43: Surgical Management of Bone Tumors - Bennett

Question 1

describe this picture

Answer 1

permeative (ill-defined)

• also know what geographic (well-defined) and moth eaten look like

Question 2

narrow margin

Answer 2

0.1-1.0 mm: tumor and surround normal bone are touching, and you see a small distance b/w them

wide = 2-10 mm: indistinct area that looks like it might be partially damaged in betweed tumor and undamaged bone

poorly defined = several centimeter or impossible to measure

Question 3

periosteal reaction = indicator of biologic activity of bone lesion

Answer 3

less –> more aggressive

If growth is very rapid, two patterns may develop:

1. “sun-burst” or “hair-on-end” appearance-periosteum has no time to lay down bone, but Sharpey’s fibers become stretched out perpendicular to the bone, and then ossify
2. Codman’s “triangle”- only the edges of the raised periosteum will ossify-this little bit of ossification forms a small angle with the surface of the bone, but not a complete triangle

Question 4

benign lesion staging

Answer 4

Stage 1: lesions that are static or tend to heal spontaneously.

Stage 2: lesions that present with a more aggressive radiographic presentation, and evidence of continued growth.

Stage 3: locally aggressive lesions, and show progressive growth not limited by barriers.

Stage 2 and 3 are histologically immature

Question 5

treatment based on staging of benign lesion

Answer 5

Benign stage 1 & 2:

• intra lesional currettage
• reconstructed with cancellous bone grafting, methyl methacrylate augmentation

Benign stage 2 & 3:

• over treat with marginal excision that removes the intra articular surface with associated fusion

adj tx: cryotherapy, phenol, polymethacrylate

Question 6

staging malignant lesions

Answer 6

Stage 1: low grade lesions

Stage 2 : high grade lesions

Stage 3: presence of metastasis

Question 7

treatment based on staginf of malignant lesion

Answer 7

Malignant stage 1 lesions: require a wide marginal excision, may require a partial or complete amputation at the appropriate level.

Malignant stage 1B and 2 lesions: result in reconstruction by Malignant stage 1B and 2 lesions: result in reconstruction, amputation

Question 8

principles of biopsy

Answer 8

• Incision placement and orientation
  
  • longitudinal and based on the anticipated area of resection
  • performed without the formation of tissue planes
  • hemostasis
• Dissection should be carried out sharply to the level of bone and remain within one fascial compartment
• Soft tissue mass sent if present
• Cortical window created
• Closed in layers