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PRIMERY BONE
TUMORS
Rahma Nilasari
09 777 033

Supervisor

: dr. Sri Sikspiriani, Sp. OT

Chapter I
Introduction

The tumor is an abnormal lump in the

body, that can be neoplastic and nonneoplastic.
Neoplastic tumor is a mass or a new
network formed in the body, has a
different shape and nature of the tissue
of origin or real.

Nomenclature of
tumors
No.
1,

2.

3.

Classification
Clinics

Pathology

Eponym

Examples

Topographic (organ
or tissue)

Mammae tumor, liver tumor,

pulmonary tumor, lymph
nodes tumor

Nature (behavior )

Benign tumor of skin and

malignant tumor of mammae

Histopathological

Adenocarcinoma,
rhabdomyosarcoma, lipoma,
and leiomyosarcoma

The nature of
pathology

Well differentiated,
moderately differentiated,
poorly differentiated, and
undifferentiated

name of inventor

Ewing sarcoma, Willms

tumor, Hodgkin disease

No.

Nature
classificaio
n

1.

Benign

Cell origin

Mesenchymal
cells;
-oma

Examples

Fibrosit
Lipids
Osteocytes
Chondrocytes
Smooth muscles
Leiomyoma

Fibroma
Lipoma
Osteoma
Chondroma

Parenchymal
Adenocortical
adenoma,
cells:
complex squamous
cell
papilloma,
name
cystadenoma. Except benign
tumor from epithelial cell of
placenta: Mola hidatidosa
2.

Malignant

Mesenchymal
cells:
-sarcoma

Fibrosit
Lipids
Chondrocytes
Chondrosarcoma
Smooth muscles
Leiomyosarcoma

Fibrosrcoma
Liposarcoma

Parenchymal
cells:

Adenocarcinoma, Squamous cell

carcinoma, Cystadenocarcinoma.

Primary bone tumor is a lump due to

abnormal

growth

of

new

cells

and

uncontrolled in the musculoskeletal system,

originating from the elements of the bone it
self and neoplastic, progressive, and the cells
never become mature.

Primary
bone
tumors

65,8% benign From 3 people

with
benign
tumors, one of
which
is
a
malignant
34,2%
malignant tumor.

Americ
a

In 2009, it was found in 2570

cases of malignant primary
bone tumor, and 1470 of them
died because this disease.

Indones
ia

in 2009, a tumor of bone and

cartilage
tumors
had
a
prevalence of 4.6% of all
tumors.

Errol Untung Hutagalung: within a period of 10

years (1995-2004) recorded 455 cases of bone
tumor that consists of 327 cases of malignant
tumors of bone (72%) and 128 cases of benign
bone tumors (28%).

Chapter II
Theoretical
Basis

A. Definition
Primary bone tumor is a lump due
to abnormal growth of new cells
and uncontrolled in the
musculoskeletal system, originating
from the elements of the bone it
self and neoplastic, progressive,
and the cells never become
mature.

B. Epidemiology
Rare cases: only 0,2% all of tumors
65,8% is benign and 34,2% is malignant
RSCM: 22% is Osteosarcoma from all of bone
tumors and 31% from all of malignant bone
tumors
90% come with an advanced stage, with a 60%
survival rate, if accompanied does not yet
metastases to the lung
From all cases of malignant bone tumors, 75% of
them will survive for 5 years

Primary bone
benign

Frequency (%)

Osteoma

39,3

Osteokondroma

32,5

Kondroma

9,8

Other

18,4

Primary bone
malignancy
Osteosarcoma

Frequency (%)

Chondrosarcoma

25,8

Ewings sarcoma

16,0

Chordoma

8,4

Malignant fibrous
histiocytoma
Angiosarcoma

5,7

Unspecified

1,2

Other

6,4

35,1

1,4

C. Etiology

The exact cause is unknown.

Influenced by 3 factors:

Genetics
Radiatio
n

Injury

D. Classification
Cell origin
Osteogenic

WHO

Benign

Malignant

Osteoid osteoma

Osteosarkoma

Osteoblastoma
Kondroma

Chondrogenic

Kondrosarkoma

Osteokondroma

Fibrogenic

Fibroma desmoplastik

Fibrosarkoma

Angiogenic

Hemangioma

Angiosarkoma
Ewings tumor

Myelogenic
Other tumors

Multiple myeloma
Neurofibroma

Giant Cell tumor

TNM classification:
T (primary tumors):

Tx : Primary tumors can not be known

T0 : No evidence of primary tumor

T1 : Tumor size is limitted to the periosteum

T2 : Tumor size penetrate to the periosteum

T3 : Tumor into the organ or structure around

the bone

N (Regional lymph nodes):

Nx

: Regional lymph nodes can not be known

N0 : Not found enlargement of regional lymph

nodes

N1 : Found enlargement of regional lymph nodes

M (metastases jauh):

Mx

: Distant metastases can not be known

M0 : No distant metastases was found

M1: Distant metastases Found

M1a

: Metastases of the lung

M1b

: Metastases of the other organ

 Destructive

lesion

with

sharply defined border

Implies

more-slow

less-aggressive,
growing,

benign

process
Narrow transition zone
Examples:

Non-ossifying
Eosinophilic

fibroma,

Chondromyxoid

fibroma,

1.
Geograp
hic bone
destructi
on

granuloma, etc

Pattern of bone destruction

 Areas

of

destruction

with ragged borders

Implies

more

growth:

rapid

probably

malignancy

Ewings

myeloma,

multiple

Examples:

2. Motheaten
appeara
nce

sarcoma, etc .

Pattern of bone destruction

Defined lesion with multiple

worm holes
Spreads trhough marrow
space
Wide transition zone
Implies
an
aggressive
malignancy:
round-cell
lesion
Examples:
Leukemia,
Ewing;s
sarcoma,
Neuroblastoma, etc

3.
Permeati
ve
pattern

Pattern of bone destruction

Periosteal Reaction

None

1.
Beni
gn

Periosteal Reaction

Solid

1.
Beni
gn

Periosteal Reaction

Lamellat
ed or
unionskinning

2.
Maligna
nt

Periosteal Reaction

Sunbur
st

2.
Maligna
nt

Periosteal Reaction

Codman
s
triangle

2.
Malign
ant

 Fluffy,
cotton like
or cloud like
densities
Examples:
Osteosarco
ma

1.
Osteoblastic

Matrix Tumor

 Comma-shaped,
punctate, annular,
popcorn-like
Examples:
echocondroma,
chondrosarcoma,
chondromyxoid
fibroma

2.
Cartilagino
us

Matrix Tumor

Osteoid Osteoma
benign tumors of bone tissue origins rare
10-25 years. Males >> females (2:1)
Location: diaphysis of femur, tibia, vertebra.
Symptom: pain and only lost by giving a salicylate
drug
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: excision of nidus and partial excision
of the bones

Radiolucent nidus
with mineralization
and surrounding
sclerosis

Osteoblastoma
Benign tumors of bone tissue origin (the epiphyseal bone) with
size > 2 cm
Young adults. Males >> females.
Location: vertebrae, ribs, finger bones, and other plat bones.
Symptom: pain and do not respon to the administration of aspirin
and NSAID drugs
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: excision of the bones and bone graft

Osteolytic

Osteosarcoma
Primary malignant bone tumor derived from primitive cells in the bone
metaphysical region. highly invasive, rapidly spreading on the
periosteum, and connective tissue outside it.
10-20 years. Males >> females (1,3:1)
Location: distal femur, proximal tibia, proximal humerus, and distal fibula
Symptom: constant pain and become heavy at night. patients also come
great lumps or because of pathological fractures, anemia, weight loss,
fevers, and decreased appetite.
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: bone amputation above the tumor or tumor joints above, and
do disarticulation. Other treatment: chemotherapy and radiotherapy.

3 types:
Osteolytic, osteoblastic, and
mixed.

Osteolytic

Codman triangles
Sunburst appearence

Chondroma
benign tumor of bone with a frequency of 9.8% of all benign bone
tumors
Young adults. Males >> females (1,3:1)
Location: distal femur, on bone tumor hands, legs, ribs, and long
bones, are solitary until multiple.
Symptom: Painless lumps.
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: Operation is performed when the tumor enlarges or
reveal any pathologic fracture. Treatment is curettage and bone
graft.

Single echocondroma in the

proximal phalanx of the
finger

Multiple
echocondroma in
the proximal
phalanx of the
index finger

Stippled and ring

shaped
calcifications of the
distal femoral
metaphysis

Osteochondroma
The second most common benign tumors (35.2%) of all benign bone tumor.
Beginning: enlargement of cortical and spongy bone intact. next: cauliflower
(cauliflower) with osteocytes as the stem component and a component
chondrocytes as interest
Adolescent age with active growth and in young adulthood
Location: metaphysical long bones, especially the distal femur. Proximal tibia
and proximal humerus.
Symptom: hard lumps and pain occurs when there is an emphasis on the area
surrounding the tumor or soft tissue.

Diagnosis: x-ray, ct-scan, histopathologic

Treatment: operation should be done immediately if there is any emphasis on

soft tissue or tumor suddenly enlarged

Osteochondroma in
the distal femur:
cauliflower

Chondrosarcoma
is a highly malignant tumor and the second largest after osteosarcoma (10%).
Tumors can be primary or secondary. The primary tumor is malignant than
secondary tumors.
30-45 years old. Males >> females.
Location: pelvis (30%), femur (20%), costa, as well as the head of the femur
(10%)
Symptom: pain is dull due to enlargement of the tumor slowly

Diagnosis: x-ray, ct-scan, histopathologic

Treatment:: This depends on tumor staging. If the tumor has not spread can be
wide excision. chondrosarcoma occur in the pelvis can be done
hemipelviktomi

Chondrosarcoma in the left hip joint

Desmoplastic Fibroma
benign tumor derived from connective tissue.

Children and adults.

Location: n the long and flat bones

Symptom: pain and swelling

Diagnosis: x-ray, ct-scan, histopathologic

Treatment: Wide excision and bone graft

Trabeculation of desmoplastic fibroma in

distal femur

Fibrosarcoma
benign tumor derived from connective tissue. 5-7% of all malignant
tumors of bone.

20-60 years old.

Locationthe metaphysical femur and the tibia. Tumors can extend to
epiphyseal, generally in the central region but can also be eccentric.
Symptom: swelling and pathologic fracture

Diagnosis: x-ray, ct-scan, histopathologic

Treatment:: operation, chemoterapy, and radiotherapy

Fibrosarcoma of
the radius
(irreguler
trabeculation)

Hemangioma
benign derived from endothelial cells of blood vessels proliferate and
undergo involution constantly to form abnormality of vascular anomalies
pleskus formation.
infants (1.1 to 2.6%) and children (10-12%). Females >> males (3:1).
Location: vertebra and cranium

Symptom: unspecified

Diagnosis: x-ray, ct-scan, histopathologic

Treatment: operation is not performed , unless the symptoms are painful

hemangioma in the
frontal skull

hemangioma in the
thoracal vertebral

Angiosarcoma

is a rare malignant tumor. Highly

metastasize rapidly to the lungs.

malignant

Can be multiple and can occur in the bone tissue.

Diagnosis: x-ray, ct-scan, histopathologic

Treatment: chemotherapy, tumor resection, and

radiotherapy

and

Lytic areas of destruction, with

minimal/ no reactive new bone
formation

Ewings Sarcoma
Malignant tumors derived from the bone marrow with a frequency of 5% of all
malignant tumors of bone.

5 20 years old. Males >> females.

Location: diaphysis and metaphysis of long bones such as the femur, tibia,
fibula, humerus.
Symptom: pain and swelling in the region of the tumor and there are other
common symptoms such as cachexia, tenderness in the tumor and elevation
of erythrocyte sedimentation rate.
Diagnosis: x-ray, ct-scan, histopathologic

Treatment: radiotherapy and amputation

Ewings sarcoma in
shaft of the femur

Multiple Myeloma
Malignant tumors of bone are often found that 17% of all malignant
tumors of organs and ranks third of malignant bone tumors.

40 70 years old. Males >> females (2:1)

Location: spine, pelvis, ribs, sternum and skull
Symptom: persistent pain, back pain which is sometimes
accompanied by radicular pain and weakness of the limbs. Pthologic
fracture.
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: radiotherapy and chemotherapy. If there is a pathological
fracture fixation and the cavity formed is filled with
methylmethacrylate cement.

Multiple myeloma:
punched out lesion

Neurofibroma
Benign tumors that can be found in the bone that develops from nerve
tissue.

20 - 30 years old.
Location: vertebrae and cranium
Symptom: tenderness, lumps, accompanied by hyperpigmentation spots
called cafe au-lait spots. Usually does not cause a nervous breakdown.
Diagnosis: x-ray, ct-scan, histopathologic
Treatment: Operation is not performed, except disrupting the lives of
patients

Giant Cell Tumor

Bone tumors that have the nature and tendency to become malignant and
agresif.

20 - 40 years old. Females >> males.

Location: epiphysis of long bones (75%), particularly in the area of the knee that
is the area of the proximal tibia, distal femur, proximal humerus, distal radius.
The rest can be found in the pelvis and sacrum.
Symptom: accompanied by pain and swelling, especially in the knee joint
effusion may be found in the joints and movement disorders. Pathologic
fracture.
Diagnosis: x-ray, ct-scan, histopathologic

Treatment: Slow-growing tumors and benign : curettage. Aggressive tumors:

excision followed by the use of bone graft or protesis.

Giant cell
tumors:
Soap buble
appearance

E. Clinical Manifestations

Pain

Swelling

Patholog
ic
fracture

Limitatio
n of
moveme
nt

F. Diagnosis

Anamnesi
s

Identity: name, sex, age

Chief complaint: pain, swelling,
etc.
Clinical history: onset, durasi,
progressivity,etc
History of disease before
History of medicine
History of family disease

Physical
examinati
on

Primary survey
Secondary survey
Local status: inspection, palpation,
ROM, NVD, sensoric function,
motoric function.

Next...
Neurologi
c
examinati
on

Radiologi
c
examinati
on

Laborator
y
examinati
on

Biopsy

Treatment

Radiotherapy
Operation
Chemotherapy

Chapter III
Conclusion

Primary bone tumor is a lump due to

abnormal

growth

uncontrolled

in

of
the

new

cells

and

musculoskeletal

system, originating from the elements of

the

bone

it

self

and

neoplastic,

progressive, and the cells never become

Bone tumors are relatively rare. The
mature.
incidence of bone tumors only 0.2% of all
bone tumors exist. Of all primary bone
tumors, 65.8% of them are benign and
34.2% were malignant

In

the

diagnosis

of

primary

bone

tumors

required a series of complete and accurate

diagnosis, which consists of history, physical
examination, and investigations (neurological,
radiology, laboratory, and biopsy). The results of
direct examination by a physician for proper
diagnose a patient's illness so that appropriate
treatment can be done and adequate.

Thank you...