OSTEOSARCOMA

Question 1

ALSO CALLED

Answer 1

OSTEOGENIC SARCOMA

Question 2

DEFINE

Answer 2

MALIGNANT TUMOUR OF MESENCHYMAL CELLS CHARACTERISED BY FORMATION OF OSTEOID / BONE BY TUMOUR CELLS.

Question 3

ON BASIS OF CLINICAL SETTING

Answer 3

PRIMARY = COMMON ,15 TO 25 YEARS
SECONDARY = OLD AGE > 45 YEARS

Question 3

CLASSIFICATION

Answer 3

ON BASIS OF CLINICAL SETTING
ON BASIS OF HISTOLOGY

Question 4

ON BASIS OF HISTOLOGY

Answer 4

OSTEOBLASTIC = NEW BONE FORMATION
CHONDROBLASTIC = BASIC CELL BEING CARTILAGE
FIBROBLASTIC = BASIC CELL BEING FIBROBLASTS
OSTEOLYTIC = MOST MALIGNANT

Question 5

SPREAD

Answer 5

LOCAL SPREAD = ARISES IN MEDULLARY CAVITY , SPREADS TO CORTEX THEN TO SOFT TISSUE , REPLACES THE MARROW CAVITY , JOINT INVOLVEMENT RARE
HEMATOGENOUS SPREAD = LUNG, BRAIN
LYMPH NODE INVOLVEMENT UNSUSUAL

Question 6

AGE

Answer 6

15 TO 25 YEARS

Question 7

SEX

Answer 7

MALE

Question 8

SITE

Answer 8

AROUND KNEE: DISTAL FEMUR, PROXIMAL TIBIA

Question 9

LOCATION

Answer 9

MEDULLARY CAVITY OF METAPHYSIS

Question 10

SYMPTOM

Answer 10

DULL ACHING PAIN ,
SWELLING
HISTORY OF MINOR TRAUMA
SOMETIME MAY PRESENT AS PATHOLOGICAL FRACTURE

Question 11

SIGN

Answer 11

SWELLING IN REGION OF METAPHYSIS,
SKIN OVER SWELLING SHINY WITH PROMINENT VEINS
MARGINS OF SWELLING NOT WELL DEFINED ( SUGGESTS MALIGNANCY )
MOVEMENT OF JOINT RESTRICTED

Question 12

RADIOLOGICAL INVESTIGATION

Answer 12

X RAY
CT
MRI
BONE SCAN
X RAY AND CT OF CHEST

Question 13

X RAY

Answer 13

SUN RAY APPEARANCE = CORTEX BREACHED AND TUMOUR GROWS INTO ADJACENT SOFT TISSUE
PERIOSTEAL REACTION = GROWING TUMOUR LIFTS UP THE PERIOSTEUM
CODMANNS TRIANGLE = TRAINGULAR AREA FORMED AT THE TUMOUR AND HOST CORTEX JUNCTION

Question 14

OTHER INVESTIGATIONS

Answer 14

BIOPSY = OPEN BIOPSY CONFIRMS DIAGNOSIS, OR FNAC CAN ALSO BE DONE
SERUM ALKALINE PHOSPAHTASE = ELEVATED

Question 15

TREATMENT

Answer 15

1. CONFIRM THE DIAGNOSIS= HISTOLOGICALLY , CLINICALLY AND RADIOLOGCALLY
2. CHECK THE SPREAD OF TUMOUR = CT SCAN , MRI , BONE SCAN , CHEST X RAY
3. FINALLY , TREATMENT OF DISEASE

Question 16

TREATMENT OF DISEASE

Answer 16

**LOCAL CONTROL =
BY SURGICAL ABLATION ; 2 METHODS : LIMB SPARING AND AMPUTATION , NOWADAYS LIMB SPARING WIDELY USED .
**CONTROL OF MICROMETASTASIS =
BY CHEMOTHERAPY , IMMUNOTHERAPY
**ROLE OF CHEMOTHERAPY =
IS STARTED AS NEO ADJUVANT AND CONTINUED AS ADJUVANT CHEMOTHERAPY , T 10 PRTOCOL OF CHEMOTHERAPY .
**ROLE OF RADIOTHERAPY =
NOT SO USEFUL , FOR THOSE WHO REFUSE SURGERY AND IN THOSE WHERE TUMOUR APPEARS IN UNOPERABLE SITES.
**IMMUNOTHERAPY =
IMMUNITY INCREASED BY GIVING ANTIBODIES, BCG VACCINE AND INTERFERON THERAPY .

Question 17

TREATMENT OF PULMONARY METASTASIS

Answer 17

BY CHEMOTHERAPY

Question 18

T 10 PROTOCOL OF OSTEOSARCOMA

Answer 18

HIGH DOSE OF METHOTREXATE
VINCRISTINE
DOXOROBUCIN
BLEOMYCIN , CYCLOPHOSPHAMIDE & DACTINOMYCIN
CISPLATIN

Question 19

FOLLOW UP

Answer 19

EARLY 6 TO 8 WEEKLY

Question 20

SECONDARY OSTEOSARCOMA

Answer 20

DEVELOPS IN BONE HAVING PREMALIGNANT DISEASES LIKE PAGETS DISEASE
SEEN IN ELDERLY > 45 YEARS
TREATMENT = SAME AS OSTEOSARCOMA

Question 21

HISTOLOGY

Answer 21

GROSS =
MUTTON LEG APPEARANCE
OSTEOBLASTIC ; GREY-WHITE , HARD GRITTY WHEN CUT
CHONDROID; BLUISH GREY
FIBROBLASTIC ; FISH FLESH APPEARANCE
OSTEOLYTIC ; AREAS OF TUMOUR NECROSIS , AND BLOOD FILLED SPACES
MICROSCOPICALLY =
ANAPLASTIC MESENCHYMAL PARENCHYMA WITH TUMOUR CELLS SURROUNDED BY OSTEOID .