Osteosarcoma[2]
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This document provides an overview of osteosarcoma, including its definition as the second most common primary bone tumor arising from mesenchymal cells that produce osteoid. It is most common in adolescents and young adults. While the pathogenesis is unknown, rapid bone growth appears to be a risk factor. Diagnosis involves evaluating symptoms, imaging findings, and biopsy. Treatment typically involves chemotherapy, surgery to remove the tumor with wide margins, and sometimes reconstruction. Prognosis and treatment approach depends on tumor grade and location.
Osteosarcoma[2]
- 1. Osteosarcoma 1 04/23/13
- 2. Overview 2 Definition Epidemiology Pathogenesis Parosteal osteosarcoma Skeletal distribution Periosteal osteosarcoma Clinical presentation High grade surface Evaluation osteosarcoma High grade osteosarcoma
- 3. Definition 3 2nd most common primary bone tumor Malignant tumor of mesenchymal origin Spindle shaped cells that produce osteoid
- 4. Epidemiology 4 Any age 75% 12-25yrs Modal incidence
- 5. Epidemiology 5 Primary vs secondary Male : female Li Fraunie syndrome
- 6. Pathogenesis 6 Unknown Modal incidence correlates with rapid bone growth Radiation exposure Cancer survivors Retinoblastoma
- 8. Classification 8
- 9. Clinical Presentation 9 Painful mass arising from bone Trauma Metastisize early in evolution 20% clinically detectable mets at dx
- 10. Evaluation 10 Suspected diagnosis by hx and physical Supported by xray
- 11. Plain Xray 11 Lytic, sclerotic or mixed Typical characteristics of malignant tumor Enneking’s 4 questions
- 12. Initial Evaluation 12 Define the extent of the disease Locally Systemically
- 13. Local 13 CT MRI +/- Angiogram
- 14. CT 14
- 15. MRI 15
- 16. Angio 16
- 17. Systemic 17 Bone scan CT Chest lab
- 18. Classic High Grade Osteosarc 18 Age, sex Presentation Physical exam Blood work Plain films Site size
- 19. Differential Dx 19 Giant Cell Tumor Aneursymal Bone Cyst Ewings Osteoblastoma Metastasis Lymphoma
- 20. Biopsy 20 Principles Dx “high grade osteosarcoma” Now What??
- 21. Chemotherapy 21 Micro metastasis What we have learned pre chemo (1970’s) Multi Institutional Osteosarcoma Study
- 22. Chemotherapy 22 Chemo cannot control clinically detectable disease Radiation is ineffective Local control is surgical
- 23. Chemotherapy 23 Best protocol is subject of ongoing trials Drugs Doxorubicin Cisplatin Ifosfamide Methotrexate Cyclophosphamide Side effects
- 24. Induction Chemotherapy 24 Arose in conjunction with development of limb sparing surgery Increase survival prognostic
- 25. Surgery 25 Limb salvage the norm Now safer procedure Wide surgical margin
- 26. Surgical options 26 Articular surface removed Osteoarticular allograft replacement Custom modular prosthesis Allograft prosthesis composite Allograft arthodesis Segment of diaphysis missing Intercalary allograft
- 27. Surgery 27 Young patient with open growth plate Rotatioplasty Conventional amputation
- 28. 28
- 29. Surgery 29 Indication for amputation Grossly displaced pathologic fracture Encasement of neurovascular bundle Tumor that enlarges during preop chemo and is adjacent to neurovascular bundle
- 30. Current Standard of Care 30 Pretreatment radiologic staging Bx to confirm diagnosis Preoperative chemotherapy Repeat radiologic staging (access chemo response, finalize surgical tx plan) Surgical resection with wide margin Reconstruction using one of many technoques Post op chemo based on preop response
- 31. Surface osteosarcoma 31 Parosteal Periosteal High grade surface osteosarcoma
- 32. Parosteal 32 5% of osteosarcomas Posterior metaphysis of distal femur Slow growing large ossified mass Confused with osteochondroma String sign Low grade treatment
- 33. Parosteal Osteosarcoma 33
- 34. Parosteal Osteosarcoma 34
- 35. Periosteal Osteosarcoma 35 Arises from surface of diaphysis Characterized by bony spicule formation perpendicular to shaft Sunburst Low grade Wide excision
- 36. High grade surface 36 Very rare 20-30’s Appearance as parosteal but histology high grade Tx as classic intermedullary