Swelling in the leg

Swelling in the leg

1. Possible causes

   • Vascular
   • Inflammation
   • Neoplasia
     • bone
       • malignant
         • osteosarcoma
       • benign
         • osteoma
         • osteoid osteoma
         • osteoblastoma
     • cartilage
       • benign
         • osteochondroma
         • enchondroma
       • malignant
         • chondrosarcoma
         • osteochondromatosis
     • miscellaneous
       • Ewing's sarcoma
       • Giant cell tumour of bone
   • Degenerative
     • osteoarthritis
   • Iatrogenic
   • Congenital
   • Autoimmune
     • rheumatoid arthritis
   • Trauma
     • fracture
   • Endocrine
     • osteoporosis

2. Anatomy

   • The popliteal region
     • bony landmarks
     • borders
     • contents
   • The thigh
     • anterior compartment
     • middle compartment
     • posterior compartment

3. osteosarcoma

   • definition
     • malignant tumor of mesenchymal cells characterized by direct formation of osteoid or bone matrix by the tumor cells (Osteogenic sarcoma).
   • aetiology
     • somatic or acquired gene changes
       • TP53 tumor suppressor gene
       • Retinoblastoma tumor suppressor
     • Age, growth and height, ethnicity, genetic and familial factors
     • germline or inherited mutations
   • types
     • primary:due to an abnormality in bone development secondary:due to another condition
     • intramedullary/juxtacortical/extraskeletal
   • signs and symptoms
     • Pain in a bone or joint that gets worse over time, especially if the pain interferes with sleep
     • a noticeable mass or lump in an arm or leg
     • painless swelling
     • Back pain or a loss of bowel or bladder control(if the tutor is in the pelvis or at the base of the spine)
     • a broken bone with no injury to explain how it occurred
     • Stiffness or swelling of joints
   • Investigations
     • laboratory tests
       • Alkaline phosphatase (ALP)
       • Tumour markers
       • Lactic dehydrogenase (LDH)
       • CBC
     • Imaging
       • X-rays/MRI/CT scan/ Radioisotopes scan
     • Biopsy
       • needle
         • core needle
         • fine needle aspiration
       • surgical
         • incisional
         • excisional
     • clinical features
       • pathological fracture
       • codman triangle
       • skip lesions
       • sunburst appearance
       • pulmonary metastasis
       • mass
   • complications
     • pulmonary metastasis
     • orbital mass
     • anemia
   • treatment
     • surgery
       • limb-salvage
         • removing the cancer and some surrounding normal tissue but leaving the limb basically intact
       • amputation
         • removing the cancer and all or part of an arm or leg
           • socioeconomic
             • Problems with acquiring status in a society, finding a job, etc.
             • Feelings of revulsion by family and society.
           • psychology
             • Anxiety, depression
             • PTSD
             • Phantom limb pain
             • appearance(poor body image)
     • chemotherapy
     • radiation therapy (in certain cases)
   • Pathophysiology
     • Osteosarcoma starts at the primitive mesenchymal cells, a defect in genes will cause it to become a cancerous cell that is marked by its production of osteoid
     • tumor cells produce osteoid describing irregular trabeculae  —tumor bone. Tumor cells are included in the osteoid matrix.
     • osteosarcoma cells act like osteoblastic cells,as they also make bone matrix but it is not as strong as the normal healthy one.
     • It is mostly local and affects metaphysis of long bones
     • The tumor is large, bulky, and is fading away.It Contains necrosis. New bone formation starts at the subperiosteal space and radiates from the central mass
     • It is a rapidly and aggressively growing tumor. It invades the medullary cavity inward. Destroys the cortex outwards, plus it invades close soft tissue
     • It does not invade epiphyseal cartilage.
     • Hematogenous, direct spread to lungs, other bones , brain, and liver

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