Bone tumor radiological approach

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Bone tumor radiological approach

  1. 1. RADIOLOGIAL APPROACH TO BONE TUMORS DR. C. K.VASU, M.D
  2. 2. THERAPEUTIC GOALS DO NOT OVERTREAT A BENIGN TUMOR DO NOT UNDERTREAT A MALIGNANT TUMOR DO NOT MISDIRECT BIOPSY
  3. 3. RADIOLOGIST CAN SEE THE THREE DIMENSIONAL GROSS PATHOLOGY IF RADIOLOGIC FINDINGS ARE NOT CORRELATING WITH THE PATHOLOGY FINDINGS:SPECIAL STAINS, ADDITIONAL IMAGES WILL HELP TUMOR MAY HAVE VARYING HISTOLOGY AND REPRESENTATIVE SAMPLE FROM EPICENTRE OF THE LESION HAS TO BE TAKEN
  4. 4. ROLE OF PLAIN RADIOGRAPH INITIAL EXAMINATION –STARTS THE DIAGNOSTIC ALGORITHM SCREENING, DETECTION,DIAGNOSIS, FOLLOWUP IN THIS COST-CONSCIOUS ERA
  5. 5. SYSTEMATIC APPROACH AGE SITE ZONE OF TRANSITION MATRIX CORTEX PERIOSTEAL REACTION SOFT TISSUE COMPONENT SINGLE - MULTIPLE
  6. 6. AGE AT PRESENTATION DIFFERENTIAL DIAGNOSIS CAN BE NARROWED 1 ST DECADE : NEUROBLASTOMA,LEUKEMIA 2 ND DECADE : OSTEOSARCOMA, EWINGS SARCOMA 3RD DECADE: GIANT CELL TUMOR ELDERLY : METASTASIS, CHONDROSARCOMA CLUE TO AGE : FROM EPIPHYSEAL FUSION
  7. 7. OSTEOSARCOMA@
  8. 8. CHONDRO BLASTOMA
  9. 9. GCT @
  10. 10. LOCATION EPIPHYSEAL : CHONDROBLASTOMA, GIANT CELL TUMOUR METAPHYSEAL : OSTEOSARCOMA, ANEURYSMAL BONE CYST DIAPHYSEAL : EWINGS SARCOMA
  11. 11. CHONDRO BLASTOMA@
  12. 12. GCT / ABC
  13. 13. E W I N G S S A R C
  14. 14. EWINGS SARCOMA
  15. 15. ZONE OF TRANSITION IT IS AN ASSESSMENT OF THE BIOLOGICAL ACTIVITY GEOGRAPHIC OR TYPE 1 (LODWIG) 1A----WITH SCLEROSIS: BONE DEPOSITION TO REDIRECT TRANSMITTED FORCES IN TYPE 1A LESIONS IDEAL POSTOP RADIOGRAPH SHOULD SHOW COMPLETE REMOVAL OF NOT ONLY SCLEROTIC RIM BUT ALSO SEVERAL MMS ―NORMAL BONE‖
  16. 16. IF SCLEROTIC RIM REMAINS HIGHER RECURRENCE CHANCE EX: CHONDROBLASTOMA, BONE CYST TYPE 1B: BIOLOGIC ACTIVITY IS SLIGHTLY MORE: NO SCLEROTIC RIM EX: GIANT CELL TUMOR
  17. 17. TYPE 1CLESION LYTIC LESION WITH ILL DEFINED MARGIN: THEY ARE MALIGNANT UNLESS PROVED OTHERWISE: EX: CHONDROSARCOMA, FIBROSARCOMA
  18. 18. MULTIPLE CLUSTERED SMALL HOLES(<5MM) (TYPE 3) PERMEATIVE PATTERN LUCENT LINEAR STREAKS DD IS SIMILAR: OSTEOSARCOMA, EWINGS SARCOMA (TYPE 2) MOTH EATEN
  19. 19. LYTI C LESI ON WIT H SCLE ROTI C
  20. 20. GCT
  21. 21. CHONDRO SARCOMA RADIUS
  22. 22. OSTEO GENIC SARCO MA
  23. 23. PERME ATIVE PATTE RN
  24. 24. CORTICAL BREAK MALIGNANT LESIONS :OSTEOSARCOMA,EWINGS SARCOMA BENIGN LESIONS: NO CORTICAL BREAK USUALLY: EX: GCT,ABC
  25. 25. GIANT CELL TUMOUR PATELLA
  26. 26. DESMOPLAS- TIC FIBROMA
  27. 27. OSTEOCHON DROMA@
  28. 28. OSTEO CHONDROMA
  29. 29. PERIOSTEAL REACTION OUTER FIBROUS LAYER AND INNER CELLULAR LAYER. 10-21DAYS : SEEN EARLIER IN YOUNGER PATIENTS INDICATION OF BIOLOGICAL ACTIVITY
  30. 30. TYPES OF PERIOSTEAL REACTION CONTINUOUS: LAMELLATED (ONION –PEEL) DISCONTINUOUS : CODMAN ANGLES COMPLEX: LAMELLATED + CODMAN MORE EXTENSIVE AND COMPLEX THE PERIOSTEAL REACTION GREATER BIOLOGICAL ACTIVITY
  31. 31. EWINGS SARCO MA@
  32. 32. LAM ELLA R APPE AREN CE
  33. 33. SU N R A Y
  34. 34. OST EOS ARC OMA
  35. 35. PAROSTEAL OSTEOSAR COMA
  36. 36. EWINS SARCOMA
  37. 37. MATRIX OSSEUS MATRIX: OSTEOMA,OSTEOID OSTEOMA---CLOUD LIKE RELATIVELY HOMOGENOUS AREA OF BLASTIC CHANGE CARTILAGE MATRIX: STIPLLED, CURVILINEAR CALCIFICATION(RINGS AND ARCS)--- ENCHONDROMA,CHONDROSARCOMA NON-MINERALIZED MATRIX: GIANT CELL TUMOR, OSTEOLYTIC OSTEOSARCOMA
  38. 38. OSTEOID OSTEOMA D/D:GARRE’S OSTEOMYELITIS
  39. 39. OST EOS ARC OM
  40. 40. CHONDRO SARCOMA @
  41. 41. MED ULLA RY NECR
  42. 42. NO MATRIX- - FIBROSA RCOMA
  43. 43. SOFT TISSUE COMPONENT DETECTED ON PLAIN XRAY- DISPLACED FAT PLANE ROLE OF CT AND MRI
  44. 44. FIBROSAR COMA@
  45. 45. E WI N GS SA RC
  46. 46. LESION MULTIPLICITY KEY DIAGNOSTIC SIGN PRIMARY BONE TUMORS USUALLY SINGLE PRIMARY : SECONDARY --1: 500
  47. 47. MULTIPLE EXOSTOSIS
  48. 48. OLLIERS DISEASE
  49. 49. ME TAS TAS IS- from bron chus
  50. 50. QUIZ
  51. 51. OSTE O CHO NDR OMA
  52. 52. OSTEOCHONDROMA METAPHYSEAL GROWS AWAY FROM THE JOINT ANY AGE NO CORTICAL BREAK NORMAL CORTEX WITH WHICH IT IS CONTINUOUS
  53. 53. CHOND RO BLAST
  54. 54. CHONDROBLASTOMA CARTILAGINOUS MATRIX BEFORE EPIPHYSEAL FUSION NARROW ZONE OF TRANSITION EPIPHYSEAL
  55. 55. GCT
  56. 56. GIANT CELL TUMOUR EPIPHYSEAL 20-45 YEARS MATRIX NOT MINERALIZED NARROW ZONE OF TRANSITION
  57. 57. OSTE OSAR COMA
  58. 58. OSTEOSARCOMA 15-25 YEARS 2 ND PEAK AT 40+ METAPHYSEAL OSTEOID MATRIX CODMAN,SUNBURST ZONE OF TRANSITION
  59. 59. CHONDRO SARCOMA
  60. 60. CHONDROSARCOMA 40 + AGE GROUP MATRIX CALCIFIED DISPROPORTIONATE SOFT TISSUE ENDOSTEAL SCALLOPING
  61. 61. EWINGS SARCOMA AGE GROUP—5-30 YEARS ONION PEEL PERIOSTEAL REACTION DD OSTEOMYELITIS WIDE ZONE OF TRANSITION DIAPHYSEAL
  62. 62. NO MATRIX- - FIBROSA RCOMA
  63. 63. FIBROSARCOMA NO MINERALIZED MATRIX LARGE SOFT TISSUE DIAPHYSEAL CORTICAL BREAK
  64. 64. OS TE OI D OS TE
  65. 65. OSTEOID OSTEOMA SCLEROTIC NIDUS WELL DEFINED NO CORTICAL BREAK
  66. 66. HEMANGIOMA SPINE
  67. 67. EWING’S SARCOMA
  68. 68. HEMANGIOMA
  69. 69. IVORY VERTEBRA
  70. 70. OSTEOCHONDROMA
  71. 71. OSTEOCHONDROMA

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