Characteristics of benign and malignant bone tumors
I. Characteristics of benign bone tumor
1.Local mass is the earliest symptom, which is often hard and without pressure pain, and grows slowly.
2. Pain Most benign bone tumors are painless. Yin Xiangfeng, Department of Traditional Chinese Medicine, Shanghai Ruijin Hospital
3.Dysfunction and compression symptoms Tumor near the joints can cause dysfunction of joint activities due to pain and swelling. Spinal cord tumors, whether benign or malignant, may cause compression symptoms.
4.Pathological fracture is rare and mostly occurs in those with intramedullary lesions (such as bone cyst, bone fibrous dysplasia, etc.).
5.X-ray performance
It has the characteristics of clear boundary and uniform density. Mostly swelling lesions or exophytic growth, slow speed, can have cortical expansion thinning. There may be sclerotic reaction bone around the lesion, and the bone destruction is unicompartmental or multicompartmental, with dotted, ring-like or lamellar ossification shadow, usually without periosteal reaction.
Characteristics of malignant bone tumor
1.Pain Almost all malignant tumors have local pain, which is intermittent and mild at the beginning, but later develops into persistent and severe pain, nocturnal pain, and may have pressure pain. If benign tumor is malignant or combined with pathological fracture, the pain may suddenly increase.
2.Lumps Local swelling and rapid development of lumps are mostly seen in malignant tumors. Local vascular anger reflects the rich blood flow of the tumor, which is mostly malignant.
3.Systemic condition Accompanied by fever, loss of appetite, emaciation, etc.
4.Pathological fracture caused by minor trauma is the first symptom of some bone tumors, and it is also a common complication of malignant bone tumors and bone metastasis cancer.
5.Dysfunction and compression symptoms Tumor in adjacent joints can cause joint activity dysfunction due to pain and swelling. Spinal cord tumor is not benign or malignant may cause compression symptoms and paraplegia.
6.Laboratory examination When there is rapid destruction of bone, such as extensive osteolytic lesions, blood calcium often increases; serum alkaline phosphatase reflects osteogenic activity, and osteogenic tumors such as osteosarcoma have significant increase; the increase of alkaline phosphatase in men indicates metastasis from prostate cancer. Positive urine Bence-Jones protein suggests possible myeloma.
7.Imaging performance
(1) X-ray manifestation: malignant bone tumor grows rapidly, the lesions are irregular with uneven density and unclear boundary, the bone destruction area is irregular in worm-like or sieve-like, if the periosteum is lifted by the tumor, new bone can be produced under the periosteum, which is called Codman’s triangle on X-ray, mostly seen in osteosarcoma. If the periosteum is lifted in stages, concentric circles or laminated bone deposits can be formed, which is called “onion skin” on X-ray, mostly seen in Ewing sarcoma. If the malignant tumor grows rapidly beyond the bone cortex and the blood vessels grow into it, the tumor bone and the reaction bone will be deposited in the direction of radial blood vessels, which will show a “sun ray” pattern.
(2) CT and MRI: It can show the relationship between the tumor and the adjacent tissues more clearly and help to formulate the treatment plan.
(3) ECT: It can show the bone metastases at an early stage.
8.Pathological histological examination is the only reliable examination to finalize the diagnosis.
9.Metastasis Often can form metastatic tumor lesions.