By

Dr.Muhammad Ben Zulfiqar(PGR-1)
Clues by Appearance of Lesion
Clues by Location of Lesion
Clues by Density of Lesion
Other Clues
Clues by Appearance of Lesion
Patterns of Bone Destruction
Periosteal Reactions
Tumor Matrix
Expansile Lesions of Bone
Clues by Appearance of Lesion
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative
Geographic Bone Destruction
Destructive lesion with sharply defined border
Implies a less-aggressive, more slow-growing,...
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative

Non-ossifying fibroma
Examples:
• Non-ossifying fibroma
• Chondromyxoid fibroma
• Eosinophilic granuloma
Moth-eaten Bone Destruction
Areas of destruction with ragged borders
Implies more rapid growth


Probably a malignancy
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative

Multiple Myeloma
Moth-eaten Bone Destruction
Examples:
Myeloma
Metastases
Lymphoma
Ewing’s sarcoma
Permeative Bone Destruction
Ill-defined lesion with multiple “worm-holes”
Spreads through marrow space
Wide transition ...
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative

Leukemia
Permeative Bone Destruction
Examples:
Lymphoma, leukemia
Ewing’s Sarcoma
Myeloma
Osteomyelitis
Neuroblastoma
Patterns of Bone Destruction

Geographic

Less malignant

Moth-eaten

Permeative

More malignant
Periosteal Reactions
Benign
None
Solid
More aggressive or malignant
Lamellated or onion peel
Sunburst
Codman’s tria...
Periosteal Reactions
• Benign
– None
– Solid

• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle

Non-ossi...
Periosteal Reactions
• Benign
– None
– Solid

• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle

Chronic ...
Periosteal Reactions
• Benign
– None
– Solid

• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle

Ewing sa...
Periosteal Reactions
• Benign
– None
– Solid

• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle

Osteo-sa...
Periosteal Reactions
• Benign
– None
– Solid

• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle
Periosteal Reactions

Solid

Sunburst

Less malignant

onion-peel

More malignant

Codman’s
triangle
Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities
Osteosarcoma
 Cartilaginous
 Comma-shaped, punc...
Tumor Matrix
Osteoblastic
 Cartilaginous
Tumor Matrix
 Osteoblastic
 Fluffy, cotton-like or cloud-like densities

as Osteosarcoma

Cartilaginous
Comma-shaped, ...
Tumor Matrix
Osteoblastic
Cartilaginous

Chondrosarcoma
Expansile Lesions of Bone
•
•
•
•
•
•

Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasi...
Expansile Lesions of Bone
Multiple
myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma

Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
Renal cell...
Expansile Lesions of Bone
Multiple myeloma
Mets

Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor

Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma

Aneurysmal bone
cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst

Fibrous dysplasia
Clues by Location of Lesion
•
•
•
•

In the Transverse Plane
In the Longitudinal Plane
Characteristic Locations by tumors
...
In the Transverse Plane
.

.
.
In the longitudinal Plane
Epiphyseal
GCT, chondroblastoma
Metaphyseal
Osteomyelitis, osteo-and chondrosarcoma
Diaphysea...
Characteristic Locations
Simple bone cyst
Proximal humerus
 Chondroblastoma

Epiphyses

 Giant Cell tumor

Epiphyses
 ...
Characteristic Locations
 Simple bone cyst

Proximal humerus

Chondroblastoma
Epiphyses
 Giant Cell tumor

Epiphyses
 ...
Characteristic Locations
 Simple bone cyst

Proximal humerus
 Chondroblastoma
Epiphyses

Giant Cell tumor
Epiphyses
 A...
Characteristic Locations
 Simple bone cyst

Proximal humerus
 Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses

A...
Characteristic Locations
 Simple bone cyst

Proximal humerus
 Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses
 A...
Characteristic Locations
 Simple bone cyst





Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses...
Clues by Density of Lesion
Sclerotic Cortical Lesions
Lytic Lesions in Children
Lytic Lesions in Adults
Blastic Lesion...
Sclerotic Cortical Lesions
Osteoid osteoma
 Brodie’s abscess
Sclerotic Cortical Lesions
 Osteoid osteoma

Brodie’s abscess
Lytic Lesions in Children
Eosinophilic

granuloma

 Leukemia
Lytic Lesions in Children
 Eosinophilic granuloma

Leukemia
Lytic Lesions in Adults
Metastatic lesions

Lung
Renal
Thyroid
 Multiple myeloma
 Primary bone tumor

Metastatic thy...
Lytic Lesions in Adults
 Metastatic lesions
 Lung
 Renal
 Thyroid

Multiple myeloma
 Primary bone tumor
Lytic Lesions in Adults
 Metastatic lesions
 Lung
 Renal
 Thyroid

 Multiple myeloma

Primary bone tumor

Chondrosar...
Blastic Lesions in Children
Lymphoma
Blastic Lesions in Adults

Metastatic disease
Breast

–female
Prostate –male
 Lymphoma
 Paget’s disease
 Fluorosis

...
Blastic Lesions in Adults
 Metastatic disease

Breast –female
 Prostate –male


Lymphoma
 Paget’s disease
 Fluorosis
Blastic Lesions in Adults
 Metastatic disease

Breast –female
 Prostate –male
 Lymphoma


Paget’s disease
 Fluorosis
Blastic Lesions in Adults
 Metastatic disease

Breast –female
 Prostate –male
 Lymphoma
 Paget’s disease


Fluorosis
Other Clues
Soft Tissue Extension
Benign vs. Malignant
Soft Tissue Extension
Usually implies malignancy


More likely to form discrete soft tissue mass

Benign conditions wit...
Soft Tissue Extension

Lymphoma

Osteosarcoma
Benign vs. Malignant
Thank You
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Bone tumors muhammad 1

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Bone tumors muhammad 1

  1. 1. By Dr.Muhammad Ben Zulfiqar(PGR-1)
  2. 2. Clues by Appearance of Lesion Clues by Location of Lesion Clues by Density of Lesion Other Clues
  3. 3. Clues by Appearance of Lesion Patterns of Bone Destruction Periosteal Reactions Tumor Matrix Expansile Lesions of Bone
  4. 4. Clues by Appearance of Lesion Patterns of Bone Destruction Geographic Moth-eaten Permeative
  5. 5. Geographic Bone Destruction Destructive lesion with sharply defined border Implies a less-aggressive, more slow-growing, benign process Narrow transition zone
  6. 6. Patterns of Bone Destruction Geographic Moth-eaten Permeative Non-ossifying fibroma
  7. 7. Examples: • Non-ossifying fibroma • Chondromyxoid fibroma • Eosinophilic granuloma
  8. 8. Moth-eaten Bone Destruction Areas of destruction with ragged borders Implies more rapid growth  Probably a malignancy
  9. 9. Patterns of Bone Destruction Geographic Moth-eaten Permeative Multiple Myeloma
  10. 10. Moth-eaten Bone Destruction Examples: Myeloma Metastases Lymphoma Ewing’s sarcoma
  11. 11. Permeative Bone Destruction Ill-defined lesion with multiple “worm-holes” Spreads through marrow space Wide transition zone Implies an aggressive malignancy  Round-cell lesions
  12. 12. Patterns of Bone Destruction Geographic Moth-eaten Permeative Leukemia
  13. 13. Permeative Bone Destruction Examples: Lymphoma, leukemia Ewing’s Sarcoma Myeloma Osteomyelitis Neuroblastoma
  14. 14. Patterns of Bone Destruction Geographic Less malignant Moth-eaten Permeative More malignant
  15. 15. Periosteal Reactions Benign None Solid More aggressive or malignant Lamellated or onion peel Sunburst Codman’s triangle
  16. 16. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Non-ossifying fibroma
  17. 17. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Chronic osteomyelitis
  18. 18. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Ewing sarcoma
  19. 19. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Osteo-sarcoma
  20. 20. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle
  21. 21. Periosteal Reactions Solid Sunburst Less malignant onion-peel More malignant Codman’s triangle
  22. 22. Tumor Matrix Osteoblastic Fluffy, cotton-like or cloud-like densities Osteosarcoma  Cartilaginous  Comma-shaped, punctate, annular, popcorn-like  Enchondroma, chondrosarcoma, chondromyxoid fibroma
  23. 23. Tumor Matrix Osteoblastic  Cartilaginous
  24. 24. Tumor Matrix  Osteoblastic  Fluffy, cotton-like or cloud-like densities as Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma
  25. 25. Tumor Matrix Osteoblastic Cartilaginous Chondrosarcoma
  26. 26. Expansile Lesions of Bone • • • • • • Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  27. 27. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  28. 28. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Renal cell carcinoma
  29. 29. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  30. 30. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  31. 31. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  32. 32. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
  33. 33. Clues by Location of Lesion • • • • In the Transverse Plane In the Longitudinal Plane Characteristic Locations by tumors Characteristic Tumors by Body Site – Pelvic Lesions – Expansile Rib Lesions – Lesions of the Spine
  34. 34. In the Transverse Plane . . .
  35. 35. In the longitudinal Plane Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo-and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma
  36. 36. Characteristic Locations Simple bone cyst Proximal humerus  Chondroblastoma Epiphyses  Giant Cell tumor Epiphyses  Adamantinoma Tibia  Chordoma Sacrum, clivus  Osteoblastoma Spine, posterior
  37. 37. Characteristic Locations  Simple bone cyst Proximal humerus Chondroblastoma Epiphyses  Giant Cell tumor Epiphyses  Adamantinoma Tibia  Chordoma Sacrum, clivus  Osteoblastoma Spine, posterior
  38. 38. Characteristic Locations  Simple bone cyst Proximal humerus  Chondroblastoma Epiphyses Giant Cell tumor Epiphyses  Adamantinoma Tibia  Chordoma Sacrum, clivus  Osteoblastoma Spine, posterior
  39. 39. Characteristic Locations  Simple bone cyst Proximal humerus  Chondroblastoma Epiphyses  Giant Cell tumor Epiphyses Adamantinoma Tibia  Chordoma Sacrum, clivus  Osteoblastoma Spine, posterior
  40. 40. Characteristic Locations  Simple bone cyst Proximal humerus  Chondroblastoma Epiphyses  Giant Cell tumor Epiphyses  Adamantinoma Tibia Chordoma Sacrum, clivus  Osteoblastoma Spine, posterior
  41. 41. Characteristic Locations  Simple bone cyst     Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
  42. 42. Clues by Density of Lesion Sclerotic Cortical Lesions Lytic Lesions in Children Lytic Lesions in Adults Blastic Lesions in Children Blastic Lesions in Adults
  43. 43. Sclerotic Cortical Lesions Osteoid osteoma  Brodie’s abscess
  44. 44. Sclerotic Cortical Lesions  Osteoid osteoma Brodie’s abscess
  45. 45. Lytic Lesions in Children Eosinophilic granuloma  Leukemia
  46. 46. Lytic Lesions in Children  Eosinophilic granuloma Leukemia
  47. 47. Lytic Lesions in Adults Metastatic lesions Lung Renal Thyroid  Multiple myeloma  Primary bone tumor Metastatic thyroid carcinoma
  48. 48. Lytic Lesions in Adults  Metastatic lesions  Lung  Renal  Thyroid Multiple myeloma  Primary bone tumor
  49. 49. Lytic Lesions in Adults  Metastatic lesions  Lung  Renal  Thyroid  Multiple myeloma Primary bone tumor Chondrosarcoma
  50. 50. Blastic Lesions in Children Lymphoma
  51. 51. Blastic Lesions in Adults Metastatic disease Breast –female Prostate –male  Lymphoma  Paget’s disease  Fluorosis Prostatic Ca.
  52. 52. Blastic Lesions in Adults  Metastatic disease Breast –female  Prostate –male  Lymphoma  Paget’s disease  Fluorosis
  53. 53. Blastic Lesions in Adults  Metastatic disease Breast –female  Prostate –male  Lymphoma  Paget’s disease  Fluorosis
  54. 54. Blastic Lesions in Adults  Metastatic disease Breast –female  Prostate –male  Lymphoma  Paget’s disease  Fluorosis
  55. 55. Other Clues Soft Tissue Extension Benign vs. Malignant
  56. 56. Soft Tissue Extension Usually implies malignancy  More likely to form discrete soft tissue mass Benign conditions with soft tissue extension  Osteomyelitis  Usually infiltration of fat
  57. 57. Soft Tissue Extension Lymphoma Osteosarcoma
  58. 58. Benign vs. Malignant
  59. 59. Thank You

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