Diagnostic strategy in MSK tumor
Sunday, November 28, 2010 2:52 AM |
0 SAID SOMETHING
Pain- pain at rest / night pain
- fever not prominent
50 – mets (destructive bone lesions)
10 – Histiocytosis
GCT – female
2. Risk factors:
– mets/pathological #
General examination :
-anemia/thrombocytopenia – suggest bone marrow infiltration.
-BUSE (calcium) – hypercalcemia in bone mets – can be fatal
-LFT (ALP, Albumin) – liver secondaries
-Specific (PSA,CEA, TFT, Bence Jones protein)
-to see bony lesions
-very sensitive to detect secondaries
-CT chest – to detect lung secondaries
-CT of the affected bone – delineate cortical involvement in details
-delineate soft tissue involvement
-blood vessel – possibility of resection of the affected vessel & anastomosis with
-nerve – if it is involved, limb salvage may not be feasible
-marrow extension - determine the extent of bone resection/skip lesion.
-muscle involvement etc.
-define vascularity of the tumor – very vascular tumor may require pre-op
-vascular involvent of the tumor
Tumor staging (Enneking)
-radiological –intracompartmental/extracompartmental/distant mets.
-done BEFORE biopsy
-histological – biopsy
-low grade/high grade tumor
Curative – patient is free from the disease.
Palliative - patient is not free from the disease but to ease the suffer eg, pain relief,
eradication of smelly/infected tumor.
-for respectable tumor/ accessible umor
-for chemosensitive tumor, syatemic spread tumor
-for inaccessible localized tumor for surgical resection
-inadequate surgical margin following resection.
Most aggressive tumor require combination of these treatment modes.
Radiotherapy is contraindicated for benign tumor!
Site :long bones
-open growth plate(GP)
-respect GP – ABC,solitary cyst,chondramyxoid fibroma
-breach GP - Chondroblastoma
-closed growth plate – GCT , chondrosarcoma
Diaphysis – Round cell tumors (Histiocytosis, leukemia,lymphoma, Ewing,
Myeloma, secondaries, neuroblastoma)
-calcification – cartilage forming tumor(chondrosarcoma,
enchondroma, chondroblastoma )
-secondaries : bladder, prostate, bronchus.
-ossification – bone forming tumor (osteosarcoma, osteoid osteoma, osteoblastoma)
-without mineralization (soft tissue tumor )
-fibrous tissue (non ossifying fibroma)
-muscle (rhabdo myosarcoma)
-massive soft tissue swelling
-wide zone of transition
-signs of distant metastasis
-certain lytic pattern (geographical, moth eaten)
I am a lecturer and a surgeon in Orthopaedic and spine, working in School of Medical Science, USM.