Swelling in the leg

Possible causes
1. Vascular
2. Inflammation
3. Neoplasia
  1. bone
    1. malignant
      1. osteosarcoma
    2. benign
      1. osteoma
      2. osteoid osteoma
      3. osteoblastoma
  2. cartilage
    1. benign
      1. osteochondroma
      2. enchondroma
    2. malignant
      1. chondrosarcoma
      2. osteochondromatosis
  3. miscellaneous
    1. Ewing's sarcoma
    2. Giant cell tumour of bone
4. Degenerative
  1. osteoarthritis
5. Iatrogenic
6. Congenital
7. Autoimmune
  1. rheumatoid arthritis
8. Trauma
  1. fracture
9. Endocrine
  1. osteoporosis
Anatomy
1. The popliteal region
  1. bony landmarks
  2. borders
  3. contents
2. The thigh
  1. anterior compartment
  2. middle compartment
  3. posterior compartment
osteosarcoma
1. definition
  1. malignant tumor of mesenchymal cells characterized by direct formation of osteoid or bone matrix by the tumor cells (Osteogenic sarcoma).
2. aetiology
  1. somatic or acquired gene changes
    1. TP53 tumor suppressor gene
    2. Retinoblastoma tumor suppressor
  2. Age, growth and height, ethnicity, genetic and familial factors
  3. germline or inherited mutations
3. types
  1. primary:due to an abnormality in bone development secondary:due to another condition
  2. intramedullary/juxtacortical/extraskeletal
4. signs and symptoms
  1. Pain in a bone or joint that gets worse over time, especially if the pain interferes with sleep
  2. a noticeable mass or lump in an arm or leg
  3. painless swelling
  4. Back pain or a loss of bowel or bladder control(if the tutor is in the pelvis or at the base of the spine)
  5. a broken bone with no injury to explain how it occurred
  6. Stiffness or swelling of joints
5. Investigations
  1. laboratory tests
    1. Alkaline phosphatase (ALP)
    2. Tumour markers
    3. Lactic dehydrogenase (LDH)
    4. CBC
  2. Imaging
    1. X-rays/MRI/CT scan/ Radioisotopes scan
  3. Biopsy
    1. needle
      1. core needle
      2. fine needle aspiration
    2. surgical
      1. incisional
      2. excisional
  4. clinical features
    1. pathological fracture
    2. codman triangle
    3. skip lesions
    4. sunburst appearance
    5. pulmonary metastasis
    6. mass
6. complications
  1. pulmonary metastasis
  2. orbital mass
  3. anemia
7. treatment
  1. surgery
    1. limb-salvage
      1. removing the cancer and some surrounding normal tissue but leaving the limb basically intact
    2. amputation
      1. 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)
  2. chemotherapy
  3. radiation therapy (in certain cases)
8. Pathophysiology
  1. 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
  2. tumor cells produce osteoid describing irregular trabeculae —tumor bone. Tumor cells are included in the osteoid matrix.
  3. osteosarcoma cells act like osteoblastic cells,as they also make bone matrix but it is not as strong as the normal healthy one.
  4. It is mostly local and affects metaphysis of long bones
  5. 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
  6. It is a rapidly and aggressively growing tumor. It invades the medullary cavity inward. Destroys the cortex outwards, plus it invades close soft tissue
  7. It does not invade epiphyseal cartilage.
  8. Hematogenous, direct spread to lungs, other bones , brain, and liver

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Swelling in the leg

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	Created by wafaa haidar about 7 years ago