Primary Malignant Lesions  

Posted bythespinebookadminPosted inTopics, Tumor

Enneking 

  1. Low grade 
  2. High grade 
  3. Mets 
  1. Intracompartmental 
  2. Extracompartmental 

Lesions 

Osteosarcoma 

  • Location: Anterior Column 
  • Presentation: pain, neurologic symptoms (70%) 
  • Ix: 
    • Lytic/ blastic/ mixed anterior column 
      • SUNBURST pattern 
    • Bone scan – very hot 
  • Mx: 
    • Tumour workup 
    • Neoadjuvant Chemo + Rads 
    • Wide Resection 
      • Sacral – total Sacrectomy with Recon with PMMA, plate/ screw devices, custom prosthesis 

Ewing Sarcoma 

  • Location: Anterior Column especially Sacrum 
  • Ix: 
    • Confusion 
    • Vertebra plana confused with eosinophilic granulomatosis 
  • Mx: Neoadjunctive treatment 
    • Responds well to radiation (will shrink it big time) 
    • Almost entirely medically managed in children 

Chordoma 

  • Location: Sacrum and Coccyx – central (GCG eccentric) both are at the front 
  • Age: adult (50>) 
  • Midline Tumour – from notochord 
  • Lytics and locally aggressive 
  • Patholoigy 
    • Philosiphilous cell 
  • Presentation: 
    • Indolent 
    • DRE anterior nodule 
  • Ix: 
    • Bright on T1 and T2 
    • Lytic lesion variable calcification 
  • Mx: En Bloc Resection 
    • Carbon ion 

Multiple Myeloma 

  • Begins as plasmocytoma 
  • Age: >60 
  • Dx: 
    • CBC Diff (10% abnormal plasma cells) 
    • Lytic Bone lesions 
    • Monoclonal gammopathy (SPEP UPEP) 
    • Anemia 
    • CRP/ ESR ++ elevated 
  • Ix: 
    • Multiple punched out lesions 
  • Mx: 
    • Chemo + Rads 
    • Operatively ONLY if neuro progression despite chemo rads 
    • Steroids with the chemotherapy