Malignant Bone Tumors
Investigations: XR, MRI, Bone Scan, Bx, CXR & CT chest.
1) Osteosarcoma – metaphysis of long bones. 10-20yrs. Rest pain. Radiolucent & dense (sunburst), cortical destruction, ST mass. Osteoid producing spindle cells. Variations -> telangiectatic, parosteal, periosteal… Rx- chemo(pre & post op), wide resection.

2) Chondrosarcoma – primary- central metadiaphyseal, lucent with calcification(popcorn) & scalloping; secondary- proximal & axial, osteochondroma with large (>2cm) STM. Dull, aching pain; 30-70yrs. High, intermediate & low grades (III,II,I). Rx- wide or radical resection. Adjuvant not effective.

3) Ewing’s Sarcoma – non-mesenchymal elements of BM. Permeative, destructive with STM & periosteal rxn(onionskin). 5-30 yrs. B symptoms & pain. Hypervascular, small round cells, +ve periodic acid Schiff (PAS) for glycogen. Ch 11&22 translocation. Rx- chemo, local control (wide resection +/- XRT), chemo.

4) Fibrosarcoma – destructive, lucent, metaphyseal lesion. Long bones. Painful, >30yrs. Herringbone pattern of collagen. Rx- wide or radical +/- adjuvant.

5) Chordoma – cells from remnant of fetal notochord. Sacrococcygeal>base of skull>spine. Central vertebral body, anterior STM. Radiolucent. Rx- wide resection, insensitive to adjuvant.

6) MFH – arise from Paget’s or bone infarct, >30yrs. Lymphatic mets. Destructive, lucent. Rx- radical resection or wide + adjuvant.

7) Multiple Myeloma – plasma cell malignancy. Lucency. B-symtoms & renal failure. Cold bone scan. Increased gamma A/B globulins on serum immunoelectrophoresis and B-J proteins in urine and serum. Rx- XRT; adjuvant chemo.; surgical stabilization.

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