Musculoskeletal tumors Janíček, P, Pazourek L., Ondrůšek Š., Rozkydal, Z. Classification nMalignant n nBenign n nTumor like lesions n nMetastases They are prodused in mesenchym Most of them are benign Malignant tumors 1-2 % of all malignancies Bone sarcomas Soft tissue sarcomas Symptoms nPain n nSwelling n nImpaired function n nPathological fracture n nGeneral symptoms (fever, weaknes, cachexia …) Diagnostics nHistory nX-ray nCT / MRI nScintigraphy of the skeleton nChest X-ray, CT of the lungs nUltrasonography of the abdomen nBiopsy (histology) n nOther imaging methods (PET, angiography, laboratory tests. Genetic examination … Biopsy nTrue cut biopsy n nNeedle biopsy under CT n nExcisional biopsy n nHistology- experienced pathologist n nBiopsy – in special centres X-ray finding in malignant bone tumors –Aggressive lesions – –Periostal reaction – –Erosions of cortex – –Endostal irregularities LacigováKarin83CT Irregularities LacigováKarin83ap LacigováKarin83boč Periostal reaction (spikes) KacarTomáš92boč WirthPatrik98ap Codman´s triangle Onion-like periostosis OujezdskýFilip83ap Osteolytic patches Mahdalová1x Erosions of the cortex YanarsanovDzhabrail95ap Goszijová1x Expansion of the tumor GojováMilada44RTGboč NguenThiThijTrang91ap Age n1. decade: EwingSA n2.-3. decade: OSA n3.-4. decade: osteoclastoma, parosteal n OSA, chondrosarcoma … n5. decade ….: Myeloma, secondary bone n tumors, chondrosarcoma Staging TNM classification T1- T4 (size and localisation) N0-2 (lymphonodes) M0, M1- lung, skeleton, liver, CNS Staging of musculoskeletal tumors (Enneking) nGrade – biological aggressivity n nLocal finding (T) n nN0-2 ( lymphonodes) n nM0-1 (metastases) Biological agresivity, Grade Summary of clinical, radiological and histological findings G0 benign cytology G1 invasive growth, mitoses, anaplastic cells G2 infiltrative growth, no anatomical margins, high vascularity G3 fast growth, dediferencial tumor cells, distant metastases Site of tumors T0 tumor in capsule T1 extracapsular growth, in compartment Satelites in reactive zone T2 extracompartmental growth Nádory skip 1 Extracompartmental growth Nádory skip 1 Reactive zone- satelite metastases Skip metastases Metastases M0 no metastases M1 metastases are present regional lymphonodes distant metastases- lung, skeleton, liver, CNS nI Low grade n A Intracompartmental G1-2 T1 M0 n B Extracompartmental G1-2 T2 M0 nII High grade n A Intracompatmental G3 T1 M0 n B Extracompartmental G3 T2 M0 nIII Metastatic n A Intracompatmental G1-3 T1 M1 n B Extracompartmental G1-3 T2 M1 n n Classification Clinical stage I.Surgery II. II. surgery + radiation + chemotherapy III. Chemoinduction + radiation (or surgery + chemotherapy) IV. Paliative management Therapy nLocal therapy –surgery –radiotherapy –others (embolisation, RFA …) – nSystemic therapy –chemotherapy –hormonal therapy –bisphosphonates –biological treatment … Surgical radicality nRadical n nWide resection n nMarginal n nIntralesional TU- schéma radikality op R0 margins of removed tumor - without tumor cells R1 microscopic infiltration R2 macroscopic infiltration Oncological radicality R0 surgery is curative R1 surgery is not curative adjuvant radiotherapy R2 debulking Surgery is not curative, only paliative Adjuvant radiotherapy and chemotherapy Surgery n n- Ablative (amputation, disarticulation) n n- Limb-salvage surgery Ablative n n HrabalFrantišek42RTG2 WasserbauerAleš Conservative hemipelvectomy Scapulectomy lopatka1 pánev2 C:\Users\PC\Pictures\jedrůlek 1.png C:\Users\PC\Pictures\jendrůlek 2.png Tumor of the pelvis 1.Stage- removal, bone cement + THA 2.Stage- replacement + THA C:\Users\PC\Pictures\lízal 1.png C:\Users\PC\Pictures\lízal 2.png Tumor of the scapula Removal, replacement of the scapula + total shoulder artroplasty Intercalary bone graft DiafTib1 DiafTib2 DiafFem1 DiafFem2 Osteocartilaginous grafts ProximHum DistFem2 DistFem1 DistTib2 Tumor endoprosthesis nResection and joint replacement TU-TEP ramena TU-THA TU-TKAfem1 TU-TKAfem2 TotFem1 TotFem3 TotFem4 Composite endoprosthesis KompozitníTU-TKA1 Kompozitní TU-TKA2