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Bone Tumor & Tumor-like lesions Sun Yat-sen Memorial Hospital SYSU
Bone Tumor & Tumor like lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When presented with a lesion in a bone, three important questions require to be answered: ,[object Object],[object Object],[object Object],[object Object],yes
1.  Aims of Imaging modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Anatomy X-ray Signs Clinical Data
2. Classification of Bone Tumor Tumor-like lesion  Bone cyst,  Fibrous dysplasia Primary Bone  Tumor Tumor from  Bone Tissue benign Osteochondroma, Giant cell tumor, Osteoma, Chondroma, Chondroblastoma malignant Osteosarcoma, Chondrosarcoma, Fibrosarcoma Tumor from  Bone  Affiliated  Tissue benign Osteoangioma, Odontogenic tumor (exp. Adamantinoma) malignant Ewing's sarcoma, Reticulum cell sarcoma of bone, Notochordoma, Myeloma Metastatic Tumor Carcinoma, Sarcoma, Neuroblastoma   Carcinoma, Sarcoma, Neuroblastoma
WHO  Classification of  Bone Tumor & Tumor like lesions ( 2002 )  1 . Cartilaginous tumor 2 . Osteogenic tumor 3 . Fibrogenic tumor 4 . Fibrohistiocytic tumor 5 . Ewing sarcoma/Primitive neuroectodermal tumor 6 . Blood-cell forming tissue tumor 7 . Giant cell tumor 8 . Notochord tumor 9 . Vascular tumors  10 . Myogenic tumor 11 . Lipogenic tumor 12 . Neural tumor 13 . Confounding tumor 14 . Other tumor 15 . Arthropathy synovial chondromatosis  16 . Bone and soft tissue tumor related c ongenital or hereditary syndrome
3,  Steps of Diagnostic Analysis---clinical data ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],exogenous  osteochondroma 3,  Steps of Diagnostic Analysis---clinical data
[object Object],[object Object],[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---clinical data
3,  Steps of Diagnostic Analysis---clinical data
[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---clinical data
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---clinical data
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---imaging data chondroblastoma
[object Object],[object Object],[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---imaging data
[object Object],[object Object],[object Object],[object Object],Multiple Myeloma   Osteogenic metastasis Giant cell tumor 3,  Steps of Diagnostic Analysis---imaging data
[object Object],[object Object],[object Object],3,  Steps of Diagnostic Analysis---imaging data benign malignant
[object Object],[object Object],[object Object],[object Object],Normal periosteal ossification   Tumor  cell ossification 3,  Steps of Diagnostic Analysis---imaging data
Differential diagnosis between Benign and Malignant Bone Tumor items Benign Malignant growth Slow, compressing neightbouring tissue, no metastasis Quick, neightbouring tissue invading, metastasis Signs of the Lesion Expansive, well-defined, thin but continue tissue  Invading, ill-defined, irregular destruction of cortex, tumor bone formation Periosteal reaction most of time (-), can be shown after pathological fracture, but no bony destruction Different forms of periosteal reaction, can be destructed by the tumor Surrounding soft tissue No mass, well-defined if there is Mass formation, indistinct demarcation with surrounding tissue
Principles in diagnosing Bone Tumors ,[object Object],[object Object],[object Object],[object Object]
Osteosarcoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radiological A ppearance ,[object Object],[object Object],[object Object],[object Object],Geographic bone destruction Moth-eaten  bone destruction Permeative  bone destruction
Osteosclerotic  Osteosarcoma ,[object Object],[object Object],[object Object],[object Object]
Osteosarcoma in superior part of tibia ( Osteosclerotic  type, ivory tumor bone), obvious tumor bone formation which invading into soft tissue Osteosclerotic Osteosarcoma
[object Object],Osteosclerotic Osteosarcoma in Fibula
Cotton like tumor bone, Codman’ triangle Osteosclerotic Osteosarcoma in Fibula
Osteosclerotic o steosarcoma in  inferior femur, obvious tumor bone formation (  ) and big mass in soft tissue (M) , cortex destruction and become thinner (  ) Osteosclerotic  Osteosarcoma M M
Osteolytic  Osteosarcoma ,[object Object],[object Object],[object Object],[object Object],[object Object]
Osteolytic  o steosarcoma in  distal metaphysis of the femur, apparent  Osteolytic  destruction is seen, associated with soft tissue mass and Codman’  triangle (  ) Osteolytic  Osteosarcoma
Osteosarcoma Osteolytic  destruction  in sup erior tebia, soft tissue mass formation, with Codman’  triangle (  )
Osteolytic  O steosarcoma in  Inferior Femur ,[object Object]
[object Object],Mixed osteosarcoma O steosarcoma in  diaphysis of   femur, bone cortex destruction, thickness decrease and defect of the cortex, mass formation in soft tissue, flocculent tumor bone inside the mass
Osteosarcoma in superior tibia, obvious bone destruction and tumor bone formation,  periosteum proliferation. Codman’  triangle (  ) Mixed Osteosarcoma
Mixed Osteosarcoma
Osteosarcoma ,[object Object],[object Object],D.D.
Giant Cell Tumor ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Giant Cell Tumor
Giant cell tumor of fibular
Giant cell tumor of radius Expansive bone destruction in the distal end of L-radius, reach to the subchondral region of the joint but the bone surface is still intact, multilocular, well-defined, no sclerosis,  no calcification or ossification inside
Giant cell tumor   Expansive bone destruction in distal end of R-radius (  ), with in complete bone shell, soft tissue formation extend outside the bone shell.
Bone cyst ,[object Object],[object Object],[object Object],[object Object],[object Object]
Radiological  Appearances ,[object Object],[object Object]
(A)  Bone cyst of   R- Humerus ,  develop longitudinally, slight expansive: (B) Complicate with pathologic fracture; (C): Recheck after fracture, density increase inside the cyst. A B C
Bone cyst of femur Radiolucent,  develop longitudinally, well-defined margin, no sclerosis.  CT show uniform low density inside the cyst.
Bone cyst of humerus   ,[object Object],[object Object]
Bone  Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Osteolytic Bone Metastases Nasopharyngeal Carcinoma  patient,  osteolytic bone destruction in R- humerus and clavicle, unclear margin, no ossification or calcification. Clavicle mass formation ( M ) M
Osteolytic Bone Metastases  Round destruction area in  cranial bones, ill-defined margin, no sclerosis
Bone Metastases
Prostatic carcinoma. Increase density in pelvis, lumbosacral vertebrae and bilateral femur . Osteoblstic Bone Metastases
Uniform increased density of L 2 , L 4 , L 5  vertebra, sacral vertebrae and iliac bone. Osteoblstic Bone Metastases
Mixed Bone Metastases Small and large patchy bone destruction area as well as increased density area in pelvis, lumbosacral vertebrae and bilateral femur.
Questions ,[object Object],[object Object],[object Object],[object Object]
 

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Bone Tumor And Tumor Like Diseases

  • 1. Bone Tumor & Tumor-like lesions Sun Yat-sen Memorial Hospital SYSU
  • 2.
  • 3.
  • 4.
  • 5. 2. Classification of Bone Tumor Tumor-like lesion Bone cyst, Fibrous dysplasia Primary Bone Tumor Tumor from Bone Tissue benign Osteochondroma, Giant cell tumor, Osteoma, Chondroma, Chondroblastoma malignant Osteosarcoma, Chondrosarcoma, Fibrosarcoma Tumor from Bone Affiliated Tissue benign Osteoangioma, Odontogenic tumor (exp. Adamantinoma) malignant Ewing's sarcoma, Reticulum cell sarcoma of bone, Notochordoma, Myeloma Metastatic Tumor Carcinoma, Sarcoma, Neuroblastoma Carcinoma, Sarcoma, Neuroblastoma
  • 6. WHO Classification of Bone Tumor & Tumor like lesions ( 2002 ) 1 . Cartilaginous tumor 2 . Osteogenic tumor 3 . Fibrogenic tumor 4 . Fibrohistiocytic tumor 5 . Ewing sarcoma/Primitive neuroectodermal tumor 6 . Blood-cell forming tissue tumor 7 . Giant cell tumor 8 . Notochord tumor 9 . Vascular tumors 10 . Myogenic tumor 11 . Lipogenic tumor 12 . Neural tumor 13 . Confounding tumor 14 . Other tumor 15 . Arthropathy synovial chondromatosis 16 . Bone and soft tissue tumor related c ongenital or hereditary syndrome
  • 7.
  • 8.
  • 9.
  • 10. 3, Steps of Diagnostic Analysis---clinical data
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18. Differential diagnosis between Benign and Malignant Bone Tumor items Benign Malignant growth Slow, compressing neightbouring tissue, no metastasis Quick, neightbouring tissue invading, metastasis Signs of the Lesion Expansive, well-defined, thin but continue tissue Invading, ill-defined, irregular destruction of cortex, tumor bone formation Periosteal reaction most of time (-), can be shown after pathological fracture, but no bony destruction Different forms of periosteal reaction, can be destructed by the tumor Surrounding soft tissue No mass, well-defined if there is Mass formation, indistinct demarcation with surrounding tissue
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. Osteosarcoma in superior part of tibia ( Osteosclerotic type, ivory tumor bone), obvious tumor bone formation which invading into soft tissue Osteosclerotic Osteosarcoma
  • 24.
  • 25. Cotton like tumor bone, Codman’ triangle Osteosclerotic Osteosarcoma in Fibula
  • 26. Osteosclerotic o steosarcoma in inferior femur, obvious tumor bone formation ( ) and big mass in soft tissue (M) , cortex destruction and become thinner ( ) Osteosclerotic Osteosarcoma M M
  • 27.
  • 28. Osteolytic o steosarcoma in distal metaphysis of the femur, apparent Osteolytic destruction is seen, associated with soft tissue mass and Codman’ triangle ( ) Osteolytic Osteosarcoma
  • 29. Osteosarcoma Osteolytic destruction in sup erior tebia, soft tissue mass formation, with Codman’ triangle ( )
  • 30.
  • 31.
  • 32. Osteosarcoma in superior tibia, obvious bone destruction and tumor bone formation, periosteum proliferation. Codman’ triangle ( ) Mixed Osteosarcoma
  • 34.
  • 35.
  • 36.
  • 37. Giant cell tumor of fibular
  • 38. Giant cell tumor of radius Expansive bone destruction in the distal end of L-radius, reach to the subchondral region of the joint but the bone surface is still intact, multilocular, well-defined, no sclerosis, no calcification or ossification inside
  • 39. Giant cell tumor Expansive bone destruction in distal end of R-radius ( ), with in complete bone shell, soft tissue formation extend outside the bone shell.
  • 40.
  • 41.
  • 42. (A) Bone cyst of R- Humerus , develop longitudinally, slight expansive: (B) Complicate with pathologic fracture; (C): Recheck after fracture, density increase inside the cyst. A B C
  • 43. Bone cyst of femur Radiolucent, develop longitudinally, well-defined margin, no sclerosis. CT show uniform low density inside the cyst.
  • 44.
  • 45.
  • 46. Osteolytic Bone Metastases Nasopharyngeal Carcinoma patient, osteolytic bone destruction in R- humerus and clavicle, unclear margin, no ossification or calcification. Clavicle mass formation ( M ) M
  • 47. Osteolytic Bone Metastases Round destruction area in cranial bones, ill-defined margin, no sclerosis
  • 49. Prostatic carcinoma. Increase density in pelvis, lumbosacral vertebrae and bilateral femur . Osteoblstic Bone Metastases
  • 50. Uniform increased density of L 2 , L 4 , L 5 vertebra, sacral vertebrae and iliac bone. Osteoblstic Bone Metastases
  • 51. Mixed Bone Metastases Small and large patchy bone destruction area as well as increased density area in pelvis, lumbosacral vertebrae and bilateral femur.
  • 52.
  • 53.