"A Swelling In The Leg"

"A Swelling In The Leg"

1. ANATOMY OF THE THIGH

   • Muscles: Hip flexors, knee extensors
   • Nerves
   • Arteries
   • Adductor canal
   • Hamstrings muscles:
   • EXAMINATION OF THE THIGH
     • Gait
       • Symmetry (No limping).
       • Spacing (the space between two feet while walking.).
       • Base (the space between two feet while standing.).
     • Movement
     • Dermatomes

2. CLASSIFICATION OF BONE TUMORS

   • Primary Tumors
     • Formed de novo, within the bone itself
       • Classified based on its many characteristics like size, borders, activity, etc.
   • Secondary Tumors
     • Mainly metastatic tumors that originate from other parts of the body and spread to bones.
     • OSTEOSARCOMA
       • Malignant tumor of mesenchymal cells characterized by direct formation of osteoid or bone matrix by the tumor cells*
         • osteoid material in direct contact with pleomorphic malignant cells
       • Risk factors
         • Teenage growth spurts
         • Higher height than normal (longer bones)
       • Symptoms
         • Fragility fracture
         • Pain in the affected bone
       • Primary osteosarcoma
         • Males > females
         • Genetic factors: mutations in 1retinoblastoma gene, and 2-P53 gene.
         • : Metaphysis of long bones, lower end femur, upper end tibia.
       • Secondary osteosarcoma
         • Older than 40 years
         • flat bones > long bones
         • Ionizing radiations: Radiotherapy
       • INVESTIGATIONS OF OSTEOSARCOMA
         • X-ray
         • MRI
         • Ultrasound
         • CT scans
         • Bone scans
         • PET" Scan
       • TREATMENT OF OSTEOSARCOMA
         • Surgery
           • to remove the cancer only (limb-sparing surgery)
             • to remove the affected limb (amputation)
         • Chemotherapy
         • Radiation therapy
   • INVESTIGATIONS OF BONE TUMORS
     • History
     • Physical examination
     • Lab test
       • CBC
       • Blood chemistry panel
     • Imagining test
       • X-ray
       • Radio-isotopic study
     • Biopsy
       • BIOPSY FROM A BONE TUMOR
         • Needle Biopsy
         • Open Biopsy
         • Why might I need a bone biopsy?
           • Evaluate bone pain or tenderness.
           • Investigate an abnormality seen on X-ray.
           • Find out if a bone tumor is malignant or benign.
           • cause of an unexplained infection or inflammation.
           • What are the risks of a bone biopsy?
             • Bruising and discomfort at the biopsy site.
             • Bone fracture.
             • Prolonged bleeding from the biopsy site.
             • Infection near the biopsy site or in the bone
   • TREATMENT OF BONE TUMORS
     • Benign bone tumors :
       • can be treated by medication
         • need often check up(x-rays)
           • some may disappear by their own
     • Malignant bone tumors :
       • Radiational therapy
         • chemotherapy
     • Surgical treatment
       • excision of the benign tumor
         • Limb salvage surgery/amputation for malignant tumor
   • EPIDEMIOLOGY OF BONE TUMORS
     • Osteochondroma: affects mostly males less than 25 Y.O.
     • Osteoma: middle aged individuals.
     • Osteoblastoma: males more than females
     • Osteoid osteoma: adults less than 25 Y.O
     • How common is osteosarcoma?

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