Malignant Bone Tumors

Neoplasms of any histogenesis are divided into two grades: low (G1) and high (G2). The majority of low-grade lesions may be managed with relatively conservative procedures while the high-grade lesions require more aggressive procedures to achieve the primary goal of a definitive oncologic surgical procedure (local control).

Low-grade lesions have a low risk for metastases (<25%).Histologically, they are well-differentiated, have few mitoses, and moderate cytologic atypia. Their clinical course is marked by indolence, when they occur in bone; there is a tendency toward circumscription by reactive new bone. Most of them can be treated with local control without adjuvant therapy. High-grade lesions have a significantly higher incidence of metastases. They are characterized by poor differentiation, a high cell/matrix ratio, a high mitotic rate and necrosis. Their clinical course is correspondingly marked by activity. Radiographically, the bone primaries are poorly marginated and have a permeated pattern and marked bone destruction and soft tissue extension. Angiographically, a reactive neovasculature usually rims the lesion. Their local resection must be followed with adjuvant chemotherapy to achieve the best results and patient survival.


 

 


Hemangio-Pericytoma of the proximal femur with
pathological fracture

Osteosarcoma of the distal femur




Osteosarcoma of the distal femur

Specimen of Osteosarcoma of the proximal tibia after
complete resection