J KMA Special Issue Bone Tumors Specific in Children Sung Taek Jung, MD Kwang Cheul Jeong, M.D Department of Orthopedic Surgery, Chonnam National University College of Medicine E mail : stjung@chonnam.ac.kr hikcj2005@naver.com J Korean Med Assoc 2006; 49(12): 1068-1081 Abstract Primary bone tumors in pediatric age group are uncommon, and even when they do occur, they are usually benign. The primary malignant tumors that occur predominantly in children are two bone tumors, namely, osteosarcoma and Ewing's sarcoma. An adequate history and physical examination are the first and most important steps in evaluating a patient with a bone tumor. All suspected bone tumors should be evaluated initially with plain roentgenograms. Then the additional diagnostic studies, such as computed tomography(ct), magnetic resonance imaging(mri) and technetium bone scan can be used, if necessary. Biopsy should be the last step in evaluation. Most of benign bone tumors usually do not require treatment other than a periodic follow up evaluation. The optimal treatment of the malignant bone tumor often requires a combination of radiation therapy, chemotherapy, and wide surgical excision or amputation. Early detection of a malignant bone tumor not only may make the difference between life and death but also may allow successful salvage surgery rather than amputation of the limb. Keywords : Pediatric; Done tumor; Benign; Malignant 1068
Bone Tumors Specific in Children Classification of pediatric bone tumors based on tissue of origin Origin Bone origin Cartilaginous origin Fibrous origin Miscellaneous Metastatic tumors Tumor Osteoid osteoma, osteoblastoma, osteosarcoma Osteochondroma, chondroblastoma, chondromyxoid fibroma, enchondroma, periosteal chondroma Nonossifying fibroma, fibrous dysplasia, osteofibrous dysplasia, desmoplastic fibroma Unicameral bone cyst, aneurysmal bone cyst, giant cell tumor, Langerhans cell histiocytosis, Ewing sarcoma, musculoskeletal manifestation of leukemia, lymphoma Neuroblastoma, retinoblastoma, hepatoblastoma A B C (A) Geographic pattern (B) Moth eaten pattern (C) Permeative pattern Different patterns of bone destruction 1069
Jung ST Jeong KC Common locations of pediatric bone tumor Epiphysis Chondroblastoma Brodie's abscess of the epiphysis Giant cell tumor Fibrous dysplasia Diaphysis Fibrous dysplasia Osteofibrous dysplasia Langerhans cell histiocytosis Ewing sarcoma Leukemia, lymphoma Osteoid osteoma Unicameral bone cyst Anterior elements of spine Langerhans cell histiocytosis Leukemia Metastasis Giant cell tumor Pelvis Ewing sarcoma Osteosarcoma Osteochondroma Metastasis Fibrous dysplasia Metaphysis Any tumor Multiple Leukemia (metastasis) Multiple hereditary exostosis Langerhans cell histiocytosis Polyostotic fibrous dysplasia Enchondromatosis Metaphysis Aneurysmal bone cyst Osteoblastoma Osteoid osteoma Rib Fibrous dysplasia Langerhans cell histiocytosis Ewing sarcoma Metastasis (A) Codman triangle (B) Onion skin (C) Sunburst Different patterns of periosteal reaction 1070
Bone Tumors Specific in Children Staging of musculoskeletal tumors Stage Grade Site and Size Metastasis IA Low Intracompartmental None IB Low Extracompartmental None IIA High Intracompartmental None IIB High Extracompartmental None III Any Any Yes From Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Othop Relat Res 1980; 153: 106 1071
Jung ST Jeong KC Radical Margin Wide Margin Marginal Margin Intralesional Margin Osteoid soteoma(ct) Surgical margins 1072
Bone Tumors Specific in Children Conventional osteosarcoma Conventional osteosarcoma 1073
Jung ST Jeong KC A (A) sessile type Osteochondroma (B) pedunculated type B 1074
Bone Tumors Specific in Children Enchondroma 1075
Jung ST Jeong KC Shepherd's crook deformity of right hip Nonossifying fibroma 1076
Bone Tumors Specific in Children Osteofibrous dysplasia 1077
Jung ST Jeong KC Simple bone cyst 1078
Bone Tumors Specific in Children Ewing's sarcoma 1079
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