Bone tumors
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This document discusses various clues that can help determine the nature of bone tumors based on imaging findings. It describes clues from the appearance of lesions such as patterns of bone destruction (geographic, moth-eaten, permeative) and periosteal reactions. It also discusses clues from the location of lesions, density of lesions, and presence of soft tissue extension. Determining these characteristics can provide insight into whether a bone lesion is likely benign or malignant.
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Bone tumors
- 2. • Clues by Appearance of Lesion • Clues by Location of Lesion • Clues by Density of Lesion • Other Clues
- 3. Clues by Appearance of Lesion • Patterns of Bone Destruction • Periosteal Reactions • Tumor Matrix • Expansile Lesions of Bone
- 4. Clues by Appearance of Lesion • Patterns of Bone Destruction – Geographic – Moth-eaten – Permeative
- 5. Geographic Bone Destruction • Destructive lesion with sharply defined border • Implies a less-aggressive, more slow- growing, benign process • Narrow transition zone
- 6. Patterns of Bone Destruction – Geographic – Moth-eaten – Permeative Non-ossifying fibroma
- 7. Geographic Bone Destruction Examples: • Non-ossifying fibroma • Chondromyxoid fibroma • Eosinophilic granuloma
- 8. Moth-eaten Bone Destruction • Areas of destruction with ragged borders • Implies more rapid growth • Probably a malignancy
- 9. Patterns of Bone Destruction – Geographic – Moth-eaten – Permeative Multiple Myeloma
- 10. Examples: • Myeloma • Metastases • Lymphoma • Ewing’s sarcoma Moth-eaten Bone Destruction
- 11. Permeative Bone Destruction • Ill-defined lesion with multiple “worm-holes” • Spreads through marrow space • Wide transition zone • Implies an aggressive malignancy • Round-cell lesions
- 12. Patterns of Bone Destruction – Geographic – Moth-eaten – Permeative Leukemia
- 13. Examples: • Lymphoma, leukemia • Ewing’s Sarcoma • Myeloma • Osteomyelitis • Neuroblastoma Permeative Bone Destruction
- 14. Patterns of Bone Destruction Geographic Moth-eaten Permeative Less malignant More malignant
- 15. Periosteal Reactions • Benign – None – Solid • More aggressive or malignant – Lamellated or onion peel – Sunburst – Codman’s triangle
- 16. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Non-ossifying fibroma
- 17. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Chronic osteomyelitis
- 18. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Ewing sarcoma
- 19. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Osteo-sarcoma
- 20. Periosteal Reactions • Benign – None – Solid • Aggressive/malignant – onion-peel – Sunburst – Codman’s triangle Osteo-sarcoma
- 21. Periosteal Reactions Solid onion-peelSunburst Codman’s triangle Less malignant More malignant
- 22. Tumor Matrix • Osteoblastic – Fluffy, cotton-like or cloud-like densities – Osteosarcoma • Cartilaginous – Comma-shaped, punctate, annular, popcorn-like – Enchondroma, chondrosarcoma, chondromyxoid fibroma
- 23. Tumor Matrix • Osteoblastic • Cartilaginous
- 24. • Osteoblastic – Fluffy, cotton-like or cloud-like densities as Osteosarcoma • Cartilaginous – Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma Tumor Matrix
- 25. • Osteoblastic • Cartilaginous Tumor Matrix Chondrosarcoma
- 26. • Multiple myeloma • Mets • Brown tumor • Enchondroma • Aneurysmal bone cyst • Fibrous dysplasia Expansile Lesions of Bone
- 27. Expansile Lesions of Bone Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
- 28. Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Renal cell carcinoma
- 29. Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone
- 30. Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone
- 31. Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone
- 32. Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone
- 33. Clues by Location of Lesion • In the Transverse Plane • In the Longitudinal Plane • Characteristic Locations by tumors • Characteristic Tumors by Body Site – Pelvic Lesions – Expansile Rib Lesions – Lesions of the Spine
- 34. In the Transverse Plane . . .
- 35. • Epiphyseal GCT, chondroblastoma • Metaphyseal Osteomyelitis, osteo-and chondrosarcoma • Diaphyseal Round cell lesions, ABC, enchondroma In the longitudinal Plane
- 36. Characteristic Locations • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior
- 37. Characteristic Locations • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior
- 38. • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior Characteristic Locations
- 39. • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior Characteristic Locations
- 40. • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior Characteristic Locations
- 41. • Simple bone cyst Proximal humerus • Chondroblastoma Epiphyses • Giant Cell tumor Epiphyses • Adamantinoma Tibia • Chordoma Sacrum, clivus • Osteoblastoma Spine, posterior Characteristic Locations
- 42. Clues by Density of Lesion • Sclerotic Cortical Lesions • Lytic Lesions in Children • Lytic Lesions in Adults • Blastic Lesions in Children • Blastic Lesions in Adults
- 43. Sclerotic Cortical Lesions • Osteoid osteoma • Brodie’s abscess
- 44. • Osteoid osteoma • Brodie’s abscess Sclerotic Cortical Lesions
- 45. Lytic Lesions in Children • Eosinophilic granuloma • Leukemia
- 46. Lytic Lesions in Children • Eosinophilic granuloma • Leukemia
- 47. Lytic Lesions in Adults • Metastatic lesions – Lung – Renal – Thyroid • Multiple myeloma • Primary bone tumor Metastatic thyroid carcinoma
- 48. • Metastatic lesions – Lung – Renal – Thyroid • Multiple myeloma • Primary bone tumor Lytic Lesions in Adults
- 49. • Metastatic lesions – Lung – Renal – Thyroid • Multiple myeloma • Primary bone tumor Chondrosarcoma Lytic Lesions in Adults
- 50. • Lymphoma Blastic Lesions in Children
- 51. • Metastatic disease • Breast – female • Prostate – male • Lymphoma • Paget’s disease • Fluorosis Prostatic Ca. Blastic Lesions in Adults
- 52. • Metastatic disease • Breast –female • Prostate –male • Lymphoma • Paget’s disease • Fluorosis Blastic Lesions in Adults
- 53. • Metastatic disease • Breast –female • Prostate –male • Lymphoma • Paget’s disease • Fluorosis Blastic Lesions in Adults
- 54. • Metastatic disease • Breast –female • Prostate –male • Lymphoma • Paget’s disease • Fluorosis Blastic Lesions in Adults
- 55. Other Clues • Soft Tissue Extension • Benign vs. Malignant
- 56. Soft Tissue Extension • Usually implies malignancy • More likely to form discrete soft tissue mass • Benign conditions with soft tissue extension • Osteomyelitis – Usually infiltration of fat
- 59. Thank You