U. Brunnemer

Diagnostics and treatment of primary bone tumors

Primary bone tumors can be either benign or malignant. Metastization is a characteristic feature of malignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.ZusammenfassungPrimäre Knochentumoren lassen sich in maligne und benigne Läsionen unterscheiden. Die Metastasierung ist ein Merkmal maligner Tumoren. Lokal zeigen maligne Tumoren ein aggressives und destruierendes Wachstum. Dieselbe Tumorentität kann verschiedene Differenzierungsgrade aufweisen, die für die Therapie von entscheidender Bedeutung sind. Auch benigne Tumoren können sich abhängig von ihrem Stadium lokal aggressiv verhalten. Der Anamnese und dem konventionellen Röntgenbild kommt in der primären Diagnostik entscheidende Bedeutung bei. Viele Tumoren zeigen hier bereits charakteristische Merkmale. Bei Verdacht auf einen malignen Prozess ist in der Regel eine Biopsie erforderlich. Diese muss strengen Qualitätsansprüchen genügen. Die Therapie der malignen Tumoren ist interdisziplinär. Nach Resektion eines Tumors stehen verschiedene biologische und alloplastische Rekonstruktionsmöglichkeiten zur Verfügung. Speziell die Behandlung von malignen Knochentumoren bedarf einiger Erfahrung und sollte daher in ausgewählten Zentren erfolgen.AbstractPrimary bone tumors can be either benign or malignant. Metastization is a characteristic feature ofmalignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.

Diagnostik und Therapie primärer Knochentumoren

Primary bone tumors can be either benign or malignant. Metastization is a characteristic feature of malignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.ZusammenfassungPrimäre Knochentumoren lassen sich in maligne und benigne Läsionen unterscheiden. Die Metastasierung ist ein Merkmal maligner Tumoren. Lokal zeigen maligne Tumoren ein aggressives und destruierendes Wachstum. Dieselbe Tumorentität kann verschiedene Differenzierungsgrade aufweisen, die für die Therapie von entscheidender Bedeutung sind. Auch benigne Tumoren können sich abhängig von ihrem Stadium lokal aggressiv verhalten. Der Anamnese und dem konventionellen Röntgenbild kommt in der primären Diagnostik entscheidende Bedeutung bei. Viele Tumoren zeigen hier bereits charakteristische Merkmale. Bei Verdacht auf einen malignen Prozess ist in der Regel eine Biopsie erforderlich. Diese muss strengen Qualitätsansprüchen genügen. Die Therapie der malignen Tumoren ist interdisziplinär. Nach Resektion eines Tumors stehen verschiedene biologische und alloplastische Rekonstruktionsmöglichkeiten zur Verfügung. Speziell die Behandlung von malignen Knochentumoren bedarf einiger Erfahrung und sollte daher in ausgewählten Zentren erfolgen.AbstractPrimary bone tumors can be either benign or malignant. Metastization is a characteristic feature ofmalignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.

Diagnostik und Therapie von Weichteilsarkomen der Extremitäten

ZusammenfassungDie Diagnose und Behandlung unklarer Weichteiltumoren stellt ein häufiges Problem im Alltag dar. Das diagnostische Vorgehen und die Entscheidung über die Wahl und den Ablauf der Therapie können über das Schicksal des Patienten entscheiden. Obwohl die Magnetresonanztomographie häufig erste Hinweise über die Raumforderung ermöglicht, ist eine definitive Klärung der Dignität allein über die histopathologische Untersuchung möglich. Der Großteil der Raumforderungen ist gutartig, sollte jedoch bis zum Ausschluss eines Malignoms als solches behandelt werden, da unbedachte Resektionen oder Biopsien die Behandlung erschweren und die Prognose verschlechtern können. Insbesondere diese Aspekte sollen hier zusammengefasst und diskutiert werden.AbstractThe diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.The diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.

Diagnosis and therapy of soft tissue sarcomas of the extremities

ZusammenfassungDie Diagnose und Behandlung unklarer Weichteiltumoren stellt ein häufiges Problem im Alltag dar. Das diagnostische Vorgehen und die Entscheidung über die Wahl und den Ablauf der Therapie können über das Schicksal des Patienten entscheiden. Obwohl die Magnetresonanztomographie häufig erste Hinweise über die Raumforderung ermöglicht, ist eine definitive Klärung der Dignität allein über die histopathologische Untersuchung möglich. Der Großteil der Raumforderungen ist gutartig, sollte jedoch bis zum Ausschluss eines Malignoms als solches behandelt werden, da unbedachte Resektionen oder Biopsien die Behandlung erschweren und die Prognose verschlechtern können. Insbesondere diese Aspekte sollen hier zusammengefasst und diskutiert werden.AbstractThe diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.The diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.

Diagnostik und Therapie von Weichteilsarkomen der Extremitäten@@@Diagnosis and therapy of soft tissue sarcomas of the extremities

ZusammenfassungDie Diagnose und Behandlung unklarer Weichteiltumoren stellt ein häufiges Problem im Alltag dar. Das diagnostische Vorgehen und die Entscheidung über die Wahl und den Ablauf der Therapie können über das Schicksal des Patienten entscheiden. Obwohl die Magnetresonanztomographie häufig erste Hinweise über die Raumforderung ermöglicht, ist eine definitive Klärung der Dignität allein über die histopathologische Untersuchung möglich. Der Großteil der Raumforderungen ist gutartig, sollte jedoch bis zum Ausschluss eines Malignoms als solches behandelt werden, da unbedachte Resektionen oder Biopsien die Behandlung erschweren und die Prognose verschlechtern können. Insbesondere diese Aspekte sollen hier zusammengefasst und diskutiert werden.AbstractThe diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.The diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.

Biologische Rekonstruktionsmöglichkeiten nach Tumorresektion

The resection of musculoskeletal tumours often makes reconstruction of the resected bone structure necessary. There are both autologous and allogenous options as well as prosthetic bone substitutes for reconstruction of the created bone defect. In cases with sufficient residual stability a boney reconstruction may not be necessary and a temporary modification of load-bearing or immobilisation will give satisfactory results. Spongey bone, tricortical bone chips, or vascular pedicled bone grafts (clavicle, fibula) can be used as autogenous grafts. Callus distraction by means of segment transport is suitable as a secondary reconstruction option for hollow bones. The use of allogenous grafts is accompanied by a high rate of complications and is rarely employed. The reversal plasty according to Borggreve offers a further option for reconstruction in cases of tumours of the femur or, respectively, the proximal lower leg. Bones that are merely temporarily weakened can be stabilised with the help of a temporary osteosynthesis.

Chirurgische Behandlung von Skelettmetastasen

Metastasis constitutes a generalisation of tumour disease within the body. The treatment of skeletal metastases must therefore be an interdisciplinary process and demands a procedure that is appropriate for the stage of disease and for the patient. In cases of an unknown primary lesion or a long interval between detection of the tumour and the occurrence of metastases, the presence of a primary bone tumour or, respectively, a secondary tumour must be taken into consideration. In cases of doubt a biopsy is urgently recommended. The options available for surgical treatment include stabilisation alone, stabilisation with radiotherapy, interlesional resection with radiotherapy, and wide or, alternatively, marginal resection. Various reconstruction procedures have their advantages and disadvantages. The therapeutic decision-making must take the current and the to be expected future condition of the patient into consideration. Advances in oncology with decisive improvements in life expectancy have led to markedly more aggressive approaches in local surgical therapy.

Diagnostik und Therapie primärer Knochentumoren@@@Diagnostics and treatment of primary bone tumors

Primary bone tumors can be either benign or malignant. Metastization is a characteristic feature of malignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.ZusammenfassungPrimäre Knochentumoren lassen sich in maligne und benigne Läsionen unterscheiden. Die Metastasierung ist ein Merkmal maligner Tumoren. Lokal zeigen maligne Tumoren ein aggressives und destruierendes Wachstum. Dieselbe Tumorentität kann verschiedene Differenzierungsgrade aufweisen, die für die Therapie von entscheidender Bedeutung sind. Auch benigne Tumoren können sich abhängig von ihrem Stadium lokal aggressiv verhalten. Der Anamnese und dem konventionellen Röntgenbild kommt in der primären Diagnostik entscheidende Bedeutung bei. Viele Tumoren zeigen hier bereits charakteristische Merkmale. Bei Verdacht auf einen malignen Prozess ist in der Regel eine Biopsie erforderlich. Diese muss strengen Qualitätsansprüchen genügen. Die Therapie der malignen Tumoren ist interdisziplinär. Nach Resektion eines Tumors stehen verschiedene biologische und alloplastische Rekonstruktionsmöglichkeiten zur Verfügung. Speziell die Behandlung von malignen Knochentumoren bedarf einiger Erfahrung und sollte daher in ausgewählten Zentren erfolgen.AbstractPrimary bone tumors can be either benign or malignant. Metastization is a characteristic feature ofmalignant bone tumors. Malignant tumors are characterized by a local aggressive and destructive behavior. The behavior of a tumor is dependent on its entity, the differentiation grade and localization and these factors are of decisive importance for the correct therapy. Even benign tumors can behave very aggressively. Different stages are defined. Patient history and conventional radiographs are the most powerful primary diagnostic tools. Many tumors show typical characteristics and if a malignant lesion is suspected a biopsy should be carried out. Several quality standards have to be respected when making the biopsy. The approach to malignant tumors is always interdisciplinary. Several biological as well as alloplastic reconstruction techniques exist. The treatment of primary malignant bone tumors requires a lot of experience and should only be done in specialized centers.