TUMORES 2. TUMORES OSEOS BENIGNOS Y MALIGNOS

Overview of Bone Lesions and Tumors

Characteristics of Bone Lesions

• The discussion begins with the identification of bone lesions typically found in males aged 5 to 35 years, characterized by a small cortical lesion surrounded by central bone sclerosis on tomography.

• Radiographic images reveal larger lesions that may require grafting; if left untreated, these tumors can grow aggressively.

Aggressive Tumor Types

• Certain aggressive tumors are noted, particularly in the hand, which are common in this demographic. The importance of recognizing these types is emphasized.

Treatment Approaches for Bone Tumors

Traditional Treatment Methods

• Traditional treatment methods include surgical resection for symptomatic cases; however, there is a low risk of malignancy associated with some lesions.

• Malignant tumors often require constant monitoring and may necessitate interventions to promote new bone growth while managing symptoms.

Diagnostic Imaging Techniques

• Initial diagnosis often relies on radiography, although not all conditions present clearly on X-rays; specific patterns like "onion skin" reactions can indicate certain pathologies.

• The "Codman triangle" is highlighted as a significant indicator of aggressive tumor behavior seen in imaging studies.

Understanding Sarcomas

Features of Chondrosarcoma

• Chondrosarcoma is identified as a primary malignant cartilage-forming tumor with diverse characteristics and behaviors; it tends to grow slowly but can be locally aggressive.

• Epidemiologically, chondrosarcoma predominantly affects older males (70% over age 50), commonly located in the pelvis and long bones such as the tibia and humerus.

Radiological Findings

• Radiographs may show small calcifications described as "popcorn-like," which do not elicit significant periosteal reactions compared to other sarcomas.

Osteosarcoma Insights

Prevalence and Symptoms

• Osteosarcoma is noted as the most common primary bone tumor, primarily affecting younger patients around 65 years old with symptoms including fever and recurrent infections due to renal issues or protein abnormalities.

Multidisciplinary Treatment Approach

• A multidisciplinary approach involving oncologists is essential for treating osteosarcoma since it responds well to radiotherapy rather than solely orthopedic intervention when fractures occur due to pathological conditions like multiple myeloma.

Benign Aggressive Tumors

Clinical Presentation

• Benign aggressive tumors are discussed as being locally invasive yet not malignant; they can lead to joint destruction if left untreated, requiring careful management strategies including curettage followed by cement filling or surgical resection with prosthetics if necessary.

Demographics and Location

Treatment of Low to Medium Aggressiveness Tumors

Overview of Treatment Approaches

• The treatment for low to medium aggressiveness tumors involves extensive curettage, often concluding with filling using methyl methacrylate. This is a form of local adjuvant therapy aimed at preventing recurrence.

• For more aggressive tumors or those that are recurrent, the approach shifts to resection, either expanded or en bloc, often necessitating bone grafting due to significant bone loss during the procedure.

Case Examples

Giant Cell Tumor

• An example presented includes a giant cell tumor depicted on the left side of an image; it shows initial stages without cortical violation but presents as a lytic lesion on the external femur.

• In cases where there is substantial joint destruction (as seen in another giant cell tumor resembling osteosarcoma), traditional curettage is not viable. Instead, an en bloc resection and reconstruction with prosthetics are required.

Ewing's Sarcoma Insights

Clinical Presentation and Diagnosis

• Ewing's sarcoma is identified as a malignant diaphyseal tumor commonly found in children, presenting symptoms such as localized pain, swelling, and fever. Notably highlighted was a case involving a 10-year-old experiencing night pain and fever.

• The imaging reveals critical destruction associated with periosteal reaction; this condition requires comprehensive treatment including chemotherapy before and after surgery, along with potential radiotherapy based on surgical margins obtained.

Treatment Protocol Summary