2. • THE MOST IMPORTANT DETERMINATORS IN THE ANALYSIS OF A POTENTIAL BONE TUMOR ARE:
1. THE MORPHOLOGY OF THE BONE LESION ON A PLAIN RADIOGRAPH
1. WELL-DEFINED OSTEOLYTIC
2. ILL-DEFINED OSTEOLYTIC
3. SCLEROTIC
2. THE AGE OF THE PATIENT
5. AGE
• OVER 30-40 YEARS WE MUST ALWAYS INCLUDE METASTASES AND MYELOMA IN THE DD.
• INFECTIONS, A COMMON TUMOR MIMICKER, ARE SEEN IN ANY AGE GROUP CAN BE WELL-DEFINED OR ILL-DEFINED OSTEOLYTIC,
AND EVEN SCLEROTIC.
• EOSINOPHILIC GRANULOMA AND INFECTIONS SHOULD BE MENTIONED IN THE DIFFERENTIAL DIAGNOSIS OF ALMOST ANY BONE
LESION IN PATIENTS < 20 YEARS.
6. LESS THAN 30 YEARS
-OSTEOSARCOMA
-EWINGS
MORE THAN 30 YEARS
-METS
-MYELOMA
-CHONDROSARCOMA
17. • OSTEOID MATRIX-
MINERALIZATION IN OSTEOID TUMORS-
TRABECULAR OSSIFICATION PATTERN IN BENIGN BONE-FORMING LESIONS
OR
AS A CLOUD-LIKE OR ILL-DEFINED AMORPHOUS PATTERN IN
18.
19.
20. Bone forming tumors
(malignant)
Osteosarcoma
• Central (medullary)
• Peripheral (surface)
-Paraosteal
-Periosteal
-High grade surface
Cartilage-forming tumors
(malignant)
Chondrosarcoma
-Differentiated chondrosarcoma
-Juxta-cortical chondrosarcoma
-Mesenchymal chondrosarcoma
-Clear cell chondrosarcoma
Marrow tumors (malignant)
-Ewing's sarcoma
-Neuroectodermal tumour
-Malignant lymphoma of bone
(Primary/secondary)
-Myeloma
Other tumors (malignant)
-Chordoma
-Adamantinoma
28. ON MRI:
T1W- HYPERINTENSE DUE TO
HEMORRHAGICCOMPONENTS
T2W- HETEROGENOUS
FLUID FLUID LEVELS ARE
OCCASIONALLY PRESENT
MIMICS ABC
29.
30.
31. • Large lobulated exophytic, cauliflower-like
mass with central dense ossification
adjacent to the bone.
• string sign: thin radiolucent line separating
the tumor from the cortex, seen in 30% of
cases.
• Cortical thickening without aggressive
periosteal reaction is often seen.
•Tumor extension into the medullary cavity is
frequently seen.
32.
33. PRIMARY SECONDARY
CENTRAL PERIPHERAL
• arising from a pre-existing bony lesion,
usually an enchondroma (central type)
or osteochondroma (peripheral type)
• Arises within
the medullary
bone
• Arises from
surface of
the bone
36. Low grade chondrosarcoma enchondroma
size larger size (5-6cm) favours Smaller size
cortical breach More common Less common
Deep endosteal
scalloping
Inv. more than 2/3 rd of cortical
thickness
Less than 2/3 rd
Soft tissue
extension
common Not seen
Age Middle aged Young age
47. • TYPICAL PRESENTATION: EXPANSILE, DESTRUCTIVE BONE LESION THAT MAY BE ASSOCIATED WITH A SOFT-TISSUE
MASS.
• ON MRI T2-WEIGHTED IMAGES WILL SHOW VERY HIGH SI, MORE OR LESS LOBULATED LIKE A CHONDROSARCOMA.
• ON CT THERE MAY BE CALCIFICATIONS ALSO RESEMBLING CHONDROSARCOMA.
• PREFERENTIAL SITE OF ORIGIN:
• SACRO-COCYGEAL
• SKULL BASE / CLIVUS
50. • RARE LOW-GRADE MALIGNANT LESION, EXCLUSIVELY FOUND IN THE DIAPHYSIS OF THE ANTERIOR
CORTEX OF THE TIBIA.
• ADAMANTINOMA MAY PRESENT AS A SOLITARY FOCUS OR MULTICENTRIC LUCENCIES
• MAY EXTEND INTO THE MARROW CAVITY.
• PLAIN RADIOGRAPHS AND CT SHOW CORTICAL LUCENCIES COMBINED WITH SCLEROSIS.
51. • ON MRI, THE LESION IS LOBULATED WITH HIGH SIGNAL INTENSITY ON T2-WEIGHTED
IMAGES AND STRONG ENHANCEMENT AFTER GD-DTPA.
• MAIN DIFFERENTIAL DIAGNOSIS: FIBROUS DYSPLASIA.
52.
53. Osteoblastic metastases
• Prostate carcinoma (MC)
• Breast carcinoma (may
be mixed)
• Carcinoid
• Medulloblastoma
• Neuroblastoma
Osteolytic metastases
• RCC
• Thyroid carcinoma
• Pheochromocytoma
• Wilms tumor
• Ewings sarcoma
• Carcinomas of GIT
Mixed
• Breast ca
• Lung ca(COOKIE BITE)
• Prostate ca
• Testicular ca
Editor's Notes
EG AND INFECTION-EXCEPTION-BENIGN CONDITIONS WHICH MIMIC BROAD ZONE.
Chondromyxoid fibroma-A well-defined, expansile lesion with regular destruction of cortical bone and a peripheral layer of new bone.
Giant cell tumor-A locally aggressive lesion with cortical destruction, expansion and a thin, interrupted peripheral layer of new bone. Notice the wide zone of transition towards the marrow cavity, which is a sign of aggressive behavior (red arrow).
Cloud-like bone formation in osteosarcoma.Notice the aggressive, interrupted periosteal reaction (arrows) Trabecular ossification pattern in osteoid osteoma.Notice osteolytic nidus (arrow).
Ill heterogeneous mass in meta and dia of distal femur. periosteum is elevated (Codman's triangle).
Ill defined heterogenous lesion in dia and metaphysis of proximal humerus with fluffy or cloud like matrix calcification.
CORONAL T2-Eccentrically located heterogenous intensity lesion involving meta and diaphsysis of distal femur extension beyond the cortex ,oedema involving the adjacent soft tissues.
CORONAL T1C+-heterogenous enhancement.
A purely destructive lesion is present in the diaphysis of long bone. Note the lamellated type of periosteal reaction (arrows). The sclerotic changes usually seen in osteosarcomas are absent, and there is no radiographic evidence of tumor bone.
k/c/o telangiectatic osteosarcoma with fluid fluid levels on axial t2 image.
CURVILINEAR RADIOLUCENT LINE
Homogeneous ossified mass adjacent to the cortical bone of the distal femur. Typical location and appearance of parosteal osteosarcoma. Sagittal T1-weighted-shows partial very low signal intensity due to the ossified matrix.
the lesions are both histologically and radiographically very similar.
ILL defined subtle radiodense lesion in diaphysis of tibia with endosteal scalloping at the medial side which is a hallmark of chondrosarcoma. MR better defines the extension of the lesion.MRI also demonstrates the endosteal scalloping
Well defined lobulated mass involving the scapula.hyperintense on T2 images and iso-to hypointense compared to muscle on T1, showing peripheral enhancement post-contrast.
Serum ldh and esr elevated.
Ill-defined lucency in the distal femur is noted, with a wide zone of transition and onion-skin periosteal reaction.
Coronal ct pelvis-Osteolytic lesion involving the right iliac bone with cortical destruction,periosteal reaction. Associated large soft tissue mass related to the right iliacus muscle.
Axial t1c+-heterogeneous post contrast enhancement, related soft tissue component is seen permeating and eroding the iliac bone together with infiltration of the iliacus muscle.
Isolated myeloma lesion without systemic marrow involvement is called a plasmacytoma.
Full skeletal sruvery-to detect risk of fracture and assessing treatment response.
Widespread lytic lesions are present with loss of height.
Multiple well-defined and expansile lucent lesions acromion of the scapula. Less expansile lesions also noted in the clavicle, as well as the proximal humeral shaft.
lytic lesions of the C2 and C3 vertebrae with cortical destruction posteriorly.sagittal T2+fse-slightly hyperintense soft tissue extension and compression of the myelum.
T1-well defined iso to hypointense lesion arising from posterior surface of clivus indenting the pons.
Saggital t2 stir-well defined lobulated hyperintense lesion involving distal end of sacrum and extending into presacral and adjacent soft tissue area.
lobulated lytic lesion within the anterior cortical bone of the proximal tibia.There is a second lucency separately more proximal within the cortical bone. Axail CT-lytic appearance of the lesion within the thickened cortical bone.
K/C/O BREAST CA-Multiple sclerotic bony lesions D8 & D12 vertebral bodies.Destructive osteolytic bony lesion at the manubrium with small extraosseous intrathoracic soft tissue component
Extensive sclerotic LESIONS throughout the pelvis and femora. No fracture or dislocation identified. (PROSTATE CA)
