OSTEOSARCOMA & EWIN'S SARCOMA

OSTEOSARCOMA

EWING’S TUMOR

PRESENTER: ABDUL MUSHIB IBRAHIM

COORDINATOR: DR MAREKO

Osteosarcoma

• DEFINITION:- is a malignant tumor of the bone.-there are 2 types:a)Primary Osteosarcomab)Secondary Osteosarcoma

CAUSE: Unknown.

a) Primary Osteosarcoma

• Arises in absence of underling bone disease or predisposing factors.

• Most common in 2nd decade of life.• Usually situated in central metaphyseal region

of long Tubular bones. * Proximal Humerus * Distal Femur * Proximal Tibia

Osteosarcoma of Humerus

Osteosarcoma of Humerus

Osteosarcoma of Humerus

Osteosarcoma of Femur

Osteosarcoma of Femur

b) Secondary Osteosarcoma

• Occurs as a background of some predisposing factor.

• Occurs in other locations (e.g Jaws).• Usually occurs later in Life.PREDISPOSING FACTORSPagets Disease (common)Irradiation (Uncommon)Fibrous Dysplasia (rare)Diaphyseal Aclasis (Very rare)

PATHOLOGY

• Tumor arises in the metaphseal region of the bone Extends in all directions.

Eventually eroding cortex, invading soft tissues. (Producing obvious extraosseous mass).

Codman’s Triangle: When penetrating the cortex, tumor lifts the periosteum. Angle betn outer surface of cortex & elevated periosteum radiologially.

Codman’s Triangle

PATHOLOGY

• Cut surface Grey-white areas of hemorrhages & necrosis.

• If untreated fungates to produce an infected malignant ulcer.

* Sometimes the ulcer overlies a Pathological fracture.

PATHOLOGY

• MICROSCOPIC FEATUREFormation of osteoid directly by tumor cells.

• SPREADMainly to the Lungs.

CLINICAL FEATURES

• SYMPTOMS1.Local Pain-Persistant ache or throb.2.Swelling of Bone.3.Pathological Fracture.4.Infected malignant Fracture.5.General Malaise, cachexia & Weight loss.6.Cough & Hemoptysis.

CLINICAL FEATURES

• SIGNSLOCAL SIGNS…..SWELLING -Usually in lower end of femur, upper end of

tibia & upper end of humerus. -Colour: affected skin may be reddened. -Tenderness: Slightly -Temp: Usually Raised -Shape: Asymmetrical. -Surface: Usually smooth but Infected M U -Composition: Firm & Not Bony Hard

DIAGNOSTIC INVESTIGATIONS

• 1-Radiology• 2-Histology

DIAGNOSTIC INVESTIGATIONS

1-Radiologya) Ostcolytic Lesions in bone with ill defined edges.b)Extension into soft tissues. Neoplastic bone tends

to be deposited as irregular spicules radiating away from the shaft to give a “sunray” appearance.

c) Codman’s Triangle.d)Pathological Fracture.e)Secondaries to Lung.

DIAGNOSTIC INVESTIGATIONS

2-Histologya)To confirm the diagnosis.b)Obtained by: Needle Biopsy or Open Biopsy

TRETMENT OPTIONS• OPERATIVEa) Amputationb)Wide Local resection with replacement of defect

by prosthesis or allograft.• ADJUVANT CHEMOTHERAPYGive Postop to control & prevent development of

metastasis.• TREATMENT OF PULMONARY 2°a) Solitary: Lobectomyb)Multiple: Chemo.

PROGNOSIS

• Prognosis is separated into 3 groups.A.STAGE I• Is rare.• Includes perosteal region• Prognosis > 90% with wide resection.

PROGNOSISB. STAGE II• Depends on site of tumor.• Size of tumor.• Degree of necrosis from Chemo.• Distant Metastatsis to lungs. (Length of time &

Number of Nodules spread over a time span).• 2-year survival after the metastases-50%, 5-

year-40% and 10 year -20% (2 yrs no spread + < 2 nodules)

PROGNOSIS

C. STAGE III• Metastasis to lungs• Depends on removing primary & lung

nodules.• survival prognosis is about 30%

ANY POINTS FOR DISCUSSION?????????????

EWING’S SARCOMA

DEFINITION

• Is a malignant round cell tumor.• Initially starts in the bones & may also include

the soft tissues.• Extraosseous Ewing's sarcoma. • Exact cell of origin for Ewing's sarcoma. (Oc).

CAUSE: UNKNOWN

• RISK FACTORS: Unknown• GENETIC FACTORS: Unknown• PREVENTION: Unknown

• male/female ratio of 1:6• Peak Age: 10-20 yrs

• affects the long bones, such as:• Pelvic Bone • Ribs• Clavicle• Femur• Humerus• Tibia

SYMPTOMS

• Pain• Swelling• tumor may be present for many months

before it becomes large enough to cause pain and swelling.

• bone weakened by disease may break after a minor injury.

DIAGNOSING

• Hx• Imaging: X-ray, CT, MRI, Bone Scan.• X-Ray will show “ONION SKIN” type periosteal

reaction• BIOPSY • Chromosomes #11 and #22 are affected.

X-ray

TREATMENT

• NON OPERATIVEChemotherapy: vincristine , dactinomycin,

cyclophosphamide and doxorubicin • OPERATIVESurgery• RADIATION Therapy

PROGNOSIS

• Five-year survival for localized disease is 70% to 80% when treated with chemotherapy.

• Long term survival for metastatic disease can be less than 10%

Any Points For DISCUSSION

THANK YOU FOR YOUR TIME