Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
BENIGN BONE TUMOURS
Presenter :Dr.Arif khan S
Moderator: Dr.Gururaj Sharma
BENIGN BONE TUMOURS
• CLASSIFICATION:
• BONE FORMING
Eg; osteoid osteoma, osteoblastoma, enostosis (bone island), osteopoi...
IMAGING
• the role of imaging in the management of a patient with a suspected bone
tumour can be broadly
subdivided as fol...
CARTILLAGE FORMING BENIGN TUMORS
ENCHONDROMA
• common benign medullary cartilaginous neoplasm
• usually found in children or young adults which can lead to...
ENCHONDROMA
• Enchondromas arise from rests of growth
plate cartilage/chondrocytes that
subsequently proliferate and slowl...
ENCHONDROMA
• Rarely an enchondroma may extend through the cortex and demonstrate a
exophytic growth pattern. This is know...
IMAGING
• X-ray & CT
Typically enchondromas are small 1 - 2cm lytic lesions with non-
aggressive features.
narrow zone of ...
IMAGES
IMAGING
• MRI
• MRI is useful in evaluating for soft tissue extension and for confirming the diagnosis.
• Enchondromas app...
IMAGES
• T1 T2 STIR
• Hypointense Hyperintense
• Ollier disease also known as
enchondromatosis, is a non-
hereditary, sporadic, skeletal
disorder characterised by
multip...
MAFUCCI’S SYNDROME
• Maffucci syndrome is a congenital non hereditary mesodermal dysplasia
characterised by multiple encho...
OLLIER’S
DISEASE

MAFFUCI’S
DISEASE

CHONDROBLASTOMA
• rare benign cartilaginous neoplasms
• less than 1% of all primary bone tumours, occurring predominantly ...
• epiphysis of a long bone (70%
occurring in the humerus (most
frequent), femur and tibia, ~ 10%
are found in the hands an...
IMAGING
• X-rays
• epiphyseal
• well defined lytic lesions; either smooth or lobulated margins with a thin
sclerotic rim
•...
IMAGE
IMAGING
• MRI
• ideal for the evaluation of transphyseal or transcortical extension.
• Demonstrating associated surroundin...
IMAGE
• T1 T2 STIR
OSTEOCHONDROMA
• Developmental anomalies rather than tumors.
• They are usually sporadic, but can be part of:
Hereditary m...
• They most commonly arise from
appendicular skeleton, especially around
the knee 3.
• lower limb - 50% of all cases femur...
• Pathologically Osteochondromas are
essentially a part of the growth plate.
• Separates and continues growing
independent...
• X-ray findings.
• An osteochondroma can be either sessile or pedunculated, and is seen in
the metaphyseal region typical...
• MRI
• MRI is best at assessing cartilage thickness
(and thus assessing for malignant
transformation), presence of oedema...
T1 T2 STIR
• Bone scan
During growth osteochondromas demonstrate increased uptake, but with
time they become no more active than norm...
CHONDROMYXOID FIBROMA
• Extremely rare, benign cartilaginous neoplasms that account for < 1% of all
bone tumours.
• Second...
IMAGING
• X-rays &CT
often seen as a lobulated, eccentric radiolucent lesion
long axis parallel to long axis of long bone
...
IMAGES
• MRI
• Non specific.
• T1- low signal (hypointense)
• T1 C+ (Gd)
• the majority (~70%) tend to show peripheral nodular en...
IMAGES
MISCELLANEOUS TUMORS
SIMPLE BONE CYST
• A.k.a Unicameral bone cysts.
• Relatively common Radiolucent bony lesions
• seen in childhood and typic...
IMAGING
• X-ray & CT
Sharply demarcated.
Radiolucent lesions.
Periosteal reactions.
Expand the bone with thinning of
the o...
MRI
MR signal characteristics for an uncomplicated lesion include
T1 - low signal
T2 - high signal
Usually there no fluid-...
T1 T2
ANEURYSMAL BONE CYST (ABC)
• Benign , Expansile
• Primarily seen in children and adolescents (80% l <20yrs of age)
• blood...
• Location
Long bones – tibia & fibula (24%),
femur (13%),
Spine 20-30% (posterior elements).
sacrum
• A variant of ABCs i...
RADIOGRAPHIC FEATURES
• X ray
sharply defined, expansile osteolytic
lesions, with thin sclerotic margins.
Eccentricity is ...
• MRI
Demonstrate Fluid Fluid level in lesion.
To distinguish between Primary and secondary (if solid component Is present...
• Bone scan:
• Doughnut sign - increased
uptake peripherally with a
photopenic centre.
ADAMANTINOMA
• LONG BONES (tibia exclusively)AND JAW.
• 2nd to 3rd decades as a locally aggressive mass .
• slight male pr...
• X-rays & CT
Appears as a multi-locular or slightly
expansile osteolytic lesion.
areas of lysis interspersed with areas
o...
. MRI
• a solitary lobulated focus
• multiple small nodules in one or more foci.
• Separated tumour foci,
defined as foci ...
IMAGES
AMELOBLASTOMA
• Ameloblastomas (previously known as an adamantinoma of the jaw) are
benign, locally aggressive tumours tha...
• d/ds
• dentigerous cyst : 20% of ameloblastomas thought to arise from pre-existing
dentigerous cysts
• odontogenic kerat...
SUMMARY
Most common location
FD = Fibrous dysplasia
EG = Eosinophilic Granuloma
NOF = Non Ossifying Fibroma
SBC = Simple Bone Cyst...
Most primary tumours are seen in patients
less than 30 years of age
In patients greater than 30 years ,
secondary tumours ...
COMMON
LOCATIONS OF
LESIONS
FD = Fibrous dysplasia
EG = Eosinophilic Granuloma
NOF = Non Ossifying Fibroma
SBC = Simple Bo...
MOST COMMON LOCATIONS
• Aneurysmal Bone Cyst
tibia, femur, fibula, spine, humerus
• Adamantinoma
tibia shaft, mandible
• C...
• Enchondroma
phalanges of hands and feet, femur, humerus, metacarpals, rib
• Osteochondroma
femur, humerus, tibia, fibula...
SPOTTERS
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Benign bone tumours
Upcoming SlideShare
Loading in …5
×

Benign bone tumours

13,659 views

Published on

mainly discussion on bone forming tumors and cartillage forming benign tumors of bone ,
priority given to imaging

Published in: Health & Medicine
  • Be the first to comment

Benign bone tumours

  1. 1. BENIGN BONE TUMOURS Presenter :Dr.Arif khan S Moderator: Dr.Gururaj Sharma
  2. 2. BENIGN BONE TUMOURS • CLASSIFICATION: • BONE FORMING Eg; osteoid osteoma, osteoblastoma, enostosis (bone island), osteopoikilosis Osteoma, • CARTILLAGE FORMING Eg; enchondroma , enchondromatosis (Ollier disease),, Osteochondroma, chondroblastoma FIBROUS BONE LESIONS Eg; fibrous dysplasia, ossifying fibroma • Miscellaneous Simple bone cyst; Aneurysmal Bone cyst;
  3. 3. IMAGING • the role of imaging in the management of a patient with a suspected bone tumour can be broadly subdivided as follows; • 1. detection • 2. diagnosis • 3. surgical staging • 4. follow-up
  4. 4. CARTILLAGE FORMING BENIGN TUMORS
  5. 5. ENCHONDROMA • common benign medullary cartilaginous neoplasm • usually found in children or young adults which can lead to pathological fractures or undergo malignant degeneration. • 3-10 % of all bone tumours and 12-24 % of benign bone tumours • Enchondromas are most frequently diagnosed in childhood to early adulthood with a peak incidence of 10-30 years. • complicated by a pathological fracture or malignant transformation into a low grade chondrosarcoma • (clinically if an enchondroma is painful in the absence of a fracture, it should be considered malignant
  6. 6. ENCHONDROMA • Enchondromas arise from rests of growth plate cartilage/chondrocytes that subsequently proliferate and slowly enlarge and are composed of mature hyaline cartilage. • they are seen in any bone formed from cartilage. • Two syndromes are associated with multiple enchondromas: Ollier disease Maffucci syndrome. • small tubular bones of the hands and feet : 50% • large tubular bones e.g. femur, tibia, humerus
  7. 7. ENCHONDROMA • Rarely an enchondroma may extend through the cortex and demonstrate a exophytic growth pattern. This is known as an enchondroma protuberans, and may either be seen sporadically or as part of Ollier disease. • Almost all enchondromas are located in the medullary cavity of tubular bones. The typical distribution is : D/ds: • bone infarct , chondrosarcoma, intraosseous ganglion • other benign lytic bone lesions, • metastases • granulomatous disease : sarcoidosis, tuberculosis
  8. 8. IMAGING • X-ray & CT Typically enchondromas are small 1 - 2cm lytic lesions with non- aggressive features. narrow zone of transition sharply defined scalloped margins : may have mild endosteal scalloping expansion of the overlying cortex may be present but there should not be cortical breakthrough unless fractured chondroid calcifications may be present : rings and arcs calcification no periosteal reaction no soft tissue mass. • The majority of enchondromas more frequently arise in the metaphyseal region,. A cartilaginous lesion in an epiphysis is more likely to be a chondrosarcoma .
  9. 9. IMAGES
  10. 10. IMAGING • MRI • MRI is useful in evaluating for soft tissue extension and for confirming the diagnosis. • Enchondromas appear as well circumscribed somewhat lobulated masses replacing marrow. • T1 intermediate to low signal • T1 C+ (Gd) enhancement is variable, and may be seen both peripherally or of translesional septae. Similar pattern of enhancement may be seen in chondrosarcomas. • T2 typically of background intense high signal they can be focal regions of signal drop out where calcification present no bone marrow or soft tissue oedema
  11. 11. IMAGES • T1 T2 STIR • Hypointense Hyperintense
  12. 12. • Ollier disease also known as enchondromatosis, is a non- hereditary, sporadic, skeletal disorder characterised by multiple enchondromas that are principally located in the metaphyseal regions. • Plain films show multiple enchondromas. Larger lesions can show cartilage calcification in a typical rings and arcs pattern. • Imaging characterestics are of same as ENCHONDROMAS
  13. 13. MAFUCCI’S SYNDROME • Maffucci syndrome is a congenital non hereditary mesodermal dysplasia characterised by multiple enchondromas with soft-tissue cavernous haemangiomas. • Imaging findings are multiple enchondromas seen associated with soft tissue swelling and phleboliths. • Enchondromas degenerate into chondrosarcomas in 15-51% 3 of cases and soft-tissue haemangiomas to vascular sarcomas in 3-5%.
  14. 14. OLLIER’S DISEASE  MAFFUCI’S DISEASE 
  15. 15. CHONDROBLASTOMA • rare benign cartilaginous neoplasms • less than 1% of all primary bone tumours, occurring predominantly in young patients (< 20 years of age). There is a male predilection. • Pathologically composed of chondroblasts, chondroid matrix, cartilage with occasional giant multi-nucleated cells.* with surrounding chondroblasts. • Aneurysmal bone cysts can be seen secondarily to underlying chondroblastoma.
  16. 16. • epiphysis of a long bone (70% occurring in the humerus (most frequent), femur and tibia, ~ 10% are found in the hands and feet)
  17. 17. IMAGING • X-rays • epiphyseal • well defined lytic lesions; either smooth or lobulated margins with a thin sclerotic rim • Internal calcifications can be seen in up to 40-60% of cases • They range in size from 1-10cm, with most being 3-4cm at diagnosis • CT • better delineation of the relationship to the growth plate and articular surface • Solid periosteal reaction (seen in up to 50% of cases) and internal calcification (calcified matrix seen in ~ 1/2 of cases) and cortical breach are also more easily appreciated. • Endosteal scalloping may be seen
  18. 18. IMAGE
  19. 19. IMAGING • MRI • ideal for the evaluation of transphyseal or transcortical extension. • Demonstrating associated surrounding bone marrow oedema. • These lesions have signal typical of cartilage: T1 - lesion itself is of low to intermediate signal T2 / STIR - lesion is of intermediate to high signal • Fluid-fluid levels may occasionally be seen .
  20. 20. IMAGE • T1 T2 STIR
  21. 21. OSTEOCHONDROMA • Developmental anomalies rather than tumors. • They are usually sporadic, but can be part of: Hereditary multiple exostoses (HME) - also known as diaphyseal aclasis Trevor disease An osteochondroma can be either sessile or pedunculated, and is seen in the metaphyseal region typically projecting away from the epiphysis.
  22. 22. • They most commonly arise from appendicular skeleton, especially around the knee 3. • lower limb - 50% of all cases femur (especially distal) - most common : 30% • tibia (especially proximal) - 15-20% • less common locations - feet, scapula • upper limb • humerus - 10-20% • less common locations - hands, pelvis • spine - the posterior elements of spine are an uncommon, but not rare, site for these tumours
  23. 23. • Pathologically Osteochondromas are essentially a part of the growth plate. • Separates and continues growing independently, without an associated epiphysis • The medullary cavity is continuous with the parent bone, and they are capped by hyaline cartilage • D/ds • hands - bizarre parosteal osteochondromatous proliferation (BPOP) • humerus - supracondylar spur : projects towards the elbow joint • malunited fracture
  24. 24. • X-ray findings. • An osteochondroma can be either sessile or pedunculated, and is seen in the metaphyseal region typically projecting away from the epiphysis. • There is often associated broadening of the metaphysis from which it arises • The cartilage cap is variable in appearance. It may be thin and difficult to identify, or thick with rings and arcs calcification and irregular subchondral bone. • CT • Better visualisation of medullary continuity and the cartilage cap.
  25. 25. • MRI • MRI is best at assessing cartilage thickness (and thus assessing for malignant transformation), presence of oedema in bone or adjacent soft tissues and visualising neurovascular structures in the vicinity. • The cartilage cap of osteochondromas appears the same as cartilage elsewhere, with intermediate to low signal on T1 and high signal on T2 and STIR weighted images. • A cartilage cap of over 1.5cm in thickness is suspicious for malignant degeneration.
  26. 26. T1 T2 STIR
  27. 27. • Bone scan During growth osteochondromas demonstrate increased uptake, but with time they become no more active than normal bone. Presence of increased activity in adulthood should raise the possibility of a complication (fracture, malignancy).
  28. 28. CHONDROMYXOID FIBROMA • Extremely rare, benign cartilaginous neoplasms that account for < 1% of all bone tumours. • Second and third decades, with approximately 75% of cases occurring before the age of 30 years. • Pathologically comprises of a variable combination on chondroid, myxoid, and fibrous tissue components organised in a pseudolobulated architecture. • Occasional osteoclast-like giant multinucleated cells are encountered particularly at the periphery. • D/ds: aneurysmal bone cyst (ABC), giant cell tumour of bone (GCT), non ossifying fibroma: younger age group, chondroblastoma: younger age group
  29. 29. IMAGING • X-rays &CT often seen as a lobulated, eccentric radiolucent lesion long axis parallel to long axis of long bone no periosteal reaction (unless a complicating fracture present) geographic bone destruction: almost 100% well defined sclerotic margin: 86% there can be presence of septations (pseudotrabeculation): 57% 2 there can be presence of matrix calcification in small porportion cases: 12.5%1 • Bone Scan – Doughnut sign (non- specific)
  30. 30. IMAGES
  31. 31. • MRI • Non specific. • T1- low signal (hypointense) • T1 C+ (Gd) • the majority (~70%) tend to show peripheral nodular enhancement. • 30% diffuse contrast enhancement and this can be either homogeneous or heterogeneous . • T2 - hyperintense
  32. 32. IMAGES
  33. 33. MISCELLANEOUS TUMORS
  34. 34. SIMPLE BONE CYST • A.k.a Unicameral bone cysts. • Relatively common Radiolucent bony lesions • seen in childhood and typically remain asymptomatic. • 1st and 2nd decades (65% in teenagers), and are more common in males • frequently found in the metaphysis of long bones, abutting the growth plate. proximal humerus: most common 50-60% proximal femur: 30%
  35. 35. IMAGING • X-ray & CT Sharply demarcated. Radiolucent lesions. Periosteal reactions. Expand the bone with thinning of the overlying bone. • Fallen fragment sign: a dependent bony fragment within the lesion. Seen when assosciated fracture is present.
  36. 36. MRI MR signal characteristics for an uncomplicated lesion include T1 - low signal T2 - high signal Usually there no fluid-fluid levels unless there has been a complication with haemorrhage. CT and MRI add little to the diagnosis, but are however helpful in eliminating other entities that can potentially mimic a simple bone cyst
  37. 37. T1 T2
  38. 38. ANEURYSMAL BONE CYST (ABC) • Benign , Expansile • Primarily seen in children and adolescents (80% l <20yrs of age) • blood-filled spaces of variable size separated by connective tissue (trabeculae of bone or osteoid tissue) and osteoclast giant cells • Not lined by endothelium. Types • Primary • Secondary (e.g chondroblastoma, fibrous dysplasia, giant cell tumour (GCT), osteosarcoma)
  39. 39. • Location Long bones – tibia & fibula (24%), femur (13%), Spine 20-30% (posterior elements). sacrum • A variant of ABCs is the giant cell reparative granuloma. seen in the tubular bones – hand , feet craniofacial skeleton.
  40. 40. RADIOGRAPHIC FEATURES • X ray sharply defined, expansile osteolytic lesions, with thin sclerotic margins. Eccentricity is typical. But very often missed out due to cortical thinning due to ballooning. CT Demonstrates these findings to a greater degree, and is also better at assessing cortical breach and extension into soft tissues. Fluid fluid levels (better than MRI)
  41. 41. • MRI Demonstrate Fluid Fluid level in lesion. To distinguish between Primary and secondary (if solid component Is present.) The cysts are of variable signal, with surrounding rim of low T1 and T2 signal. Focal areas of high T1 and T2 signal are also seen presumably representing areas of blood of variable age.
  42. 42. • Bone scan: • Doughnut sign - increased uptake peripherally with a photopenic centre.
  43. 43. ADAMANTINOMA • LONG BONES (tibia exclusively)AND JAW. • 2nd to 3rd decades as a locally aggressive mass . • slight male predilection. • Since it is a low-grade malignancy, it can metastasise to distant locations including : lung, bone, lymph nodes, pericardium and liver. • D/ds • fibrous dysplasia • osteofibrous dysplasia : has a more ground glass texture on CT
  44. 44. • X-rays & CT Appears as a multi-locular or slightly expansile osteolytic lesion. areas of lysis interspersed with areas of sclerosis Lesions tend to have an eccentric epicentre. lack of periosteal reaction
  45. 45. . MRI • a solitary lobulated focus • multiple small nodules in one or more foci. • Separated tumour foci, defined as foci of high signal intensity on either T2 or T1-weighted contrast- enhanced images, interspersed with normal-appearing cortical or spongious bone . C+(Gd) : tends to show intense and homogeneous static enhancement, although there is no uniform dynamic enhancement pattern.
  46. 46. IMAGES
  47. 47. AMELOBLASTOMA • Ameloblastomas (previously known as an adamantinoma of the jaw) are benign, locally aggressive tumours that arise from the mandible, or less commonly from the maxilla. • They are slow growing and tend to present in the 3rd to 5th decades of life, with no gender predilection. • X-rays &CT findings • It is classically seen as a multilocualted (80%), expansile "soap-bubble" lesion, with well demarcated borders and no matrix calcification. • erosion of the adjacent tooth roots can be seen which is highly specific. • larger it may also erode through cortex into adjacent soft tissues. • MRI findings • ameloblastomas demonstrate a mixed solid and cystic pattern, with a thick irregular wall, often with papillary solid structures projecting into the lesion. • These components tend to vividly enhance
  48. 48. • d/ds • dentigerous cyst : 20% of ameloblastomas thought to arise from pre-existing dentigerous cysts • odontogenic keratocyst (OKC) -unilocular with thin poorly enhancing walls • odontogenic myxoma - can be almost indistiguishable • aneurysmal bone cyst (ABC) • fibrous dysplasia
  49. 49. SUMMARY
  50. 50. Most common location FD = Fibrous dysplasia EG = Eosinophilic Granuloma NOF = Non Ossifying Fibroma SBC = Simple Bone Cyst CMF = Chondromyxoid fibroma ABC = Aneurysmal bone cyst HPT = Hyperparathyroidism with Brown tumor GCT = Giant cell tumour
  51. 51. Most primary tumours are seen in patients less than 30 years of age In patients greater than 30 years , secondary tumours (eg ;brown tumours) and metastatic deposits are common.
  52. 52. COMMON LOCATIONS OF LESIONS FD = Fibrous dysplasia EG = Eosinophilic Granuloma NOF = Non Ossifying Fibroma SBC = Simple Bone Cyst CMF = Chondromyxoid fibroma ABC = Aneurysmal bone cyst HPT = Hyperparathyroidism with Brown tumor GCT = Giant cell tumour
  53. 53. MOST COMMON LOCATIONS • Aneurysmal Bone Cyst tibia, femur, fibula, spine, humerus • Adamantinoma tibia shaft, mandible • Chondroblastoma femur, humerus, tibia, tarsal bone (calc), patella • Chondromyxoid fibroma tibia, femur, tarsal bone, phalanx foot, fibula
  54. 54. • Enchondroma phalanges of hands and feet, femur, humerus, metacarpals, rib • Osteochondroma femur, humerus, tibia, fibula, pelvis • Solitary Bone Cyst proximal humerus, proximal femur, calcaneal bone, iliac bone
  55. 55. SPOTTERS

×