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Bone Tumors & Tumor-Like lesions (Classification of Major Primary…
Bone Tumors & Tumor-Like lesions
Benign tumors outnumber their maligancy counterparts
Classification of Major Primary Tumor involving Bone
20% hematopoietic (MCmultiple myeloma
26% bone-forming
30%cartilage-forming
15% unknown origin
4% Notochordal
In older adult tumor; tumor likely malignant
Bone infacts, chronic osteomyelitis, Paget disease, radiation, metal prostheses, Inc. risk of bone neoplasia
Bone forming tumors
prod. unmineralized osteoid or mineralized woven bone
1) Osteoid Osteoma
< than 2 cm
Male teenagers 20's
appendicular skeleton 50% femur % tibia
sev. nocturnal pain (PGE2) relieve by aspirin
cortical bone=tx by radioablation
2)Osteoblastoma
2cm
P. spine (laminae & pedicles)
pain unresponsive to aspirin
Not induce a marked bony reaction
Tx:curettage or excision
3) Osteosarcoma
malignant tumor=osteoid matrix or mineralized bone
MOST com. Prim. Malignant tumor of bone,
Exclusive MYELOMA & LYMPHOMA
men>women
metaphyseal region*
bimodal age distribution
Predisposing conditions:
Paget disease, bone infarcts & prior radiation
Morpho:
bulky tumor, gritty, gray-white, hemorrhage & cytic degeneration
tumor cell is CC
Neoplastic bone=fine, lace-like architecture, primitive trabeculae
Pathogenesis
RB,TP53,INK4a,MDM2 & CDK4
MOST common subtype=metaphysis of long bone
primary, intramedullary, osteoblastic & high grade
hematogenous spread to lungs
<20% 5-yr survival rate-pt w/ metastases; recurrent 2ndary osteosarcoma
60-%-70% 5yr survival rate-w/o metastases
10%-20%=pulmonary metastases
Osteoid osteoma & Osteoblastoma
Micro=random interconnecting trabeculae of woven bone rimmed by osteoblasts