PRIMARY BONE TUMORS AND TUMOR LIKE LESIONS OF THE CLAVICLE

Abstract

Background: Tumors and tumor-like lesions of the clavicle are uncommon and often present with a diagnostic problem. Although almost every type of tumor has been reported from this location the true incidence of primary tumors is 0.5–1%.

Materials and Methods: A retrospective review of the Scottish Bone Tumor Registry (1940–2000). All histologically confirmed lesions with minimum 5 year follow-up are included.

Results: 32 lesions were identified from the registry. The age at presentation varied from 4 years to 84 years. There were 7 myelomas, 10 lymphomas, 2 Ewing sarcomas,1 osteosarcoma, 1 chondrosarcoma, 1 Giant Cell tumor, 1 Aneurismal bone cyst, 1 chondroma, 1 unicameral bone cysts, 1 non-ossifying fibroma, and 6 eosinophilic granulomas. 3 cases presented with pathological fractures. Majority lesions involved the medial third. Malignant lesion underwent excision and adjuvant chemo-radiotherapy. The cumulative 5 year survival was 80% when adequate surgical margins were achieved. Death was usually due to soft tissue and skeletal metastasis. Benign lesions were treated with curettage and bone grafting or by partial excision of the clavicle. 3 cases of eosinophilic granulomas and the solitary chondroma required no further treatment after biopsy.

Discussion: Metastatic tumors are more common than primary tumors in this region. Among primary lesions, malignant tumors are more common than benign. All ages can be affected. The subcutaneous location of the clavicle usually aids in early diagnosis. Anatomically, the medial third was the commonest site involved. Prognosis is good if adequate surgical margins can be achieved and if there is no distal spread. Partial or total claviclectomy usually results in good functional outcomes.