NEOPLASMA of MUSCULOSKELETAL

TISSUES
(bone)

ANDRI R. WINOTO
dr. SpOT(K) Hand and Microsurgery Reconstruction

Sub Department of Orthopedic and Traumatology

dr. Kariadi General Hospital
Medical School of Diponegoro University
 Classification (Aegerter,1975)
I.Reactive Bone Lesion II.Hamartomas III.True Neoplasms of
Affecting Bone Bone
A. Osteogenic
A.Osteogenic A. Oteogenic 1. Osteosarcoma
1. Osteoid osteoma 1. Osteoma 2. Parosteal sarc
2. Osteoblastoma 2. Osteochondroma B. Chondrgenic
1. Benignchondroblasto
B. Chondrgenic ma
B.Collagenic 1. Enchondroma 2. Chondromyxoid
fobroma
1. Subperiosteal cortical
defect C. Collagenic 3. Chondrosarcoma
2. Non-osteogenic fibroma 1. Angioma C. Collagenic
2. Aneurysmal bone 1. Fibrosarcoma
cyst 2. Angiosarcoma
D. Myelogenic
1. Ewings tumor
2. Reticulum cell sarc
3. Hodgkins disease
E. Osteoclastoma (GCT)
 Diagnosis
Clinical history
Physical signs

Biochemical findings (lab)

Radiographic features
Scintigraphy (bone scan)

Computed tomograpphy

Arteriography (angiography)

MRI

Biopsy
Microscopic appearance
 Primary Neoplasms and
Neoplasma-like Lesions
of Bone

Classifications:
World Health Organization,
Lichtenstein, Aegerter.
Primary neoplasms
1% of all age groups
Secondary neoplasms

Types of Specialists:
Orthopaedic surgeon
Radiologist
Patologist
Medical oncologist
 General Considerations
incidence, pathogenesis, clinical features, diagnosis,
treatment

Incidence:
osteosarc-during childhood
GCT- during adult life

Site incidence
metaphyseal regions

Neoplastic cells do not destroy

bone, their presence incites
local osteoclastic resorption
of bone
I. Reactive Bone Lesion
II.Hamartomas Affecting Bone

A.Oteogenic
Osteoma
osteochondroma
osteochondroma
 RATE OF GROWTH
(Lodwick)
Grade 1
1a. Sclerotic margin
without complete cortical
penetration
1b. Sharp margin, non-sclerotic
margin without total
cortical penetration
1c. Poorly defined margin,
totally penetrated the
cortex
Grade 2
geographic lesion + moth-eaten
and/or permeative destruction

Grade 3
motheaten and/or permeative
destruction only
PERIOSTEAL REACTIONS
Radiographic Features Osteosarcoma

Osteolysis: bone resorption

Osteosclerosis: bone deposition

Expansion

Codmans triangle

Onion skin

Sunburst appearance

Pathological fracture
chondrosarcoma
D. Myelogenic
Ewings tumor
 SURGICAL STAGES

Stage IA G1, T1, M0 Low grade, intracompartmental lesion, without metastasis

Stage IB G1, T2, M0 Low grade, extracompartmental lesion, without metastasis
Stage IIA G2, T1, M0 High-grade, intracompartmental lesion, without metastasis
Stage IIB G2, T2, M0 High-grade, extracompartmental lesion, without metastasis

Stage IIIA G1 or G2, T1, Intracompartmental lesion with metastasis

M1

Stage IIIB G1 or G2, T2, Extracompartmental lesion with metastasis

M2
SurgicalStaging System (SSS)
William F. Enneking

Stage I: (G1,T1,Mo)
Low-grade,
intracompartmental,
metastase (-)
Stage IB:(G1,T2,Mo)
low-grade, extracompartmental,
metastase (-)
Stage IIA:(G2,T1,Mo)
High-grade,intracompartement.
Metastase (-)
Stage IIB:(G2,T2,Mo)
High-grade,extracompartment.
Metastase (-)
Stage IIIA: (G1 or G2,T1,M1)
Intracompartment,
metastase (+)
Stage IIIB:(G1 or G2,T2,M2)
Extracompartment,
metastase(+)
Principles of Treatment

Accurate diagnosis
Benign neoplasms and non-malignant
lesion: surgically (excision,
curettement, bone grafting)

Malignant primary neoplasms: surgical

ablation, eradication, with or
without radiotherapy and adjuvant
chemotherapy

Ennekings staging system

Limb-sparing, extremity saving,

Limb-salvaging
Types of Specialists:
Orthopaedic surgeon
Radiologist
Patologist
Medical oncologist
CONCLUSION

EARLY DETECTION
(VERY EXPENSIVE)
LATE must be AMPUTATION
(paliative treatmant)
SO
PREVENTION
HEREDITARY
SOSIAL PROBLEM