Radiology pediatric bone tumors


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Radiology pediatric bone tumors

  1. 1.  Hamartomatous fibro-osseous metaplasia Age: 10-70; common in 2nd- 3rddecade Common locations:◦ femur, tibia, pelvis, ribs, skull 70% monostotic
  2. 2.  Radiography:◦ Variable: fibrous matrix- ground glass osteoid matrix-sclerotic◦ Zone of transition narrow (sclerotic rim)
  3. 3. -Sclerotic lesion in femursecondary to presence ofincreased woven bone-Pathologic fracture
  4. 4.  90% unilateral 3% Albright’s Syndrome◦ precocious puberty, café-au-lait spots, polyostotic bonelesions Femur- Sheppard’s crook varus deformity Cherubism- expanding facial bones, sinuses Pregnancy- lesions may enlarge
  5. 5.  Monostotic: UBC Polyostotic: Ollier’s disease, mets Rib lesions: EG, Ewing’s, mets Skull base: meningioma- skull base hyperostosis,Paget’s
  6. 6. -Differential Dx: UBC- FD may appear verycystic on MR-UBC cold on bone scan; FD- warm
  7. 7.  Occurs only in the tibia and fibula Infants and children X-ray: mixed lucent/sclerotic, thickened cortex(anterolateral), anterior bowing, synchronoustibia/fibula DDX: adamantinoma (epithelial nature)◦ slightly older age >20
  8. 8.  Epiphyseal lesion Age: <30 (growth plate usually open) X-ray: epiphysis, lytic destructive lesion, centrallylocated, usually extends into metaphysis, DDX: CIGG – chondroblastoma, infection, GCT,intraosseous ganglion, DDX: EG, ABC, mets, myeloma
  9. 9. T1T2T1 GAD
  10. 10.  PF: S.T. mass with vascular calcifications MRI: T1:◦ Lacy high signal within lesion represents fat withinlesion◦ T2 and T1 post Gad: tortuous vascular channelspossible phleboliths◦ Most common S.T. mass of childhood; intramuscular;size may vary throughout the day
  11. 11.  Primary small cell bone neoplasm Derived from reticulocyte- occurs in areas of redmarrow; long bones, axial skeleton Diaphyseal- older; Metaphyseal younger Age: 1st–2nddecade; 96% Caucasian
  12. 12.  Radiography◦ Highly aggressive tumor; permeative pattern◦ Medullary tumor; infiltrative; periosteal reaction-spiculated, lamellated- many layers present◦ No mineralized matrix◦ S.T. mass common◦ DDX: EG, lymphoma, OS, infection
  13. 13.  Typically metastatic to bone; common tumor inchildhood In childhood- acute leukemia,◦ lymphocytic or undifferentiated 50% of children have osseous involvement attime of DX, and 70-80% during disease
  14. 14.  Childhood radiographic changes◦ Radiolucent metaphyseal bands- growth arrestdisturbance; not leukemic infiltrate- involve areas of rapidgrowth◦ Diffuse osteopenia- often the only finding◦ Periosteal reaction- lamellated◦ Osteolytic lesions- permeative/ moth eaten◦ Sclerotic lesions
  15. 15.  One of the most common bone tumors Almost always in long bones (femur, tibia) Age: Usually > 2 y.o. and < 20 y.o. Histo: fibroblasts and giant cells Usually regress with age; rarely seen in 30’s Usually an incidental finding
  16. 16.  Radiography◦ Unilateral or bilateral◦ Osteolytic lesion; well defined; sclerotic margin; oval,scalloped, lobulated, eccentric,◦ Metadiaphyseal, cortically based,◦ Periosteal reaction absent- unless path fracture◦ Femur: posteromedial; healing begins in diaphysealregion
  17. 17.  Jaffe-Campanacci Syndrome◦ Multiple NOFs◦ Café-au-lait spots◦ Mental retardation precocious puberty, hypogonadism, cryptorchidism, ocularanomalies, cardiovascular anamolies
  18. 18. T1T2T1 GAD
  19. 19.  Uncommon: long bones, spine, hands, feet,pelvis, shoulder Age: 5- 20 y.o. Usually metaphyseal Highly vascular expansile lesion; multiple cavities-filled with blood Primary or secondary lesion; solid component
  20. 20.  Radiography◦ Expansile, geographic lytic lesion; eccentric◦ Usually metaphyseal◦ Margin- sharp, nonsclerotic; outer margin thinned, maybe imperceptible radiographically◦ MRI/ CT fluid-fluid levels◦ DDX: UBC, NOF, FD, Osteoblastoma- spine,Telangiectatic osteosarcoma
  21. 21.  Long bones- (prox humerus/ femur) metaphyseal-move toward diaphysis with bone growth Age: 1sttwo decades of life Bone cyst- serosanguineous fluid Bony septations Pathologic fractures 2/3’s of cases
  22. 22.  Radiography◦ Well-defined lytic lesion- central in medullary space;bone expansion, sharp margin◦ Periosteal reaction only in presence of path fracture-“fallen fragment sign”◦ Radiolucent with trabeculation◦ DDX: FD, ABC, NOF
  23. 23.  Nonneoplastic lesion of bone(reticulohistiocytosis) Usually solitary- EG◦ Multiple- Hand-Schuller-Christian◦ Systemic- Letterer-Siwe◦ Long bones, skull, spine, ribs, pelvis◦ Age: 1sttwo decades (5 – 10 y.o.)
  24. 24.  Radiography◦ Variable: osteolytic oval, slow growing lesionoccasionally aggressive appearing◦ Medullary space; centrally located◦ Periosteal reaction – 10% of cases◦ Nucs scan – negative 1/3 of cases
  25. 25.  Metaphyseal- epiphyseal lesion; long bones Age: 20 - 50 y.o. (growth plate closed) rare underage 15 y.o. Progressive potentially malignant lesion Histo: Giant cells and mononuclear spindleshaped cells
  26. 26.  Radiography◦ Lytic lesion; arises in metaphysis and extends intoepiphysis; growth plate closed◦ Well defined, nonsclerotic margin, abuts articularsurface, eccentric, usually large (> 4-6cm)◦ Radiographic appearance does not help in determining ifbenign or malignant
  27. 27.  Exostosis; bony projection with a cap of hyalinecartilage; aberrant cartilage Metaphyseal, points away from joint; long bones,around knee Age: 2nddecade; growth stops when growth platecloses Single or multiple; sessile, pedunculated Malignant potential; increase with multiple lesions
  28. 28.  Radiography◦ Bony projection; contiguous medullary space and cortex;overlying cartilage cap◦ Pedunculated/ sessile◦ Pain- malignant transformation/ mechanical problems,bursa formation◦ Cartilage cap; normally < 1-2 cm
  29. 29.  DDX:◦ Single lesion: Parosteal osteosarcoma (no continuity ofmedullary space and cortex)◦ Multiple: Enchondromatosis; FD◦ Malignant Transformation: Chondrosarcoma; Pain; Growth after growth plate closes Cartilaginous cap > 2cm thick
  30. 30. T1T2T1 GAD
  31. 31.  Similar to osteoblastoma; < 2 cm in size Femur/ tibia/ bones of the hands/ feet/ spine Usually cortical;Fibrovascular nidus (< 1cm);adjacent reactive bony sclerosis Night pain relieved by aspirin Age: < 25 y.o.
  32. 32.  Radiography◦ Round/ oval radiolucency (nidus <1-2cm)◦ Cortically located◦ Thick adjacent bony sclerosis Nucs: “Target” sign; MR: Nidus- bright on T2with marked enhancement with Gad; CT usedto identify the nidus DDX: stress fracture, osteomyelitis
  33. 33.  Malignant bone tumor that forms osteoid tissue Most common primary malignant bone tumorother than multiple myeloma Involves areas of active growth; Metaphysis;femur, humerus, tibia, pelvis Age: 2nddecade
  34. 34.  Radiography◦ Aggressive tumor; lytic (permeative)/ sclerotic(amorphous, cloudlike)/ mixed◦ Periosteal reaction: lamellated, spiculated◦ Large S.T. mass; skip lesions (MRI)
  35. 35.  Subtypes◦ Telangiectatic: (<20y.o.) Lytic, expansile, aggressive,may mimic ABC radiographically◦ Parosteal: (2nd-5thdecades) low grade, better prognosis,stuck on appearance post femur◦ Periosteal: (20 y.o.) Surface OS, aggressive, betterprognosis than conventional OS; tibia◦ Multicentric: synchronous lesions, poor prognosis;sclerotic lesions; children
  36. 36.  Synovial metaplasia; multiple osseous/cartilaginous intraarticular loose bodies Nourished by synovial fluid Limited ROM/ pain DDX: PVNS, loose bodies DJD Monoarticular; knee, hip, shoulder, elbow
  37. 37.  Radiography◦ Effusion present; abnormal calcifications◦ Ossified loose bodies seen on plain film◦ Cartilaginous loose bodies seen on MR◦ Secondary OA◦ Pressure erosive changes