Bone Tumors: Causes

Pathogenesis (development of disease)

Different bone tumors develop in different ways. Depending on the tissue from which the neoplasm originates, the following classification of bone tumors results:

  • Osseous tumors – originate from osteoclasts (cells that break down bone) or osteoblasts (cells that break down bone).
    • Osteoblastoma (synonym: giant osteoid osteoma) (benign/benign).
    • Osteoid osteoma (benign)
    • Osteoma (benign) – pedunculated bone tumor, spongy (sponge-like) structure.
    • Osteosarcoma (malignant / malignant)
  • Cartilaginous tumors – originate from cartilaginous tissue.
  • Connective tissue tumors (synonym: bone fibromas) – originate from connective tissue.
    • Desmoplastic bone fibroma (benign).
    • Fibrous bone dysplasia (Jaffe-Lichtenstein) (benign).
    • Non-osseous fibroma (NOF) (benign).
    • Osseous fibrosarcoma (malignant)
    • Ossifying fibroma of bone (synonym: osteofibroma) (semimalignant).
  • Histiocytic bone tumors.
    • Benign fibrous histiocytoma (benign).
    • Malignant fibrous histiocytoma (MFH) (malignant).
    • Giant cell tumor (osteoclastoma) (benign)
  • Osteomyelogenous tumors – originate from the bone marrow space.
    • Ewing’s sarcoma (malignant)
    • Plasmocytoma (synonyms: medullary plasmocytoma; multiple myeoloma, Kahler’s disease) (malignant).
  • Bone hemangioma – originates from the vessels of the bone.

Etiology (causes)

The exact causes of bone tumors are still unclear. It has been observed that both benign (benign) and malignant (malignant) tumors cluster in families. For example, chondrosarcoma appears to be associated with a genetic predisposition, whereas this influence has not been observed for Ewing’s sarcoma.Children and adolescents with genetic diseases such as Paget’s disease (disease of the skeletal system with bone remodeling) are more likely to develop osteosarcoma. Biographic causes

  • Genetic burden from parents, grandparents (chondrosarcoma, osteochondromatosis (multiple osteocartilaginous exostoses)).
    • Osteochondromatosis is inherited in an autosomal dominant manner.
      • Known chromosomal defects: on chromosome 8q24 [EXT1] and 11p11-13 [EXT2].
    • Genetic disorders (secondary osteosarcoma).
      • Bilateral retinoblastoma – malignant neoplasm of the eye.
      • Bloom syndrome (BLM) – rare disorder; symptoms: increased tumor risk esp. for leukemias and solid tumors, photosensitivity, pigmentary abnormalities, fertility disorders, growth retardation
      • Li-Fraumeni syndrome – autosomal-dominant inherited disease leading to multiple tumors (including astrocytomas).
  • Ethnicity – Caucasians (whites) are more commonly affected by Ewing’s sarcoma, Asians rarely, and African-Americans almost never.
  • Age – increasing age (the incidence of metastases increases).

Disease-related causes

  • Primary benign (benign) bone tumors – increased risk of secondary malignant bone tumors (chondrosarcoma).
  • For secondary osteosarcoma:
    • Fibrous dysplasia (synonym: Jaffe-Lichtenstein) – Systemic disease of the skeleton that begins in childhood and may affect only one bone (monostotic) or multiple bones (polyostotic). Due to marrow fibrosis (pathological proliferation of connective tissue) and spongiosis (porous-spongy, pathological remodeling of bone tissue) of the compacta (outer marginal layer of the bone), the affected bones lose load-bearing capacity; sporadic occurrence.
    • Bone infarction – due to various causes without the presence of infection (aseptic).
    • Multiple osteochondromas
    • Paget’s disease (synonyms: Paget’s disease of bone) – disease of the skeletal system with bone remodeling.
    • Osteomyelitis – acute or chronic inflammation of the bone and bone marrow, usually due to bacterial infection; combination of osteitis and myelitis (bone marrow/spinal cord).
  • For secondary malignant fibrous histiocytoma (MFH):
    • For MFH of the skin.
      • In scar tissue
      • In places of chronic inflammation
      • In irradiated areas (radiotherapy/radiation therapy).
    • Enchondroma – benign (benign) bone tumor originating from cartilage tissue.
    • Fibrous dysplasia – malformation of bone tissue, that is, the bones form tumor-like protrusions.
    • Bone fracture (bone fracture)
    • Bone infarction (demise of bone tissue).
    • Paget’s disease – disease of the skeletal system in which there is a gradual thickening of several bones.
    • Osteomyelitis (bone marrow inflammation).
  • The following other primary tumors can lead to bone metastases – secondary malignant bone tumors:
    • Mammary carcinoma (breast cancer) (50-85%).
    • Prostate carcinoma (prostate cancer) (50-75%)
    • Bronchial carcinoma (lung cancer) (30-50%)
    • Renal cell carcinoma (kidney cancer) (30-45%)
    • Thyroid carcinoma (thyroid cancer) (about 30%).
    • Pancreatic carcinoma (pancreatic cancer) (5-10%).
    • Colorectal carcinoma (colon cancer) (5-10%).
    • Gastric carcinoma (stomach cancer) (5-10%)
    • Hepatocellular carcinoma (liver cancer) (about 8%).
    • Ovarian carcinoma (ovarian cancer) (2-6%).
    • In 3-10% of cases, no primary tumor is found.

    Localization (descending order of frequency): lung, liver, skeletalLocalization in the skeleton: vertebral body, pelvis, ribs, proximal (toward the middle of the body) end of the femur (end of the femur), humerus (humerus).

Radioactive exposure

X-rays

Tumor therapies

Bone tumors are more common in people who have undergone chemotherapy and/or radiatio (radiation therapy) in childhood due to another tumor disease. The aggressive tumor therapies alter the genome (genetic material) of the osteoblasts. This is especially true for the primary malignant bone tumors chondrosarcoma, Ewing’s sarcoma, and osteosarcoma.