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Musculoskeletal problems and injuries - part 5

Có vẻ như là một yếu tố di truyền. Osteosarcomas thứ cấp thường phát triển ở người lớn trong khu vực xương bất thường (ví dụ, bệnh Paget) hoặc đáp ứng một số loại tiếp xúc với chất gây ung thư (phổ biến nhất là chiếu xạ). Khiếu nại trình bày phổ biến nhất của bệnh nhân với u xương ác tính là đau, | 142 Jeffrey G. Jones and Doug Poplin osteosarcomas occur most commonly in children and young adults and are most common in males. There appears to be a genetic predisposition. The secondary osteosarcomas generally develop in adults in areas of abnormal bone e.g. Paget s disease or in response to some sort of carcinogen exposure most commonly irradiation . The most common presenting complaints of patients with osteosarcoma are local pain tenderness and swelling. It most often occurs in the medullary cavity of the metaphyseal end of the long bones of the extremities. Radiographs computed tomography CT scans or MRI scans often provide a characteristic picture of subperiosteal or soft tissue penetration of the tumor with extraosseous bone density. To confirm the diagnosis however biopsy is required. Great advances have been made in treatment recently with a combination of surgery radiotherapy and chemotherapy depending on the specific type of lesion providing the best chances for survival.27 Chordoma Chordoma is a malignant bone tumor seen most commonly in the sacrum and spine. It is thought to arise from remnants of the notochord. These tumors are usually seen in middle-aged and elderly adults. Radiographs CT scans or MRI scans usually show the mixed lytic and sclerotic lesions of the chordoma.30 Metastatic Malignant Tumors Tumors that commonly metastasize to bone include thyroid breast prostate bronchus kidney bladder uterus ovary testicle and adrenal tumors. Lymphomas most commonly spread to bone from primary involvement of lymph nodes but also are seen rarely primarily in the skeleton. Bone scans are thought to be the best screening test for patients suspected of having skeletal metastasis.31 Patients with metastatic bone disease most often present with pathological fracture or pain. The radiographical appearance of these lesions tends to be sclerotic in prostate and breast metastasis and lytic in lung bowel kidney and thyroid. Biopsy of the bony lesion is helpful