Orthopaedic oncology;Multilobular Tumour of Bone




Multilobular tumour of bone (MTB) is the most common tumour among the canine skull. MTB usually presents as a firm, circumscribed and generally slow growing bone tumour in older dogs from medium or large breeds. It is characterised by dominant presence of multiple osteoid or cartilage containing lobules that are separated by fibrous septae. Biological behaviour may vary from benign to malignant.

The Multilobular tumour of bone (MTB), although uncommon, is the most common tumour of the canine skull.

MTB usually presents as a firm, circumscribed and generally slowgrowing bone tumour in older dogs from medium or large breeds. Its biological behaviour may range from benign to malignant, as it has the potential to invade, metastasise and recur. Histologically, it is characterised by the dominant presence of multiple osteoid- or cartilage- containing lobules that are separated by fibrous septae. MTB should be differentiated from other bone tumours. Although most frequently found

in dogs, MTB has been reported in humans, cats, a horse and a ferret. The clinical signs depend on the tumour location. Depending on its location and stage in the clinical course, surgical resection may result in long-term remission.


Cancer pain
The most common symptom of bone tumors is pain, which will gradually increase over time. A person may go weeks, months, and sometimes years before seeking help; the pain increases with the growth of the tumor. Additional symptoms may include fatigue, fever, weight loss, anemia, nausea, and unexplained bone fractures. Many patients will not experience any symptoms, except for a painless mass. Some bone tumors may weaken the structure of the bone, causing pathologic fractures.


An arm bone tumor

Bone tumors may be classified as "primary tumors", which originate in bone or from bone-derived cells and tissues, and "secondary tumors" which originate in other sites and spread (metastasize) to the skeleton. Carcinomas of the prostate, breasts, lungs, thyroid, and kidneys are the carcinomas that most commonly metastasize to bone. Secondary malignant bone tumors are estimated to be 50 to 100 times as common as primary bone cancers.


Projectional radiography ("X-ray") is the optimal initial imaging modality for evaluating undiagnosed primary bone tumors.CT scan, MRI and/or histopathology can aid in reaching a final diagnosis, as well as staging thereof.

Surgical treatment


Treatment for some bone cancers may involve surgery, such as limb amputation, or limb sparing surgery (often in combination with chemotherapy and radiation therapy). Limb sparing surgery, or limb salvage surgery, means the limb is spared from amputation. Instead of amputation, the affected bone is removed and replaced in one of two ways: (a) bone graft, in which bone is taken from elsewhere on the body or (b) artificial bone is put in. In upper leg surgeries, limb salvage prostheses are available.

The other surgery is called Van Nes rotation or rotationplasty which is a form of amputation, in which the patient's foot is turned upwards in a 180 degree turn and the upturned foot is used as a knee.

Types of amputation:

Below knee
Above knee
Hip disarticulation
Hemipelvectomy or hindquarter, in which the whole leg is removed with one half of the pelvis
Below elbow
Above elbow
Shoulder disarticulation
Forequarter (amputation of the whole arm, along with the shoulder blade and the clavicle)

The most radical of amputations is hemicorporectomy (translumbar or waist amputation) which removes the legs, the pelvis, urinary system, excretory system and the genital area (penis/testes in males and vagina/vulva in females). This operation is done in two stages. First stage is doing the colostomy and the urinary conduit, the second stage is the amputation. This is a mutilating operation and is only done as a last resort (e.g. when even pelvic exenteration does not work or in cases of advanced pelvic/reproductive cancers)


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