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Malignant Musculoskeletal Disease & Bone Tumours - Coggle Diagram
Malignant Musculoskeletal Disease & Bone Tumours
ALL
may present with bone pain in children
sometimes primarily @ night
Intro to malignant bone tumours
rare before puberty
persistent localised bone pain, swelling, pathologic #
most common site = limbs
do x-ray early, followed by MRI + bone scan
usually otherwise well @ dx
x-ray shows destruction + variable periosteal new bone formation
chest CT to look for lung mets
do BM sampling to look for BM involvement
tx options
usually chemo followed by surgery
amputation avoided when possible using en bloc resection (tumour excision covered in whole by continuous shell of healthy tissue) + endoprosthetics
Neuroblastoma
usually in young children - most common before 5y/o
may present with systemic arthritis
bone pain from mets
arises from neural crest tissue in adrenal medulla + symp NS (can lie anywhere along symp chain from neck to pelvis)
spontaneous regression can occur in v young infants
spectrum of disease from benign (ganglioneuroma) to highly malignant (neuroblastoma)
most have abdo mass
BM suppression causes weightloss + malaise
a/w pallor, hepatomegaly, limp
raised urinary catechol levels
prognosis based on age + stage
poor if >1y/o + advanced disease
tumour genetics a/w poor prognosis: overexpression of N-myc oncogene, chromo 1p deletion, chromo 17q material gain
risk of relapse high with met disease
tx
localised: surgery alone
mets: chemo, autologous stem cell rescue, surgery, radiotx
Ewing tumour
malignant
seen more in younger children
M>F
often substantial soft tissue mass
this MRI shows large destructive soft tissue mass
radiotx often used, esp when resection impossible/incomplete (e.g. pelvis/axial skeleton)
plain x-ray shows destructive bone lesion in proximal humerous
abnormal tracer uptake in proximal left humerus
Osteoid osteoma
benign
affects adolescents, mainly boys
usually femur, tibia or spine
pain more severe @ night, responds to NSAIDs
localised tenderness, soft tissue swelling, joint effusion if near a joint, scoliosis if in spine
x-ray usually diagnostic
sharply demarcated radiolucent nidus of osteoid tissue surrounded by sclerotic bone
if normal can do CT/MRI
tx = surgical removal
Osteogenic sarcoma
malignant
more common than Ewing
M>F
