bone tumors

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I- DEFINITION :

  • Tumor : uncontrolled proliferation of cells

—> normal : benign
—> Anormales : malignant

Produisante different tissues

  • The name is from that & rsquo tissues; it happen.
  • bone tumors :

– bone products.
– cartilaginous products.
– mesenchymal products.

II- ANATOMOPATHOLOGIE :

Bone tumors :

  1. bone-producing tumor.
  2. producing tumor of cartilage tissue.
  3. Giant cell tumor producer.
  4. producing bone marrow tumor.
  5. connective tissue producing tumor.
  6. Pseudo tumor lesion (benign tumor)
  7. Secondary tumors of the & rsquo; bones.

1- bone-producing tumors :

  • Benign tumor: osteoma, osteoid osteoma, ostéoblastome.
  • Malignant tumor: osteosarcom.

2- producing tumors of cartilage :

  • Benign tumor : chondrome, osteochondroma, chondro myxoid fibroma.
  • Malignant tumor : chondrosarcome.

3- Tumors of the bone marrow : malignancies

  • Sarcome d’Ewing : (child) and reticulum.
  • bone lymphosarcoma.
  • myelomas.

4- Tumors of connective tissue :

  • fibroma desmodie : benign tumor
  • Lipome osseux : tumor border.
  • Fibrosarcome.

5- Pseudo tumor Tumors :

  • bone cyst
  • aneurysmal cyst.
  • metaphyseal gap.
  • Granulome éosinophile.
  • fibrous dysphasia.

III- CLINICAL PICTURES :

A- painful tumors :

  • night pain : ostéoblastome, osteoid osteoma.
  • Cold pain : glomus tumor (from the connective tissue)
  • Malignant tumors are painful tjrs.
  • Painful tumors should undergo a biopsy.

B- large tumors :

  • Fat des ostéochondromes (near the joints), discharge tendons, nerves and vx.
  • The Chondromas nearly belts can limit the amplitudes and suppress the neurovascular axis
  • Soft tissue invasion by malignant tumors.
  • Upsetting nearby organs
  • Gene linked to the volume :

– Projection and tension
– Tumor close to the & rsquo; joint stiffness (^l amplitude)
– vascular compression : pulse.
– nerve compression : motor skills and sensitivity.
– Conflict with a tendon

C- the Pain + swelling :

  • Chondrome solitaire : treatment : Complete resection and reconstruction with bone graft and plate.
  • Exostose ostéogénique
  • Chondrosarcome :

– soft tissue involvement
– local recurrence.

D- pathological fractures :

  • Fractures without violent trauma.
  • Child :

– Bone cyst of the & rsquo; child "femur, humerus "
– Ossifying fibroma not "femur, tibia »
– Granulome éosinophile.
– fibrous dysphasia.

  • Adult :

– Giant cell tumor.
– aneurysmal cyst.

IV- STANDARD RADIOLOGY :

  • Benign tumor :

– well surrounded Image.
– normal cortical.

  • Malignant tumor :

– Ostéolyse large.
– No clear outline.
– Out of the cortical.
– Periosteal reaction "child"
– Soft tissue invasion

  • special Images :

– Benign tumor : Solitary bone cyst : Migration to the shaft with growth
– Malignant tumor :

1- Ostéosarcome :
– lytic area
– lamellar periosteal reaction
– Out of the cortical
– burning image & rsquo; grass and ossification of the soft parts.

2- peripheral chondrosarcoma :
– immediate development in the soft parts.
– Shape difficult to highlight a Rx.

3- Soft tissue invasion :
– chondroma periosteal (the cortical)
– Ostéosarcomes (Never foot or hand)

4- early forms :
– Small areas gummed.
– Small periosteal reaction in front of & rsquo; a dense area.

V- SUPPLEMENTARY REPORT :

  • features :

– TDM
– IRM
– Bone scan
– arteriography
– Biology report (myeloma)
– BIOPSY

  • Biopsy :

– Systematic ;
– Essential for the diagnosis and decide the course of treatment
– The pathological diagnosis is sometimes difficult.

  • TDM : means & rsquo; topographic analysis, shows the nidus
  • scintigraphy : net uptake
  • IRM : mandatory for the Surgical Treatment +++
  • Assessment of extension : TDM, IRM, scintigraphy
  • sometimes sufficient radio

– osteochondroma
– essential cyst
– gaps cortical

  • Sometimes entire skeleton

– Hereditary multiple exostoses
– Granulome éosinophile
– Enchondromatose (Ollier) : metaphyseal ++, asymmetrical lesions (sidedness in 50%)

WE- ARGUMENTS TOPOGRAPHICAL :

A- Depending on the location :

  • metaphyseal

– cartilaginous tumors
– cysts
– nonossifying Fibroids

  • epiphyseal

– Chondroblastomes
– Giant cell tumors
– aneurysmal cyst

  • Diaphyses

– fibrous dysplasia,
– Adamantinomes : Lyse patchy cortical
– osteoid osteoma : cortical condensation, the nidus

B- According to the & rsquo; affected bone :

  • Rachis

– Granulomes éosinophiles
– Angiomes, aneurysmal cyst, osteoblastomas, chordomes

  • Os place : Granulomes éosinophiles
  • Bones of the hand : Chondromes
  • trend multifocal

– fibrous dysplasia,
– Enchondromatose
– osteochondromatosis

C- often difficult diagnosis :

  • bone cyst
  • fibrous dysplasia

VII- TREATMENT :

  • Surgery :

– Amputation,
– Resection (must pass away from injuries)
– Reconstitution (by prosthesis).

  • Chemotherapy

Pr Bouzitouna's course – Faculty of Constantine