Bone and Joint Surgery
Bone Cysts
Bone Cysts and other tumor-like formations
The formations in this group are the lesions recognized as a result of a crack or fracture in the bone secondary to weakening of bone and the ones which are incidentally found during X-ray studies. These lesions are called as pseudotumors or tumor-like lesions in orthopedic oncology. These lesions are not actually tumors and do not carry the risk of turning into tumor or cancer. Likewise, they do not spread to distant organs and cause life-threatening conditions. However, they damage the bone in which they are located and lead to problems like fracture, crack, deformation, and growth disorders.
Lesions Like Bone Tumor
Stress fracture
Osteomyelitis; Bone inflammation
Metabolic Bone Diseases; Osteoporosis and Osteomalacia
Solitary bone cyst
Aneurysmal bone cyst
Fibrous cortical defect - non-ossified fibroma
Bone islet
Fibrous Dysplasia
Bone necrosis
Paget's disease
Solitary Bone Cyst
Benign bone cysts filled with fluid are seen in children and young people.
More than 90% of them are located near shoulder and hip region.They are frequently asymptotic until fracture or crack occurs.
Cysts grow with development of the skeleton and then passes to the steady state.
Treatment;
Closed methods:
Draining of cystic fluid and steroid or bone marrow injection,
Endoscopic cleaning of cyst and calcium (synthetic bone filling) implementation
Open methods:
It is applied in recurrent cases or to weight-bearing areas
Possibility of recurrence is around 20-25%.
Aneurysmal Bone Cyst
Cystic lesions in bone filled with blood;
They are frequently located at end points of long bones;
Findings
Pain and swelling
Treatment;
Curettage; draining and cleaning of cyst
Mechanical methods; high speed burr or cauterization with Argon plasma
Filling cyst with bone or bone filling
Supportive application with titanium plate or screws if there is risk of fracture
Recurrence rate is stated as 25-40%.
Fibrous Cortical Defect - Non-Ossified Fibroma
Connective tissue development in bone
A few mm – a few cm in size 80% of them occur in peripatellar bones
Generally they are found incidentally and are asymptomatic.
They recover by themselves
Treatment is not necessary
If they grow too much, they should be followed up since fracture may ocur
Bone Islet
It consists of small nodules of bone
It is located in the spongelike part of the bone.
Generally they are 2-20 mm in diameter, however they can reach to 10 cm.
If they reach large sizes in appearance they may imitate bone cancer or inflammation.
Lesions smaller than 2 cm do not require biopsy
Growing lesions or lesions that are associated with pain require biopsy
Fibrous Dysplasia
It is a developmental lesion that occurs when connective tissue changes places with normal bone.
It may develop in single or several bone(s).
It is most frequently seen in ribs, calvarial bones and femur
It is usually asymptomatic and may result with skeletal deformation and fracture in some patients.
It is active during skeletal development and passes to silent state after skeletal development.
Surgical treatment;
Painful lesions,
Advancing deformation
Risk of fracture or fracture formation
Nonunion of pathologic fracture
Treatment;
Fixation with titanium nail or plates + bone transplantations
Bone Tumors
Primary bone tumors that equal to 5% of all tumors seen in humans follow the digestive system and tumors in reproductive organs regarding frequency.
Soft tissue tumors
Soft tissue sarcomas are cancerous (malignant) tumors which appear in soft tissues of your body.
Sarcoma
Sarcoma is the common name of malignant tumors originating from bone and soft tissue. Tumors are generally termed as the cell type creating cancer and sarcoma suffix. For example; the malignant tumor of cartilage cell is called chondrosarcoma and malignant tumor of fat cell is called liposarcoma.
Bone Sarcomas
Bone tumors are divided into two; benign and malignant.
Benign tumors are not cancerous formations. They do not spread into the organs from the bones they are located and threat life. The body can control and prevent the development and spreading of these tumors. These tumors are surgically treated. Although the benign bone tumors can relapse after the surgery, they can be excised with a new surgery.
Malignant bone tumors are called as bone cancers. These tumors leave the bones in which they are located and spread into the adjacent tissues and organs. The body fails to limit this spreading. The cells which cause bone cancer spread into distant organs, frequently lung, via blood vessels, from the region in which they are located. These spreading are referred as metastasis. Metastases occur especially in cases of delayed diagnosis and treatment and they cause to life-threatening conditions.
Cancers that are secondary to the bone itself are defined as primary bone cancer. These are cancers that originate from bone, cartilage, connective tissue and bone marrow which form the bone. Frequency of primary bone cancers is approximately 1 in 100.000. It is estimated that 500 to 600 new bone cancer cases occur every year in our country. Bone tumors are frequently located in arm and leg bones and more rarely in pelvic bone and ribs. Bone cancers are more frequently seen in children and the young compared to adults.
Bone cancers are referred as sarcoma. If the cell group that causes cancer is bone cell, it is referred as osteosarcoma, if cartilage cell as chondrosarcoma, and if connective tissue cell as fibro-sarcoma. There are cancer types among bone cells with unknown origin like Ewing sarcoma.
Osteosarcoma is the most common bone cancer type. It usually occurs in child and young patients between 10-25 years of age. It is two times more common in men compared to women. Generally in rapid growth periods, they are located at end points near the joint where epiphyseal plates exist in bone. Tumor is in peripatellar area in approximately 70% of the patients.
The second common bone cancer is Ewing sarcoma. These tumors are also common in children and young individuals. Their locations are generally the middle segments of arm and leg bones which are referred as long bones. It holds flat bones, i.e. pelvic bone and ribs, more frequently than osteosarcoma does.
Chondrosarcomas, originating from cartilage cells, generally occur after 40 years of age. These tumors are frequently located at pelvic bone and long bones.
Apart from these, there are very rarely seen bone cancers like;
fibrosarcoma,
chordoma and adamantinoma.
These tumors occur after the age of 30.
Apart from the primary bone cancers, there are cancers that do not originate from bone, although spread into bone from other organs. These are referred as secondary bone cancers or metastasis. These cancers are more frequently seen than the cancers originating from the bone itself. In such cases, cancer is not referred as bone cancer but as the cancer of the organ that spreads to bone. For example, bone metastasis of breast cancer. Among the cancers spreading to bone lung cancer, breast cancer in female and prostate cancer in male, thyroid and kidney cancers, gastric cancer and intestinal cancers can be counted respectively.
Cancers with bone marrow or blood cell origins like leukemia, lymphoma and myeloma are also located in bone. However, these are different cancer types and their treatments are very different from bone cancer treatments.
• Soft Tissue Sarcomas
Soft tissue sarcomas originating from connective tissue are malignant tumors. These occur at more advanced ages compared to bone cancers. Frequently seen soft tissue sarcomas include tumors like malignant fibrous histiocytoma, liposarcoma, synovial sarcoma, rhabdomyosarcoma. However, soft tissue sarcomas are seen with many types. Their treatments are also different from the treatments of bone cancers. Chemotherapy is not a frequently used method in soft tissue sarcomas, however it is used in some tumor types. The main therapy is large surgical resection and radiotherapy. Soft tissue sarcomas can have high or low grades, similar to bone sarcomas. Low grade ones are cancers that grow slowly and show low risk of spreading to distant organs. On the other hand, high grade soft tissue sarcomas grow rapidly and have tendency to spread to distant organs at early stage. They make distant spreading via blood frequently to lung and more rarely to posterior abdominal cavity and other organs.
