, notochordal tumors, hematopoietic tumors, and miscellaneous tumors.[1][2] In addition, bone and cartilage tumors may be sub-classified according to tumor location into 4 subtypes: diaphysis, metaphysis, epiphysis, and ungrouped/others.[3] "Primary bone 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, is another nomenclature to classify bone tumors.[4] 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.[5]
Classification
Bone and cartilage tumors may be classified according to the WHO histological classification system into benign and malignant tumors, and categorized into 5 sub-types: cartilage tumors, osteogenic tumors, fibrohistiocytic tumors, notochordal tumors, hematopoietic tumors, and miscellaneous tumors.[1][2] In addition, bone and cartilage tumors may be sub-classified according to tumor location into 4 subtypes: diaphysis, metaphysis, epiphysis, and ungrouped/others.[3]
Primary Tumors
- Primary tumors of bone can be divided into benign and malignant tumors.
- Common benign bone tumors, include:
- Common malignant bone tumors, include:
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:
Causes
Bone and cartilage tumors may be caused by precursor lesions, such as radiation injury, chronic osteomyelitis, and some genetically determined syndromes (McCune-Albright syndrome, Ollier disease, Maffucci syndrome, and Beckwith-Wiedemann syndrome).[1]
Differential Diagnosis
The table below summarizes the findings that differentiate common bone tumors according to location, age, histological features, imaging features, and tumor origin.[6][7]
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 |
Epidemiology and Demographics
Bone and cartilage tumors are uncommon, they represent 0.2% of all neoplasms in general population. The prevalence of bone and cartilage tumors is approximately 0.9 per 100,000 individuals. Bone and cartilage tumors have a bimodal age distribution. These tumors are more frequent in children and adolescents, and older adults. The average age at diagnosis is between 10-25 years old and 60-75 years old. Males are more commonly affected than females, with a 1.5:1 ratio.[8] Bone and cartilage tumors are slightly more common among individuals of Caucasian race.[9]
Screening
According to the the National Cancer Institute (NCI) there is insufficient evidence to recommend routine screening for bone or cartilage tumors.[10]
Diagnosis
Evaluation of Bone or Cartilage Mass
The evaluation of bone or cartilage mass will depend on patient age, location, margin, periosteal reaction, opacity, and size.[11]
History and 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
Laboratory Studies
Laboratory findings consistent with the diagnosis of bone and cartilage tumors, may include elevated LDH, alkaline phosphatase(related with prognosis), aspartate aminotransferase (AST).
Imaging
Conventional radiography is the method of choice to diagnose a primary bone tumors.
Other Diagnostic Studies
Other diagnostic studies may include: bone scintigraphy and bone biopsy.[12]
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. [3]
References
- ↑ 1.0 1.1 1.2 Bone tumors. https://en.wikipedia.org/wiki/Bone_tumor Accessed on February 2, 2016
- ↑ 2.0 2.1 Alina Maria Sisu. On the Bone Tumours: Overview, Classification, Incidence, Histopathological Issues, Behavior and Review Using Literature Data. http://www.intechopen.com/books/histopathology-reviews-and-recent-advances/on-the-bone-tumours-overview-classification-incidence-histopathological-issues-behavior-and-review Accessed on February 2, 2016
- ↑ 3.0 3.1 Miller TT (2008). "Bone tumors and tumorlike conditions: analysis with conventional radiography". Radiology. 246 (3): 662–74. doi:10.1148/radiol.2463061038. PMID 18223119.
- ↑ Henk Jan van der Woude and Robin Smithuis. Bone tumor - Systematic approach and Differential diagnosis. Radiology assistant. http://www.radiologyassistant.nl/en/p494e15cbf0d8d/bone-tumor-systematic-approach-and-differential-diagnosis.html Accessed on February 2, 2016
- ↑ "Questions and Answers about Bone Cancer" (PDF). Centers for Disease Control and Prevention. Retrieved 18 April 2012.
- ↑ Bone tumors. https://en.wikipedia.org/wiki/Bone_tumor Accessed on February 2, 2016
- ↑ Alina Maria Sisu. On the Bone Tumours: Overview, Classification, Incidence, Histopathological Issues, Behavior and Review Using Literature Data. http://www.intechopen.com/books/histopathology-reviews-and-recent-advances/on-the-bone-tumours-overview-classification-incidence-histopathological-issues-behavior-and-review Accessed on February 2, 2016
- ↑ Franchi A (2012). "Epidemiology and classification of bone tumors". Clin Cases Miner Bone Metab. 9 (2): 92–5. PMC 3476517. PMID 23087718.
- ↑ Tubiana-Hulin M (1991). "Incidence, prevalence and distribution of bone metastases". Bone. 12 Suppl 1: S9–10. PMID 1954049.
- ↑ Bone Cancer—Health Professional Version (2016) http://www.cancer.gov/types/bone/hp Accessed on February, 8th 2016
- ↑ Balach T, Stacy GS, Peabody TD (2011). "The clinical evaluation of bone tumors". Radiol. Clin. North Am. 49 (6): 1079–93, v. doi:10.1016/j.rcl.2011.07.001. PMID 22024289.
- ↑ Focacci C, Lattanzi R, Iadeluca ML, Campioni P (1998). "Nuclear medicine in primary bone tumors". Eur J Radiol. 27 Suppl 1: S123–31. PMID 9652512.