Primary Bone Tumours

Synovial chondromatosis Table 108.1: WHO classification of bone tumours. Introduction Bone tumours in childhood cause considerable anxiety to both the affected child and the parents. They may present with vague symptoms or a fracture and can easily be confused with osteomyelitis or some tumour-like lesions that may be developmental in origin. Benign lesions account for 50% of all bone lesions; some may be large enough to cause significant disability. Primary malignant tumours of the bone make up for 6% of all childhood malignancies1 and are indeed the most common malignancy of adolescence after leukaemias and lymphomas. Overall diagnosis depends on factors such as age of patient, site of lesion, imaging (plain x-rays, computed tomography (CT), nuclear studies, magnetic resonance imaging (MRI)), and, if possible, the histopathology and immunohistochemistry. Thus, a multidisciplinary team approach is vital to the diagnosis and management of bone tumours. The mainstay of treatment of benign lesions is surgery to limit disability, with reconstruction as needed. As chemotherapy has become more advanced with fewer side effects, the focus of treatment of bone malignancies has changed from surgery to neoadjuvant chemotherapy followed by wide excision and then chemotherapy or radiotherapy as appropriate. The aim of this chapter is to acquaint the reader with the common lesions of the bone,2 and the differential diagnosis, investigations, and management of the common malignancies. For simplicity in this chapter, the demographics, pathophysiology, clinical presentation, investigations, prognosis, and outcomes are listed together, and management of individual lesions is described separately.