Bone Tumours

Bone tumours occur due to an abnormal proliferation of bone cells, and these can be either benign or malignant.

– One of the most common symptoms that bone cancers produce is bone pain. However, this is a very ambiguous symptoms as bone pain can be poorly localised and due to many differentials.

– Therefore, it is important to look out for particular red flags which may indicate bone cancer.

Guidelines:

– For unexplained bone pain/swelling in children and young people –> urgent X-ray within 48 hours

– If results suggest sarcoma –> referral to specialist within 2 weeks (for adults) and 2 days (for children)

Osteosarcoma

This is a malignant proliferation of primitive cells that differentiate into osteoblasts

– It is the most common primary malignant bone cancer

– It is usually seen in children and young adolescents, and occurs towards the ends of the long bones (usually legs)

– It is associated with mutations of the Rb gene; hence, it is sometimes seen in children with a positive medical history of retinoblastoma earlier in life

Symptoms:

– Red flags symptoms (e.g. one pain that is worse at night or wakes you up from sleep)

Tests:

– X-Ray shows a sclerotic pattern of disease

– CT/MRI

– Bone biopsy to look at histology

Management:

Surgical en bloc resection of tumour with adjuvant chemotherapy

Ewing Sarcoma

This is a malignant proliferation of primitive cells which is seen in children and adolescents

– Unlike the osteosarcoma, this usually gives tumours in the middle of the long bones and pelvis

– It is due to a chromosome translocation between 11–> 22 affecting the EWSR1 gene

– It metastasises very quickly, and many patients diagnoses already have metastases

Unlike osteosarcoma, the tumour gives lytic (destroying bone lesions) which appear more lucent on x-ray

– X-rays show an onion skin appearance.

– If there a multiple lytic bone lesions, this produces a “moth eaten” pattern of disease

– Similar to the osteosarcoma, the inflammation also produces a periosteal reaction which may give rise to the Codman triangle finding on X-ray

Osteoid osteoma

This is a type of benign tumour which grows on bone and usually affects adolescents (especially boys)

– It typically involves the spine, femur or tibia giving rise to bone pain

– Osteomas themselves (a benign tumour made of bone) represent the most common benign neoplasm of the nose and paranasal sinuses

Symptoms:

– Bone pain that is more severe at night with localised tenderness and swelling

Tests:

X-Ray shows sharp demarcated radiolucent (black) focus of osteoid tissue surrounded by sclerotic bone

Management:

Surgical Removal (amputation)