18. Bone tumors

Essay 18- Bone tumours

• Etiology
• Unclear
• Assumed to be result of polyetiological factors:
• Endogenous (genetic)
• Exogenous (carcinogens)
• Types
• Benign
• Malignant
• Metastatic
• Classification (Vinogradova)
• Tumors formed from bone-forming tissues: benign (osteoma), malignant (osteosarcoma)
• Tumors formed from cartilaginous tissue: chondroblastoma, malignant chondrosarcoma
• Tumors formed from connective tissue: fibroma, myxoma, fibrosarcoma
• Tumors formed from reticular tissue: reticulosarcoma

Benign bone tumours

Osteoma

• General info
• Originates from the bone forming connective tissue that has osteogenic properties
• Begins in childhood and has very slow course (10-20 years)
• Often affects flat bones
• Symptoms
• Palpated as a solid oval elevation of the bone of small size
• Tissues above it are freely movable
• Complaints depend on location:
• If under nail of big toe, may cause nail deformation with pain
• Diagnosis
• History
• Physical exam
• X-ray:
• Reveals a dense rounded formation, which is intimately connate with the corticalis of the bone - compact osteoma
• The hyponychial osteoma has a spongiosal structure - spongiosal osteoma.
• Treatment
• Operational if there are complaints or for cosmetic considerations
• In hyponychial osteoma, operational treatment is mandatory- resection of the affected area!

Osteidosteoma

• General info
• Benign bone tumor which affects the hip and tibia
• Affects from young age (20-30yrs)
• Symptoms
• Pain which intensifies at night
• Movements in the adjacent joints are limited and painful
• Diagnosis
• History
• X-ray:
• Oval lightening appears in cortical bone and is called “nidus” with a diameter of 1-1.5cm
• Around the nest there is bone sclerosis, which is less pronounced in the spongy bone and more pronounced when the focus is in the cortical bone!
• Treatment
• Operative- complete resection of the nidus