Msk imaging pelvic bone t d vanel

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Msk imaging pelvic bone t d vanel

  1. 1. Bone tumors of the pelvis Daniel Vanel Istituto Ortopedico Rizzoli. Bologna (Italia)
  2. 2. RIZZOLI TUMORS 3.398 cases of Bone Tumors of pelvis (Istituto ortopedica RIZZOLI 1900/2012) Systemic Tumors 306 (9.0%) Bone Metastasis 846 (24.9%) Benign Tumors 864 (25.4%) Primary Malignant Tumors 1.382 (40.7%)
  3. 3. BENIGN TUMORS Total BENIGN tumors : 864 (25.4%) 46% 54% Average: 27 - Median: 23 - Range: 0-79 30 25 20 % 15 10 5 0 0-9 10-19 20-29 30-39 40-49 age 50-59 60-69 70-79
  4. 4. BENIGN TUMORS Total BENIGN tumors : 864 cases (25.4%)
  5. 5. BENIGN TUMORS Case 1: 20 year old man; pain DESMOID FIBROMA non calcified and low signal on T2 è fibrous tissue
  6. 6. BENIGN TUMORS Case 2: 18 year old man; pain ANEURISMAL BONE CYST fluid fluid levels è embolisation After embolisation
  7. 7. BENIGN TUMORS Case 3: 17 year old man; pain OSTEOID OSTEOMA small nidus, huge inflammatory reaction. è Radio frequency treatment
  8. 8. BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain T1 FSE T2 fs T1 gd
  9. 9. BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain ? 1. metastasis 2. normal variant (red marrow) 3. angioma 4. other
  10. 10. BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain ? 1. biopsy 2. follow up 3. ignore
  11. 11. BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain 1. metastasis 2. normal variant (red marrow) 3. angioma 4. other
  12. 12. BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain 1. biopsy 2. follow up 3. ignore
  13. 13. BENIGN TUMORS Benign notochordal cell tumor (BNCT) Yamaguchi  et  al       Skeletal Radiol 2008.
  14. 14. BENIGN TUMORS Benign notochordal cell tumor (BNCT) Skeletal Radiol 2008. 100 spines (cadavers) 26 BNCT / 20 patients (M:F 2:1) · same location as chordoma
  15. 15. BENIGN TUMORS Benign notochordal cell tumor (BNCT)
  16. 16. BENIGN TUMORS Benign notochordal cell tumor (BNCT) SIMILARITIES between BNCT and chordoma Location: bone Immuno: + CK18 and vimentin, S-100 protein, EMA, CAM5.2, AE1/AE3, brachyury MRI : hypoT1 et hyperT2
  17. 17. BENIGN TUMORS Benign notochordal cell tumor (BNCT) DIFFERENCES between BNCT and chordoma BNCT Chordoma Growth minimal; sclerosis Slow but aggressive Sft tissues Histologiy Thick bone trabeculae myxoïd component Rx and CT sclerotic normal cortex and soft tissues Lytic Soft tissues invaded MRI no cm uptake Uptake after injection
  18. 18. BENIGN TUMORS Benign notochordal cell tumor (BNCT) BNCT and Chordoma
  19. 19. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months.
  20. 20. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months. T1
  21. 21. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months. T1 After biopsy
  22. 22. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months.
  23. 23. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months.
  24. 24. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months.
  25. 25. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months.
  26. 26. BENIGN TUMORS Benign notochordal cell tumor (BNCT) 29 year old man, pain for 9 months. BNCT invading the soft tissues ! BNCT a still moving entity!
  27. 27. HEMOPATHIES Total systemic bone tumors : 306 cases (9%) 41% 59% Average: 48 - Median: 49 - Range: 1-84 20 18 16 14 12 % 10 8 6 4 2 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 age
  28. 28. HEMOPATHIES Total systemic bone tumors : 306 cases (9%) 17 Myeloma 140 Hodgkin Lymphoma 149 Non Hodgkin Lymphoma 0 25 50 75 100 125 150
  29. 29. HEMOPATHIES LLC
  30. 30. HEMOPATHIES B cell high grade LYMPHOMA
  31. 31. HEMOPATHIES MYELOMA
  32. 32. HEMOPATHIES MYELOMA 62 year old woman
  33. 33. HEMOPATHIES MYELOMA 69 year old man T1FSE
  34. 34. MALIGNANT TUMORS METASTASES Total metastasis bone tumors : 846 cases (24.9%) Including 11 cases from neuroblastoma 41% 59% Average 57 - Median: 59 - Range: 1-88 30 25 20 % 15 10 5 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 age
  35. 35. MALIGNANT TUMORS METASTASES Lytic or sclerotic PROSTATE BREAST
  36. 36. MALIGNANT TUMORS THYROID METASTASES
  37. 37. MALIGNANT TUMORS PRIMARY TUMORS Total primary tumors : 1.382 cases (40.7%) 40% 60% Average: 38 - Median: 35 - Range: 2-87 25 20 15 % 10 5 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 age
  38. 38. MALIGNANT TUMORS PRIMARY TUMORS Total primary tumors : 1.382 cases Adults : CHONDROSARCOMA Children : EWING
  39. 39. MALIGNANT TUMORS PRIMARY TUMORS Surgical classification
  40. 40. MALIGNANT TUMORS PRIMARY TUMORS 60 year old man, pain CHONDROSARCOMA
  41. 41. MALIGNANT TUMORS PRIMARY TUMORS 60 year old man, pain
  42. 42. MALIGNANT TUMORS PRIMARY TUMORS 60 year old man, pain
  43. 43. MALIGNANT TUMORS PRIMARY TUMORS 60 year old man, pain
  44. 44. MALIGNANT TUMORS PRIMARY TUMORS CHONDROSARCOMA normal SI and acetabulum
  45. 45. MALIGNANT TUMORS PRIMARY TUMORS Missed CHONDROSARCOMA Prothesis.
  46. 46. MALIGNANT TUMORS PRIMARY TUMORS OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years
  47. 47. MALIGNANT TUMORS PRIMARY TUMORS OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years
  48. 48. MALIGNANT TUMORS PRIMARY TUMORS OSTEOSARCOMA
  49. 49. MALIGNANT TUMORS PRIMARY TUMORS CHONDROSARCOMA Zone I and nerve
  50. 50. MALIGNANT TUMORS PRIMARY TUMORS EWING Pregnant Zone I, ½ sacrum, ½ zone II
  51. 51. MALIGNANT TUMORS PRIMARY TUMORS EWING Pregnant Zone I, ½ sacrum, ½ zone II
  52. 52. MALIGNANT TUMORS PRIMARY TUMORS EWING Pregnant Zone I, ½ sacrum, ½ zone II 15 years follow up
  53. 53. MALIGNANT TUMORS PRIMARY TUMORS CHONDROSARCOMA 70 year old man
  54. 54. MALIGNANT TUMORS PRIMARY TUMORS 10 years follow up CHONDROSARCOMA 70 year old man
  55. 55. Gilles Missenard
  56. 56. Bone tumors of the pelvis KEY POINTS Ÿ  BNCT Ÿ  Frequent metastases Ÿ Local staging for primary malignant tumors: CT , MRI

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