bone reaction and lesion margin

2. LESION MARGIN
• WHAT TUMOR DOES TO BONE
• IT USUALLY REVEALS THE NATURE OF LESION
• LYTIC PROCESS DO NOT AFFECT THE BONE DIRECTLY BUT ACT VIA THE NATIVE
BLASTS AND CLASTS WITHIN THE BONE SO THE ULTIMATE OUTCOME DEPENDS
ON THE BALANCE STRUCK BETWEEN BONE TUMOR VAGARIES AND ATTEMPT AT
MAINTAINING HOMEOSTASIS BY BONE

3. • SLOW GROWING TUMOR WILL SHOW
• RELATIVELY SHARP
• SCLEROTIC
• WELL DEFINED EDGES
• AGGRESSIVE TUMOR
• ILL DEFINED MARGIN DUE TO INFILTERATION AND DESTRUCTION

4. LODWICK CLASSIFICATION
I. GEOGRAPHIC LESION
II. MOTH EATEN
III. PREMEATIVE

5. GEOGRAPHIC
• SHARP, WELL DEFINED MARGIN
• SLOW GROWING LESIONS THAT PROGRESSIVELY EAT AWAY ALL THE BONE IN
WHICH THEY OCCUPY PRODUCING GEOGRAPHIC PATTERN
• LESION IS WELL CIRCUMSCRIBED WITH NARROW ZONE OF TRANSITION FROM
NORMAL BONE AND ACTUAL EDGE OF TUMOR

6. IA – DISCRETE SCLEROTIC
MARGINS SEPARATING FROM
NORMAL BONE
• CHONDROBLASTOMA
• NONOSSIFYING FIBROMA
• UNICAMERAL BONE CYST
• ENCHONDROMA

7. IB – EITHER NON SCLEROTIC
MARGINS OR THOSE HAVING
AN EXPANDED CORTICAL
SHELL THAT EXCEEDS 1CM
• GAINT CELL TUMOR
• ANEURYSMAL BONE CYST
• TELANGIECTATIC
OSTEOSARCOMA

8. IC – INDISTINCT MARGINS
BUT SHOULD NOT BE
CONFUSED FOR MOTH
EATEN
THEY ARE FOCALLY
DESTRUCTIVE AND LOCALLY
INFILTRATIVE
• OSTEOBLASTOMA

9. MOTH EATEN
• MORE AGGRESSIVE THAN GEOGRAPHIC
• THE SCATTERED BONES REPRESENTS THE ACTIVE
DESTRUCTIVE PROCESS SEPARATED BY AREAS OF
NORMAL BONE
• LATER THESE HOLES COALESCE TO FORM LARGER
AREAS OF BONE DESTRUCTION
• EWINGS SARCOMA
• CHONDROSARCOMA
• FIBROSARCOMA

10. PERMEATIVE
• ILL DEFINED, DIFFUSE, NARROW DESTRUCTIVE PROCESS OF BONE
• REPRESENTS AGGRESSIVE PATTERN
• MARGINS ARE INDISTINGUISHABLE AND MERGE WITH NORMAL BONE IN AN
INFILTRATING PATTERN
• GROWTH IS ALWAYS PARALLEL TO THE BONE AXIS WHILE TRANSVERSE MAY
REPRESENT BLOW OUT AND RESULT IN FRACTURE
• CONDROSARCOMA

12. BONE REACTION
• WHAT BONE DOES TO TUMOR
• PROLIFERATION MAY BE MEDULLARY OR PERIOSTEAL
• VERY AGGRESSIVE PROCESSES WILL NOT HAVE NO MEDULLARY REACTION AS
THEY EAT UP EVERYTHING
• DEPENDS ON
• INTENSITY
• AGGRESSIVENESS
• DURATION

15. • SOLID OR INTERRUPTED
• SLOW GROWING LESIONS PRODUCE AN
AMORPHOUS (THICK) OR CLOSELY LAMINATED
SOLID PERIOSTEAL RESPONSE IN
COMPARISON TO AGGRESSIVE PROCESS THAT
GENERATE A WIDELY LAMINATED OR SUN
BURST APPEARANCE

16. RAGSDALE EXPANDED
CLASSIFICATION
• SOLID PERIOSTEAL
• CONTINUOUS PERIOSTEAL
• INTERRUPTED PERIOSTEAL
• COMPLEX PERIOSTEAL

17. SOLID PERIOSTEAL
• SHELL FORMATION OCCURS WHEN SLOW EXPANDING LESIONS REMOVE
ENDOSTEAL BONE THAT IS REPLACED BY SUBPERIOSTEAL BONEDEPOSITION
,THICKENING THE ORIGINAL BONE CONTOUR

18. SMOOTH SHELL
• SMOOTH OUTER CONTOUR AND
RESULT FROM LESION APPLYING
UNIFORM PRESSURE ON THE
CORTEX
• OFTEN ECCENTRIC
• OSTEOID OSTEOMA

19. RIDGED SHELL
• TRABECULATED, SEPTATED OR SOAP
BUBBLE REACTION THAT DEVELOPS
FROM UNEVEN GROWTH OF
AGGRESSIVE PROCESS
• NONOSSIFYING FIBROMA
• ABC
• GCT
• ENCHONDROMA

20. • LOBULATED SHELLS
• FASTER GROWING ARE
RADIOPENIC AND
REPRESENT CORTICAL
BULGES WHILE SLOWER
GROWING REGIONS
DESTROY LESS BONE
VISIBLE AS CRESCENTS AND
ARCS

21. CONTINUOUS PERIOSTEAL
• CORTEX IS RADIOLOGICALLY INTACT ALTHOUGH VARYING DEGREE OF
SUBPERIOSTEAL TUMOR PENETRATION OCCURS IN THE LAMINATED AND
PARALLEL SPECULATED FORMS

22. SOLID PERIOSTEAL REACTION
• MULTIPLE LAYERS OF NEW BONE ARE
DEPOSITED DUE TO CHRONIC PERIOSTEAL
STIMULATION BY RELATIVELY INNOCUOUS
LESION
• APPEAR AS SINGLE SOLID MASS DUE TO
MICROSCOPIC SEPARATION
• INTRACORTICAL OSTEOID OSTEOMA
• LOW GRADE INFECTION

23. SINGLE LAMELLAR REACTION
• SINGLE UNIFORM RADIODENSE LINE SEPARATED FROM UNDERLYING CORTEX
AND MAY OR MAY NOT JOIN THE CORTEX AT EXTREMES
• OSTEOMYELITIS

24. LAMELLATED REACTION
• CONTINUOUS REACTION CONSISTS OF
MULTIPLE CONCENTRIC PLANES OF
OSSIFICATION WITH RADIOLOGICALLY
APPRECIABLE SPACE IN BETWEEN FORMING
THE TYPICAL ONION SKIN
• ACUTE OSTEOMYELITIS
• EWINGS SARCOMA
• OSTEOSARCOMA

25. PARALLEL SPECULATED REACTION
• SEEN WITH MALIGNANT PROCESS RESULTING
FROM NEW BONE FORMATION ALONG THE
RADIALLY ORIENTED PERIOSTEAL VESSELS
THAT EXTEND FROM PERIOSTEUM TO THE
CORTEX

26. INTERRUPTED PERIOSTEAL
REACTION
CODMAN ANGLE
• IT IS SEEN IN AGGRESSIVE BONE DESTROYING LESION
• IT RESULTS FROM ANY PROCESS THAT AGGRESSIVELY LIFTS THE PERIOSTEUM
CAUSING SUBPERIOSTEAL BLEEDING
• REACTIVE BONE FORMS BENEATH THE PERIOSTEUM AT MARGIN WHILE THE
LESION DESTROYS AND PENETRATES THE ADJACENT CORTICAL BONE
LEAVING RADIOPOENIC AREA

27. • ACUTE OSTEOMYELITIS
• CHONDROSARCOMAS
• OSTEOSARCOMAS
• OSTEOMAS

28. COMPLEX PERIOSTEAL
SUN BURST PATTERN
• RESULTS FROM COMBINED SIMULTANEOUS
REACTIVE BONE FORMATION AND MALIGNANT
OSTEOID PRODUCTION FORMING RAYS OF SUN
THAT SEEN TO EMANATE FROM CENTRAL TUMOR
MASS
• OSTEOSARCOMA
• HEMANGIOMA
• EWINGS SARCOMA

29. THANK YOU