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TUMORI KOSTIJU (tumori kostiju (osteosarkom (th (kirurški, kemoth,…

- - - - kirurški
      - kemoth
      - izlječenje 75%
  - - - 0.2% svih
    - - nije poznata
  - - - Metastatic
        
        Most common malignant tumor
        
        Where?
        
        ✦ Spine
        ✦ Femur
        ✦ Pelvis
        ✦ Ribs
        
        Symptoms
        
        ✦ Pain (more severe at night)
        ✦ Pathologic fractures
        ✦ Gradual onset (over weeks)
        ✦ Hypercalcemia (in case of bony destruction)
        ✦ Elevated serum levels of alkaline phosphatase & Ca
        
        Primry tumor is in the breast, lung, prostate and kidney
        
        Diagnosis
        
        ✦ X-ray & CT to detect, localize
        ✦ Biopsy for confirmation
        
        Treament goal
        
        ✦ Prevent pathologic fractures
        ✦ Promote survival w/ max functioning
      - Primary tumor
        
        Chondrosarcoma
        
        Where?
        
        ✦ Pelvis
        ✦ Shoulder
        ✦ Ribs
        
        ✦ Slow growing
        ✦ Metastize late
        ✦ Cartilaginous origin
        --> ✦ Mesenchymal
        chondrosarcoma
        
        Treatment
        
        ✦ Must be early as it responds well to early radical surgical excision
        ✦ Resistant to radiotherapy
        
        Diagnosis
        
        ✦ In x-ray, you can observe irregular circular calcified spots
        ✦ Early diagnosis is important!
        
        Osteosarcoma
        
        Clinical manifestations
        
        ✦ Deep, localized pain & nighttime awakening
        ✦ Swelling in the affected bone
        ✦ Skin overlying the tumor warm, shiny, and stretched
        
        Treatment
        
        Surgery & multiagent chemotherapy
        
        Characteristics
        
        ✦ Agressive & extremely malignant
        ✦ Most common malignant primary
        bone tumor
        ✦ Osteogenic
        
        Bimodal distribution
        
        75% < 20 years old
        
        Prox. tibia, prox. humerus & distal femur
        
        Elderly w/ predisposing
        factors ( Paget disease, bone infarcts,
        or prior irradiation)
        
        Prox. femur, humerus & pelvis
        
        Pathogenesis
        
        Grow rapidly in a circular, ball-like mass in the bone tissue
        
        Move from the metaphysis of the bone out into the periosteal
        
        Spread to adjacent soft tissues
        surface --> Metastasis to lung (common)
        Spread through the bloodstream
        
        Cause
        
        Unknown
        
        Ewing Sarcoma
        
        Characteristics
        
        ✦ 2nd most common primary tumor
        ✦ Common in children and youngsters
        ✦ Densly packed small cells w/ round nuclei
        ✦ Traslocation of chromosomes 11 and 31
        
        Radiosensitive tumor
        
        Where?
        
        ✦ Fumur (most common)
        ✦ Pelvis
        
        Diagnosis
        
        ✦ Biopsy (important)
        ✦ X-ray
        ✦ Gammography (for localization)
        
        Treatment
        
        ✦ Multiagent chemotherapy
        ✦ Surgery
        ✦ Radiation therapy
        
        Clinical manifestations
        
        ✦ Bone pain
        ✦ Restriction of movement
        ✦ Tenderness over involved bone
        ✦ Fever
        ✦ Weight loss
        ✦ Bone fractures
  - - - Cartilaginous tissue origin
        
        Most common types
        
        Chondromas
        
        Definition
        
        Where?
        
        ✦ In bones of endochondral origin
        ✦ They can arise within the medullary cavity or on the surface of bone
        ✦ Hands and feet
        
        Treatment
        
        Observation or Surgery
        
        Benign tumors of hyaline cartilage
        
        Giant cell tumor
        
        Definition
        
        ✦ Aggressive tumor
        ✦ Often behaves like a malignant tumor, metastasizing
        through the bloodstream
        
        Characteristics
        
        ✦ Pathologic fractures are common
        ✦ Common around the knee, wrist, shoulder
        ✦ Mix of mononuclear and multinucleated osteoclast-type giant cells
        
        Osteochondromas
        
        Most common
        
        Where?
        
        ✦ Only in bones of endochondral origin
        ✦ Arising from the metaphysis
        near the growth plate of tubular bones
        
        Definition
        
        ✦ Benign cartilage-capped tumor attached to the
        underlying bone by a bony stalk
      - Fibrous tissue origin
      - Common in growing bone
        Asymptomatic