1.EWING’S SARCOMA 2.SIMPLE BONE CYST

1. 1.EWING’S SARCOMA
2.SIMPLE BONE CYST

2. 1.EWING’S SARCOMA

3. Ageof Incidence
Age of incidence 5 to 30 years
Peak incidence b/w 5 to 17 years
Rarely occurs after 30 years

4. Presenting complaints
 Localized pain and swelling
 Fever anemia and weight loss
 Sign and symptoms stimulate Hodgkin's
lymphoma and osteomylitis

5. LOCATIONS
 Involves Metadiaphysis
 Arise in medullary cavity
 Long bones 60%
 Axial skeleton 40%

6. Conventional Radiography
 Poorly marginated lytic lesion
 Permeative or mottled type
 Soft Tissue mass or infiltration with
or without cortical break
 Soft tissue mass ( saucerization)
 Periosteal Reaction

7. Periosteal reaction
 Lamellar type( onion skinning)
 Sun burst or spiculated
 Codman triangle
Less common findings
Thickened cortex
Bone expansion
Pathologic fracture

8. Mottled, osteolytic lesion (blue circle) with poorly marginated edges in the diaphysis
of the bone.
Sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white
arrows).

9. Mixed lytic sclerotic lesion in diaphysis with permeative
destructive pattern spiculated periosteal reaction soft
tissue extension

10. X ray femur lateral view showingWell defined expansile lesion with
mottled appearance is visualized in diaphysis of femur. No calcification
seen. cortical break is seen anteriorly. no soft tissue extension seen

11. MRI
 Method of choice for stagging
 Assess intra and extra osseous
involvement
 Helps in evaluation of chemotherapy
response

12. MRI
 T1
Low intensity with heterogeneous
contrast enhancement
 T2
High signal intensity

14. MR coronal image both thighT1 Post contrast showing heterogeneously
enhancing mass in diaphyseas in medulary cavity of RT femur with
cortical break fracture. edema is also seen

15. X ray femur showing subtle cortical thickening in diaphyseas butT1
post contrast image shows homogenously enhancing soft tissue mass
in medial aspect of femur in proximal diaphyseas

16. CT Scan
Evaluate

 Bone destruction
 Extra osseous involvement

17. Bone scan
 Increased uptake in areas of
destruction
 Whole body scan for detecting
metastatic disease

18. PET Scan
 PET Scan with FDG
Recommended for early detection of
changes in tumor metabolism
Angiography
Not standard for Ewing's sarcoma

19. Differential diagnosis
 Osteosarcoma
 Osteomylitis
 Eosinophilic granuloma

20. Osteosarcoma

22. Osteomyelitis
 Shorter duration less aggressive
periosteal reaction

23. Predictors of Prognosis
 Size of tumor
 Resectibility of tumor

24. Treatment
 Depends upon extension and stage
Chemotherapy
Radiation therapy
Surgical resection

25. 2.SIMPLE BONE CYST

26.  Common in 10 to 20 years age
 Solitary benign bone lesion
 Male to female ratio 3. 1

27. Location
 Intra medullary
 Involves Metaphysis
 Abut growth plate
 Proximal ends of tibia fibula and
humerus
 May involve iliac and calcaneus over
2o yrs

28. Clinical features
 Asymptomatic
 Pain and swelling of adjacent joint
 May present with fracture

29. Conventional radiography
 Well defined solitary lytic lesion
 Narrow zone of transition
 Thin sclerotic margins
 Some times expansile

30.  No periosteal reaction
 Long axis parallel to bone
 Fallen fragment sign

31. Single well defined lytic lesion in metadiphysis with sharp zone of transition
and pathological fracture

32. X ray femur frontal projection showing well defined
rounded lytic lesion with sclerotic margins in greater
trochantor of femur

33. Well defined expansile lytic lesion with sclerosis and
fracture seen in metadiaphyseas

35. MRI FINDINGS
 Un complicated SBC
T1 Low signal intensity
T2 High signal intensity
 Complicated SBC
Heterogeneous signal
intensity on T1 T2
Gadolilnium- Peripheral enhancement

36. CT SCAN
 Air fluid or Fluid fluid Levels
Bone scan
 Photopenic / cold spot

37. Diffrential diagnosis
Giant cell tumor
Aneurysmal bone cyst
Chondromyxoid tumor

38. Giant cell tumor

39. Aneurysmal bone cyst

40. Treatment
 Curettage and bone grafting
 Nailing
 Inj of bone marrow
 Cryotherapy
 Methyl prednisolone inj to promote
healing

41. Thank you