Dr.

Ahmad Al-Ajlan
Age M:F ratio Site Presentation x-ray features Metaphysic lytic Incidental RX Non-wbb*, if:
Incidentally local steroids Pathological # self limited

452 SURG
NOTE

Simple bone cyst

1-20 M=F

Humerus Femur Pathological # pain

lesion

very benign never transform to

malignant

well define
sclerotic margin

Wbb

curettage +Bone graft

Humerus Femur Swelling Pathological # Pain

20 M=F

Metaphysic lytic
lesion

full of blood
curettage + Bone graft

ABC
Aneurysmal bone cyst

Tibia Spine Scapula

well define
sclerotic margin

Never be

malignant

recurrence is high

Expansile Lower limb metaphysic lytic Asymptomatic Incidental

lesion

Very common Never be

Self limited malignant

Non ossifying fibroma

FCD (fibrous cortical defect)

2-20 M>F

(mostly around
the knee)

well define
sclerotic margin

Femur

pain by activity and by

NSAID

metaphyseal or

Osteoid osteoma

10-35 M>F

Tibia Spine Tarsal bones

diaphyseal lytic lesion

Self limited by
given NSAID

Never transfer to
malignant

no pathological # &
swelling

Nidus less than

1cm sclerotic patch

If sever

surgery

Easy Bones Series

Dr. Ahmad Al-Ajlan

Femur
10-35

452 SURG
Swelling then pain If transfer to malignant
malignant manifestation

Sclerotic patch Nidus inside the

patch more than 1cm curettage + Bone graft may transfer to malignant

Tibia Spine Tarsal bones

Osteoblastoma

M>F

well define Metaphyseal lesion Huge swelling

10-35

Out-growth of the
bone

Just reassure the

patient

2 types

Osteochondroma

Knee Upper humerus

pressure symptoms:

(pedunculated type & Sessile type)

M>F

artery.nerve.vein.tendon.s kin

Cartilaginous cap Direction of the

tumor is away from the bone Metaphyseal or lesion

Surgery (only

Pedunculated type # Small bone

15-40 (mainly)

excision no bone graft) when there is complication or cosmetic

Commonest

benign tumor

The only surface

tumor (exostosis)

Swelling Pathological # pain

diaphyseal lytic

Enchondroma

M=F

Femur Humerus

curettage + Bone graft

well define
sclerotic margin

Incidentally:
5-25

Chondroblastoma

Knee Humerus

incidentally joint symptom collapse

Epiphyseal lytic
lesion

Non-wbb it

leave

M>F

well define no sclerosis

Wbb Curettage + bone graft

collapse:

Curettage +elevate collapsed cartilage + bone graft

Easy Bones Series

Dr. Ahmad Al-Ajlan

Pain then swelling then
pathological # Investigation: Never metastasize unless conversion to frank malignancy. Before Tx asses the tumor: soft tissue extension by MRI joint extension Bone extension by CT & do bone biopsy, cbc & bone scan

452 SURG
Epiphyseal lytic
lesion

Non-wbb:

Ill define No sclerosis No new bone

formation because it will eaten by osteoclast

Radical excision + bone graft + arthrodesis for nearby joint

Benign aggressive
tumor

20-40

Knee Humerus Radius

wbb:

Giant cell tumor

M>F

Excision + prosthesis

Originate from

Radio- &

osteoclast (so it is called osteoclastoma)

Soft tissue
extension

chemotherapy indicated in: frank malignancy & recurrence

Pain then swelling then

pathological #

Metaphyseal lytic
or sclerotic lesion

Tumor with cachectic

Investigation: CT to the bone MRI to soft tissue bone scan for metastasis Search of metastasis: CT of the chest MRI of the brain US of the abdomen Blood work: change in liver enzyme liver metastasis

Ill define No sclerotic

margin

metastasis palliative Tx only

the commonest
primary malignancy of bone

Tumor without
metastasis: - Limb salvage procedure - amputation in case of the involvement of whole compartment or pathological #

10-20

Osteosarcoma

Knee Humerus

M>F

Periosteal reaction:
Codman triangle sun rays appearance onion peal appearance

metastatic tumor
of the bone are more common than primary

Easy Bones Series

Dr. Ahmad Al-Ajlan

Febrile patient high wbc pain & redness
5-25

452 SURG
Originate from Diaphyseal lytic
lesion

endothelial lining of bone marrow canal

Tibia Femur Humerus

skin ulceration swelling

Investigation: Same as osteosarcoma

ill define peal onion

appearance

Ewing sarcoma

Same as osteosarcoma

misdiagnosed as

M>F

acute osteomyelitis (mimic to AOM)

extension to soft
tissue

can cause early

metastasis, but it discovered early due to its characteristic presentation

Radio- & bone ache (backache

+osteopenia) chemotherapy +

Multiple myeloma

Old age (>50) F>M

Central bones (skull, ribs, pelvic, spine)

multiple lytic
lesions

bone marrow transplantation

Investigation: protein electrophoresis pens johns protein bone marrow aspiration bone biopsy

mottled
appearance

if there is
pathological # internal fixation

solitary or multiple
Old age (50) Central bones (skull, ribs, pelvic, spine) Investigation: Same as osteosarcoma

or just osteoporosis (called carcinomatosis) Same as osteosarcoma

tumor outside the

bone

the commonest
tumor are: Thyroid Breast Lung Stomach Kidney Ovary prostate

Bone metastasis

sclerotic: If from prostate sclerotic If from breast lytic

may be lytic or

*Wbb = weight bearing bone

Easy Bones Series