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Beingn bone tumours

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  • 1. Beingn bone tumours
  • 2. • Bone forming tumours: 1. Bone island 2. Osteoid osteoma 3. Osteoblastoma • Cartilage forming tumour 1. Chondroma 2. Chondroblastoma 3. Chondromyxoid fibroma 4. osteochondroma
  • 3. • Fibrous tumours 1. Fibrous cortical defect 2. Non ossifying fibroma
  • 4. Bone island ( aka enostosis) • Single/multiple • Always medullary in location • Normal compact lamellar bone • Uniformly dense , round/oval lesion • Chr radiating thorn like spicules • Usually <15mm , can be as large as 4cm • Periosteal new bone reaction/ cortical expansion donot occur • Normally bone island donot show increased uptake on bone scan • In patients with breast- or prostate cancer a bone island can be mistaken for an osteoblastic metastasis
  • 5. Osteoid Osteoma • 20- 30 yrs • M:F=3:1 • Intermittent bone pain of several wks/ mnths duration occuring esp at night with dramatic releif by aspirin • Diaphysis of long bones are the site of predilection esp at proximal end of femur and tibia • Spine usually involves neural arch and not the vertebral body
  • 6. Imaging features • Round/ oval area of radiolucency with a sclerotic margin • Radiolucency contains a small dense opacity ( nidus) • Usually prominent periosteal and endosteal reaction. • Radionuclide scan shows intense focal area of increased activity surrounded by less intense activity from reactive sclerosis • It must be differentiated from osteoblastoma, and other causes of chronic cortical thickening eg chronic sclerosing osteomyeltis.
  • 7. Osteoblastoma • Long h/o pain at night ( relief by aspirin is not a feature) • M=F • <30 yrs • Rare lesion • MC affects spine( esp posterior arch and flat bones • A typical osteoblastoma is larger than 2 cm, otherwise it completely resembles osteoid osteoma. • There is associated reactive sclerosis • Calcification / ossification of osteoid tissue w/I tumour may cause amorphous increase in density.
  • 8. Chondroma • single tumours are common • MC in phalanges of hand and feet • Although any bone maybe affected • Risk of malignant transformation is greatest in flat bones.
  • 9. Imaging features: • Well defined zone of radiolucency in medulla • Small bones of hand and feet are likely to expand and thin the overlying cortex • Usually present with incidental fracture • No destruction of cortex occurs • No periosteal reaction occurs • Flecks of calcification are frequenty present w/I tumour
  • 10. Juxtacortical chondroma • arises at the surface of the bone. • Scalloping of cortical bone is possible, • no marrow involvement. • It may be difficult to differentiate from a
  • 11. Multiple enchondromas
  • 12. Mafucci’s syndrome • Multiple enchondromas+ cavernous hamenagiomas in soft tissues
  • 13. Chondroblastoma • Relatively rare • Epiphysis/apophysis • Long h/o pain • Well defined radiolucent oval lesion within epiphysis is characterisitic • Thin rim of sclerosis and cortical expansion is seen • Tumour can extend into metaphysis • Stippled calcification occurs in 50% leisons • No malignant transformation
  • 14. Chondromyxoid fibroma • 20-30 yrs • M=F • Usually occurs around the knee • Occurs in metaphysis • Radiolucent well defined eccentric metaphysial lesion with surrounding sclerosis • Cortex maybe expanded • Calcification in lesion is extremely uncommon
  • 15. Osteochondroma • Osseous outgrowth from bony cortex • Single>multiple • When multiple k/a diaphyseal aclasia • Very small risk of malignancy (chondrosarcoma) • Arise mainly from tubular bones near metaphysis • MC around knee , proximal end of humerus • Sessile/pedunculated • When pedunculated grows away from metaphysis being directed towards diaphysis
  • 16. • Bony protrusions covered by cartilaginous cap • Growth in childhood takes place in the cap, • A thick cartilaginous cap in an adult is suspicious of chondrosarcoma.
  • 17. Fibrous cortical defect • Common lesion • 2-15 yrs • MC around knee ( sp distal posteromedial femoral cortex) • Blister like expansion of cortex with thin shell of overlying bone • Always sharply defined, maybe slightly lobulated
  • 18. • lucent intracortical defects • outlined by a thin rim of sclerosis • no involvement of the underlying medullary cavity • no periosteal reaction
  • 19. Non ossifying fibroma • Similar to FCD except that it is much larger • 10-20yrs • MC around knee ( esp distal end of femur) • Eccentric well-defined lytic lesion with sclerotic lobulated margin. • Usually located around the knee in diaphysis or meta/diaphysis and does not occur in hands, feet, spine and flat bones. • Found as incidental finding or presents with a fracture. • The natural course is a sclerotic filling over time.