1) The radiographic appearance of margins is the most important indicator of whether a primary bone tumor is aggressive or non-aggressive. Margins are classified into three types - round/oval type I margins typically correspond to less aggressive lesions, while moth-eaten type II and permeative type III margins indicate more aggressive lesions.
2) Other radiographic features like cortical expansion, periosteal reaction, and matrix mineralization provide supplementary information but are less specific indicators of aggressiveness compared to margins. Cortical expansion is more common in slow-growing benign lesions while permeative margins typically indicate malignancy.
3) Together, analysis of margins, cortical changes, periosteal reactions and matrix mineralization on
Dr.salah.radiology.radiological approach to bone diseasesabas_lb
This document provides guidance on evaluating solitary bone lesions based on radiographic findings. Key factors include the patient's age, location and characteristics of the lesion, presence of cortical destruction or a periosteal reaction, and whether the lesion is mono- or polyostotic. Together these factors can help determine if a lesion is likely benign and slow-growing or potentially malignant and aggressive.
The document provides an overview of musculoskeletal tumors, including:
- Benign bone tumors are most common, while primary malignant bone tumors are rare but account for 5% of childhood cancers.
- Presentation includes pain, swelling, and pathological fractures. Examination looks for swelling, adenopathy, and metastasis.
- Plain X-rays are used to characterize tumors based on location, margins, destruction pattern, and other features. Biopsy is needed for diagnosis.
- Treatment involves surgery such as limb salvage or amputation, with reconstruction options. Chemotherapy and radiotherapy are used as adjuvants for malignant tumors.
Fibro osseous lesions of jaws/oral surgery courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASESShivangani Arya
The document discusses the use of radiographic aids in diagnosing periodontal diseases. It provides a history of x-rays and dental radiography, describing their discovery and early uses. It then discusses various intraoral and extraoral radiographic techniques used in periodontal examinations, including periapical, bitewing, occlusal and panoramic images. It outlines how these techniques help assess bone loss, detect calculus, and evaluate treatment outcomes. The document also describes how periodontal bone destruction appears radiographically, such as lamina dura disruption, widening of periodontal ligament space, and the formation of interdental craters.
A Large Intra-Articular Ossicle in the Knee Joint-A Rare Occurrence_Crimson P...CrimsonPublishersAICS
This document presents a case report of a rare occurrence of a large intra-articular ossicle in the knee joint of a 14-year-old male. Magnetic resonance imaging found a large ossicle impinging on the anterior cruciate ligament, causing lifting of the ligament anteriorly and laterally. Intra-articular ossicles in the knee are uncommon but can grow to a significant size, as seen in this case, producing mass effect and clinically mimicking an ACL injury. The etiology of intra-articular ossicles is unclear but may be congenital, traumatic, or degenerative in origin.
Radiographic aids in the diagnosis of periodontal diseaseDara Ghaznavi
This document discusses how radiographs can aid in the diagnosis of periodontal disease. Radiographs reveal changes to calcified tissues but not current cellular activity. Normal interdental septa appear as thin radiopaque lines along the alveolar crest. Early periodontal disease leads to disruption of the lamina dura and crestal cortication. As the disease progresses, bone loss appears as wedge-shaped radiolucencies and reduced height of the interdental bone. Furcation involvement and periodontal abscesses can also be detected radiographically, though clinical examination is still needed.
Bitewing radiographs are best for diagnosing dental issues. While some argue parallel periapical films provide the best view, higher kilovoltage is recommended for long-scale, low-contrast images. It is important to compare images from different visits using the same technique. Periodontal disease appears on radiographs as two-dimensional overlapping bony walls and superimposed roots, while the clinical picture shows a more advanced relationship between hard and soft tissues. Radiographs have limitations as a minimum of 55-60% demineralization must occur before changes appear, and they do not demonstrate incipient disease.
Dr.salah.radiology.radiological approach to bone diseasesabas_lb
This document provides guidance on evaluating solitary bone lesions based on radiographic findings. Key factors include the patient's age, location and characteristics of the lesion, presence of cortical destruction or a periosteal reaction, and whether the lesion is mono- or polyostotic. Together these factors can help determine if a lesion is likely benign and slow-growing or potentially malignant and aggressive.
The document provides an overview of musculoskeletal tumors, including:
- Benign bone tumors are most common, while primary malignant bone tumors are rare but account for 5% of childhood cancers.
- Presentation includes pain, swelling, and pathological fractures. Examination looks for swelling, adenopathy, and metastasis.
- Plain X-rays are used to characterize tumors based on location, margins, destruction pattern, and other features. Biopsy is needed for diagnosis.
- Treatment involves surgery such as limb salvage or amputation, with reconstruction options. Chemotherapy and radiotherapy are used as adjuvants for malignant tumors.
Fibro osseous lesions of jaws/oral surgery courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
RADIOGRAPHIC AIDS IN THE DIAGNOSIS OF PERIODONTAL DISEASESShivangani Arya
The document discusses the use of radiographic aids in diagnosing periodontal diseases. It provides a history of x-rays and dental radiography, describing their discovery and early uses. It then discusses various intraoral and extraoral radiographic techniques used in periodontal examinations, including periapical, bitewing, occlusal and panoramic images. It outlines how these techniques help assess bone loss, detect calculus, and evaluate treatment outcomes. The document also describes how periodontal bone destruction appears radiographically, such as lamina dura disruption, widening of periodontal ligament space, and the formation of interdental craters.
A Large Intra-Articular Ossicle in the Knee Joint-A Rare Occurrence_Crimson P...CrimsonPublishersAICS
This document presents a case report of a rare occurrence of a large intra-articular ossicle in the knee joint of a 14-year-old male. Magnetic resonance imaging found a large ossicle impinging on the anterior cruciate ligament, causing lifting of the ligament anteriorly and laterally. Intra-articular ossicles in the knee are uncommon but can grow to a significant size, as seen in this case, producing mass effect and clinically mimicking an ACL injury. The etiology of intra-articular ossicles is unclear but may be congenital, traumatic, or degenerative in origin.
Radiographic aids in the diagnosis of periodontal diseaseDara Ghaznavi
This document discusses how radiographs can aid in the diagnosis of periodontal disease. Radiographs reveal changes to calcified tissues but not current cellular activity. Normal interdental septa appear as thin radiopaque lines along the alveolar crest. Early periodontal disease leads to disruption of the lamina dura and crestal cortication. As the disease progresses, bone loss appears as wedge-shaped radiolucencies and reduced height of the interdental bone. Furcation involvement and periodontal abscesses can also be detected radiographically, though clinical examination is still needed.
Bitewing radiographs are best for diagnosing dental issues. While some argue parallel periapical films provide the best view, higher kilovoltage is recommended for long-scale, low-contrast images. It is important to compare images from different visits using the same technique. Periodontal disease appears on radiographs as two-dimensional overlapping bony walls and superimposed roots, while the clinical picture shows a more advanced relationship between hard and soft tissues. Radiographs have limitations as a minimum of 55-60% demineralization must occur before changes appear, and they do not demonstrate incipient disease.
The document discusses various radiographic clues that can help determine the nature of bone lesions. It describes clues provided by the appearance of lesions, including patterns of bone destruction (geographic, moth-eaten, permeative) and periosteal reactions. Certain appearances provide clues about benign versus malignant lesions. Location of lesions and lesion density also provide clues. Characteristic locations are described for several lesions. Sclerotic, lytic and blastic lesions have different potential underlying causes in children versus adults. Soft tissue extension is also a potential clue.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
A rare case of patellar osteoblastoma with anteriorrohit raj
This case report describes a rare case of osteoblastoma in the patella of a 21-year-old male who presented with 6 months of anterior knee pain. Imaging showed a well-defined lytic lesion in the patella. The patient underwent curettage of the lesion and bone grafting. Histopathological examination confirmed the diagnosis of osteoblastoma. At follow-up the patient's symptoms had resolved and the bone graft had consolidated properly with no recurrence of the tumor. Osteoblastoma is a rare benign bone tumor that can present as knee pain. Though rare, it should be considered in the differential diagnosis of patellar lesions.
Ossifying fibroma vs fibrous dysplasia of the jaw/rotary endodontic courses b...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This study analyzed 43 patients with facial asymmetry using 3D CT scans to classify the asymmetry into objective groups. Measurements of the maxilla and mandible were analyzed using statistical tests and cluster analysis. Four groups were identified: Group 1 with a shifted mandibular body (44%); Group 2 with a significant difference in ramus height and menton deviation to the short side (39%); Group 3 with atypical asymmetry including menton deviation and prominence on one side (12%); and Group 4 with severe maxillary canting and ramus/menton differences (5%). The study aims to improve diagnosis and treatment of facial asymmetry through an objective classification system.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Radiographs play an important role in the diagnosis and treatment of periodontal diseases. They provide important information regarding the anatomical structures and periodontal bone loss.
This document presents a case report of a central odontogenic fibroma. It describes a patient who presented with asymptomatic expansion of the buccal and lingual cortical plates. Radiographs and biopsy revealed a well-defined mixed radiodensity lesion containing epithelial islands and calcified material resembling dentin or cementum, consistent with central odontogenic fibroma. The lesion was surgically removed. Histological examination confirmed the diagnosis of central odontogenic fibroma, a rare benign odontogenic tumor originating from dental ectomesenchyme.
This document discusses the use of radiographs in assessing periodontal disease and bone destruction. It provides information on normal interdental bone appearance and outlines criteria for evaluating bone loss patterns seen in periodontal disease. Key findings include lamina dura disruption being an early sign of periodontitis and interdental cratering appearing as irregular reduced bone density. Furcation involvement is suggested by diminished bone trabeculae radiodensity or marked bone loss on a single root. Additional imaging techniques like CBCT can provide further detail on lesion morphology.
The document discusses various temporomandibular joint (TMJ) findings that can be seen on cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI). It begins by describing the normal TMJ anatomy and capsule structures visible on imaging. It then discusses various abnormal and pathological TMJ findings that can be developmental, soft tissue related, or due to remodeling/arthritis. Developmental conditions covered include hemifacial microsomia, condylar aplasia, hypoplasia, and hyperplasia. Soft tissue abnormalities include internal derangements and disc displacements. Remodeling and arthritic changes described are flattening, erosion, osteophytes, sclerosis, and subchond
Approach to a case of musculoskeletal tumourorthoprince
This document provides an approach to evaluating bone tumors based on age, duration of symptoms, site of lesion, margins, type of destruction, periosteal reaction, matrix of the lesion, and blood investigations. Key factors include age of the patient, as certain tumors are more common in different decades; duration of symptoms, with longer duration suggesting benign and shorter suggesting malignant; site of the lesion in the bone and body; characteristics of the margins, destruction and periosteal reaction on imaging; and relevant blood tests depending on suspected tumor type. The approach aims to systematically analyze these various criteria to determine a differential diagnosis and guide further evaluation and staging of potential bone tumors.
Dr. Abdelhady provides a lecture on odontogenic tumors. The lecture aims to help students classify and diagnose odontogenic tumors, examine patients presenting with facial swellings, and determine differential diagnoses and management techniques for mandibular and maxillary swellings. Specific odontogenic tumors discussed include cementoblastoma, odontogenic fibroma, central giant cell granuloma, cherubism, fibrous dysplasia, and ossifying fibroma. Radiographic features, histology, treatment options and prognosis are described for each tumor type.
Bone cancer is a rare type of cancer that begins in the bones, most commonly affecting the long bones of the arms and legs. Some common types of bone cancer include osteosarcoma, Ewing sarcoma, and malignant fibrous histiocytoma. Symptoms include bone pain, tenderness, broken bones, fatigue, and unintended weight loss. Risk factors include smoking, age, race, and prior radiation treatment. Treatment options for bone cancer include chemotherapy, radiation therapy, and surgery. Prevention methods involve maintaining a healthy lifestyle through diet, exercise, and avoiding tobacco and excessive sun exposure.
This study evaluated the accuracy of ultrasonography (US) in assessing sutural opening during rapid palatal expansion (RPE) by comparing US findings to oral radiographs in 29 patients undergoing RPE treatment. US examinations were performed immediately after appliance placement and at 10 and 20 turns to evaluate the midpalatal suture. The US and radiographic findings at each time point were comparable in assessing sutural opening during expansion. The study concluded that US provides an accurate, easy to use, and radiation-free method for evaluating midpalatal sutural expansion during RPE treatment.
Mandibular Radiolucencies; A Systematic Approach to DiagnosisAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty
of Dental Medicine, Al-Azhar University. Conventional radiography may revel a variety of
radiolucent legions in the mandible. Interpretation of such radiolucencies can be challenging either
because the clinical presentation may be non specific or because the ;legion is detected
incidentally. Further, interpretation may vary from one examiner to another. thus, systemic
approach is necessary to diagnose the legion or at least provide a meaningful deferential
diagnosis. This approach should focus on specific radiographic parameters. Initially, the legion
should be placed in the category of either normal or abnormal. The presented parameters includes
describing the legion in terms of: 1- Location, 2- Margins, 3- Size and shape, 4- Effect on
surrounding structures. Obviously, however diagnosis of a legion should never be made
exclusively on the bases of radiographic interpretation. Radiographic interpretation should be used
along with clinical information and other tests to formulate a deferential diagnosis.
Osteogenesis Imperfecta (OI), also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. The document discusses the various types of OI, from the mildest Type I to the most severe Type II which is often lethal. Type I is the most common and involves increased bone fragility without severe deformity. Type II causes bone fractures in the womb and death shortly after birth. Type III is progressively deforming and causes multiple fractures leading to short stature and wheelchair dependence. Treatment involves physiotherapy, orthopedic care, and bisphosphonates which increase bone density and reduce fractures in children but not adults. More research is being done on drugs like terip
Metastatic Bone Disease & Role of Zoledronic AcidMRINMOY ROY
Metastatic Bone Disease is Cancer that begins in an organ, such as the lungs, breast, or prostate, and then spreads to bone.
More than 1.2 million new cancer cases are diagnosed each year. Approximately 50% of these tumours can spread (metastasize) to the skeleton.
With improved medical treatment of many cancers — especially breast, lung, and prostate — patients are living longer. However, the primary cancers in more of these patients are spreading to bone. The tumours that result are called bone metastases.
Here the role of Zoledronic Acid have been fall in place in treatment.
This document discusses skeletal metastases, or bone tumors that have spread from other primary cancers. The key points are:
- The most common primary cancers that metastasize to bone are breast, prostate, lung, and kidney cancers.
- Metastases typically involve the axial skeleton and proximal long bones. Lytic lesions that destroy bone are most common, followed by sclerotic lesions with new bone formation.
- Radionuclide bone scans are very sensitive for detecting metastases, while other imaging like CT, MRI, and PET can provide additional details on location and extent of disease.
- It is important to distinguish solitary bone metastases from primary bone tumors or other bone diseases based on features like lesion size
Cemento osseus dysplasia (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)Doctor Faris Alabeedi
Cemento-osseous dysplasia is a non-neoplastic fibro-osseous lesion that commonly affects the tooth-bearing regions of the jaws in middle-aged black women. It has three variants defined by location: periapical cemento-osseous dysplasia near the tooth apex, focal cemento-osseous dysplasia associated with a single tooth, and florid cemento-osseous dysplasia with involvement of multiple jaw quadrants. Radiographically, lesions appear as well-defined radiolucencies early on and progress to mixed or diffuse radiopacities as they mature. Histologically, lesions contain mineralized bone and cementum-like
La unidad se centra en los tipos de animales y sus características, y se llevará a cabo del 7 de enero al 8 de febrero. Cubrirá vocabulario relacionado con las características físicas de los animales, como aletas, branquias y pelaje; sus formas de reproducción, nutrición y respiración; y la clasificación entre vertebrados e invertebrados.
The document discusses various radiographic clues that can help determine the nature of bone lesions. It describes clues provided by the appearance of lesions, including patterns of bone destruction (geographic, moth-eaten, permeative) and periosteal reactions. Certain appearances provide clues about benign versus malignant lesions. Location of lesions and lesion density also provide clues. Characteristic locations are described for several lesions. Sclerotic, lytic and blastic lesions have different potential underlying causes in children versus adults. Soft tissue extension is also a potential clue.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
A rare case of patellar osteoblastoma with anteriorrohit raj
This case report describes a rare case of osteoblastoma in the patella of a 21-year-old male who presented with 6 months of anterior knee pain. Imaging showed a well-defined lytic lesion in the patella. The patient underwent curettage of the lesion and bone grafting. Histopathological examination confirmed the diagnosis of osteoblastoma. At follow-up the patient's symptoms had resolved and the bone graft had consolidated properly with no recurrence of the tumor. Osteoblastoma is a rare benign bone tumor that can present as knee pain. Though rare, it should be considered in the differential diagnosis of patellar lesions.
Ossifying fibroma vs fibrous dysplasia of the jaw/rotary endodontic courses b...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This study analyzed 43 patients with facial asymmetry using 3D CT scans to classify the asymmetry into objective groups. Measurements of the maxilla and mandible were analyzed using statistical tests and cluster analysis. Four groups were identified: Group 1 with a shifted mandibular body (44%); Group 2 with a significant difference in ramus height and menton deviation to the short side (39%); Group 3 with atypical asymmetry including menton deviation and prominence on one side (12%); and Group 4 with severe maxillary canting and ramus/menton differences (5%). The study aims to improve diagnosis and treatment of facial asymmetry through an objective classification system.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Radiographs play an important role in the diagnosis and treatment of periodontal diseases. They provide important information regarding the anatomical structures and periodontal bone loss.
This document presents a case report of a central odontogenic fibroma. It describes a patient who presented with asymptomatic expansion of the buccal and lingual cortical plates. Radiographs and biopsy revealed a well-defined mixed radiodensity lesion containing epithelial islands and calcified material resembling dentin or cementum, consistent with central odontogenic fibroma. The lesion was surgically removed. Histological examination confirmed the diagnosis of central odontogenic fibroma, a rare benign odontogenic tumor originating from dental ectomesenchyme.
This document discusses the use of radiographs in assessing periodontal disease and bone destruction. It provides information on normal interdental bone appearance and outlines criteria for evaluating bone loss patterns seen in periodontal disease. Key findings include lamina dura disruption being an early sign of periodontitis and interdental cratering appearing as irregular reduced bone density. Furcation involvement is suggested by diminished bone trabeculae radiodensity or marked bone loss on a single root. Additional imaging techniques like CBCT can provide further detail on lesion morphology.
The document discusses various temporomandibular joint (TMJ) findings that can be seen on cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI). It begins by describing the normal TMJ anatomy and capsule structures visible on imaging. It then discusses various abnormal and pathological TMJ findings that can be developmental, soft tissue related, or due to remodeling/arthritis. Developmental conditions covered include hemifacial microsomia, condylar aplasia, hypoplasia, and hyperplasia. Soft tissue abnormalities include internal derangements and disc displacements. Remodeling and arthritic changes described are flattening, erosion, osteophytes, sclerosis, and subchond
Approach to a case of musculoskeletal tumourorthoprince
This document provides an approach to evaluating bone tumors based on age, duration of symptoms, site of lesion, margins, type of destruction, periosteal reaction, matrix of the lesion, and blood investigations. Key factors include age of the patient, as certain tumors are more common in different decades; duration of symptoms, with longer duration suggesting benign and shorter suggesting malignant; site of the lesion in the bone and body; characteristics of the margins, destruction and periosteal reaction on imaging; and relevant blood tests depending on suspected tumor type. The approach aims to systematically analyze these various criteria to determine a differential diagnosis and guide further evaluation and staging of potential bone tumors.
Dr. Abdelhady provides a lecture on odontogenic tumors. The lecture aims to help students classify and diagnose odontogenic tumors, examine patients presenting with facial swellings, and determine differential diagnoses and management techniques for mandibular and maxillary swellings. Specific odontogenic tumors discussed include cementoblastoma, odontogenic fibroma, central giant cell granuloma, cherubism, fibrous dysplasia, and ossifying fibroma. Radiographic features, histology, treatment options and prognosis are described for each tumor type.
Bone cancer is a rare type of cancer that begins in the bones, most commonly affecting the long bones of the arms and legs. Some common types of bone cancer include osteosarcoma, Ewing sarcoma, and malignant fibrous histiocytoma. Symptoms include bone pain, tenderness, broken bones, fatigue, and unintended weight loss. Risk factors include smoking, age, race, and prior radiation treatment. Treatment options for bone cancer include chemotherapy, radiation therapy, and surgery. Prevention methods involve maintaining a healthy lifestyle through diet, exercise, and avoiding tobacco and excessive sun exposure.
This study evaluated the accuracy of ultrasonography (US) in assessing sutural opening during rapid palatal expansion (RPE) by comparing US findings to oral radiographs in 29 patients undergoing RPE treatment. US examinations were performed immediately after appliance placement and at 10 and 20 turns to evaluate the midpalatal suture. The US and radiographic findings at each time point were comparable in assessing sutural opening during expansion. The study concluded that US provides an accurate, easy to use, and radiation-free method for evaluating midpalatal sutural expansion during RPE treatment.
Mandibular Radiolucencies; A Systematic Approach to DiagnosisAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty
of Dental Medicine, Al-Azhar University. Conventional radiography may revel a variety of
radiolucent legions in the mandible. Interpretation of such radiolucencies can be challenging either
because the clinical presentation may be non specific or because the ;legion is detected
incidentally. Further, interpretation may vary from one examiner to another. thus, systemic
approach is necessary to diagnose the legion or at least provide a meaningful deferential
diagnosis. This approach should focus on specific radiographic parameters. Initially, the legion
should be placed in the category of either normal or abnormal. The presented parameters includes
describing the legion in terms of: 1- Location, 2- Margins, 3- Size and shape, 4- Effect on
surrounding structures. Obviously, however diagnosis of a legion should never be made
exclusively on the bases of radiographic interpretation. Radiographic interpretation should be used
along with clinical information and other tests to formulate a deferential diagnosis.
Osteogenesis Imperfecta (OI), also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. The document discusses the various types of OI, from the mildest Type I to the most severe Type II which is often lethal. Type I is the most common and involves increased bone fragility without severe deformity. Type II causes bone fractures in the womb and death shortly after birth. Type III is progressively deforming and causes multiple fractures leading to short stature and wheelchair dependence. Treatment involves physiotherapy, orthopedic care, and bisphosphonates which increase bone density and reduce fractures in children but not adults. More research is being done on drugs like terip
Metastatic Bone Disease & Role of Zoledronic AcidMRINMOY ROY
Metastatic Bone Disease is Cancer that begins in an organ, such as the lungs, breast, or prostate, and then spreads to bone.
More than 1.2 million new cancer cases are diagnosed each year. Approximately 50% of these tumours can spread (metastasize) to the skeleton.
With improved medical treatment of many cancers — especially breast, lung, and prostate — patients are living longer. However, the primary cancers in more of these patients are spreading to bone. The tumours that result are called bone metastases.
Here the role of Zoledronic Acid have been fall in place in treatment.
This document discusses skeletal metastases, or bone tumors that have spread from other primary cancers. The key points are:
- The most common primary cancers that metastasize to bone are breast, prostate, lung, and kidney cancers.
- Metastases typically involve the axial skeleton and proximal long bones. Lytic lesions that destroy bone are most common, followed by sclerotic lesions with new bone formation.
- Radionuclide bone scans are very sensitive for detecting metastases, while other imaging like CT, MRI, and PET can provide additional details on location and extent of disease.
- It is important to distinguish solitary bone metastases from primary bone tumors or other bone diseases based on features like lesion size
Cemento osseus dysplasia (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)Doctor Faris Alabeedi
Cemento-osseous dysplasia is a non-neoplastic fibro-osseous lesion that commonly affects the tooth-bearing regions of the jaws in middle-aged black women. It has three variants defined by location: periapical cemento-osseous dysplasia near the tooth apex, focal cemento-osseous dysplasia associated with a single tooth, and florid cemento-osseous dysplasia with involvement of multiple jaw quadrants. Radiographically, lesions appear as well-defined radiolucencies early on and progress to mixed or diffuse radiopacities as they mature. Histologically, lesions contain mineralized bone and cementum-like
La unidad se centra en los tipos de animales y sus características, y se llevará a cabo del 7 de enero al 8 de febrero. Cubrirá vocabulario relacionado con las características físicas de los animales, como aletas, branquias y pelaje; sus formas de reproducción, nutrición y respiración; y la clasificación entre vertebrados e invertebrados.
This document discusses the establishment of a European network called SUB-URBAN to improve understanding and use of underground spaces in cities. The network aims to coordinate research on 3D/4D modeling of city subsurfaces across European institutions. This will help integrate subsurface knowledge and maximize its economic, social and environmental benefits for sustainable urban development. The network will develop tools to disseminate subsurface models and train decision-makers on their use.
Asperger's Syndrome is a developmental disability characterized by impairments in social interaction and communication, as well as restrictive and repetitive behaviors. It was first identified in 1944 but not widely recognized until the 1980s. Asperger's is thought to have a genetic component and may be influenced by environmental factors affecting brain development. It occurs in about 48 out of every 10,000 children. Assessment involves evaluating social, language, behavioral, and developmental history. Characteristics include difficulties with social skills, establishing relationships, flexibility, and restricted interests. Suggested supports include social skills training, sensory integration activities, visual aids, and structured learning environments.
This document summarizes a study that investigated the ability of Lactobacillus paracasei BEJ01 (LP) to prevent immunotoxic effects of chronic zearalenone (ZEN) exposure in mice. Mice were given ZEN alone, LP alone, or ZEN and LP together daily for 15 days. Compared to controls, ZEN decreased body weight gain and immune parameters, while addition of LP to ZEN strongly reduced these adverse effects of ZEN. Mice that received ZEN and LP showed no significant differences from controls in parameters measured. The study suggests that LP has potential to protect against immunotoxicity from chronic ZEN exposure.
Planète Enfants is working to rebuild schools in earthquake-affected areas to a higher standard of quality and safety than before. They are assessing structural solutions and improvements to security, education quality, resources like libraries and internet access, and teacher training. Temporary reception centers provide childcare, medical care, and function as schools until classrooms are rebuilt. The organization is committed to ensuring all children can access education by providing uniforms, school supplies, and support to vulnerable children and families.
Tips for the move in/ move out process
- Applications
-Inspections
-Deposits
-Agreements
-Accounting
-Normal "wear and tear"
-Pictures
-Storing
-Stored items
This document is a thesis submitted by Kumar Deepam to the University of Limerick for the degree of MSc in Financial Services. The thesis measures the effectiveness of microfinance in promoting socio-economic development in North India through statistical analysis of primary and secondary data. Survey data was collected from 100 respondents below the poverty line in Lucknow, India and analyzed using chi-square tests, t-tests and logistic regressions. The findings show microfinance has had a positive impact on poverty reduction and gender equality in North India, though outreach remains low. Young entrepreneurs and women are more likely to benefit from microloans. The thesis provides recommendations to expand microfinance's role in socio-economic development.
Evelyn Lisbeth Tarco Lema nació en 1997 en Latacunga y actualmente estudia ingeniería en la Universidad de las Fuerzas Armadas ESPE-Latacunga. Proviene de una familia humilde compuesta por sus padres y tres hermanos. Sus principales sueños son graduarse como profesional, conseguir un trabajo bien remunerado, y formar una familia unida. Sus mayores influencias han sido sus padres, quienes la han apoyado en sus estudios.
This document is a contract of employment between an employer and domestic worker. It outlines the terms of employment including duties of both parties, wages, termination conditions, transportation and repatriation costs. The contract is for a period of [NUMBER] years, during which the domestic worker will reside and work only at the employer's specified address, performing household duties as instructed. The employer must provide accommodation, meals, insurance and respect religious beliefs. Grounds for termination by either party and dispute resolution processes are also defined.
Magnets create a distant force that can move magnetic materials without touching them. They have two poles, north and south, that either attract or repel depending on whether the poles are different or the same. Magnets are used in many everyday devices like refrigerators, phones, TVs and computers. A compass also uses magnetic forces and always orients itself to point toward the Earth's north magnetic pole.
Este documento presenta un resumen autobiográfico de Alondra Oña en 3 oraciones o menos:
Alondra nació en Quito en 1997, es la primera de 4 hermanas y se graduó de bachillerato en ciencias generales. Actualmente estudia en la Universidad de las Fuerzas Armadas con el objetivo de convertirse en una profesional exitosa en administración hotelera y turismo.
This document provides guidance on evaluating solitary bone lesions based on radiographic findings. Key factors include the patient's age, location and characteristics of the lesion, presence of cortical destruction or a periosteal reaction, and whether the lesion is focal or generalized. Aggressive lesions are suggested by an irregular shape, indistinct borders, breakthrough of the cortex, or involvement of multiple bones. Benign lesions tend to be well-defined, expand the bone, and have a narrow transition zone between abnormal and normal bone.
A bone tumor is an abnormal growth of cells within a bone. There are two main types: benign tumors, which are non-cancerous, and malignant tumors, which are cancerous and can spread. Common benign bone tumors include osteochondromas, non-ossifying fibromas, and enchondromas. Primary malignant bone cancers include osteosarcoma, Ewing sarcoma, and chondrosarcoma. Secondary bone cancers spread from other parts of the body like the breast, prostate, or lungs. Diagnosis involves imaging tests, biopsies, and blood/urine tests. Treatment depends on whether the tumor is benign or malignant but may include surgery, radiation, chemotherapy, or cryos
A bone tumor is an abnormal growth of cells within a bone. There are two main types: benign tumors, which are non-cancerous, and malignant tumors, which are cancerous and can spread. Common benign bone tumors include osteochondromas, non-ossifying fibromas, and enchondromas. Primary malignant bone cancers include osteosarcoma, Ewing sarcoma, and chondrosarcoma. Secondary bone cancers spread from other parts of the body like the breast, prostate, or lungs. Diagnosis involves imaging tests, biopsies, and blood/urine tests. Treatment depends on whether the tumor is benign or malignant but may include surgery, radiation, chemotherapy, or cryos
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Ameloblastoma is benign slow-growing but locally invasive neoplasm of odontogenic origin. In 2005, the WHO has classified ameloblastomas into multi cystic, unicystic and peripheral subtypes. The clinical picture, radiographic findings and differential diagnosis are presented. Treatment of ameloblastomas is primarily surgical. There has been some debate regarding the most appropriate method for removing. These range from conservative to radical modes. Some authors advocate conservative approach and thought that ameloblastoma are essentially benign in nature and should be treated as such. However, this conservative approach result in recurrence rates of 55% to 90%of the cases. Currently, the standard of care for ameloblastoma includes en bloc resection with 1-2 combine margin and immediate bone reconstruction. Despite the medical nature of a surgical resection, it may actually involve less morbidity than extensive hard and soft tissue resection with associated extensive morbidity that may be warranted in case of recurrence following inadequate primary treatment.
Giant cell tumor is a benign but locally aggressive bone tumor. It most commonly affects long bones like the distal femur and proximal tibia in skeletally mature patients aged 15-40. On imaging, it appears as an eccentric, epiphyseo-metaphyseal lesion that is lytic with thinning or destruction of the cortex. Biopsy is required for diagnosis. Treatment options include curettage with or without adjuvants, en bloc resection, embolization, or amputation depending on tumor size, location and involvement of surrounding tissues. The goal is to remove the tumor completely while reconstructing any bony defects to restore function.
This document provides an overview of the approach to orthopedic oncology. It begins with an introduction and outlines the classification, clinical presentation, staging, and types of primary bone tumors. Bone tumors are classified based on the dominant tissue and can be benign or malignant. Clinical evaluation involves history, physical exam, imaging, and biopsy. Staging uses the Enneking system to describe the grade, site, and presence of metastases. Primary bone tumors discussed include benign entities like osteoid osteoma and giant cell tumor as well as malignant tumors such as osteosarcoma, Ewing's sarcoma, and chondrosarcoma. Treatment depends on the tumor type, location, and stage.
This document provides an overview of tumors of bone. It begins with an introduction to bone tumors, classifying them as either primary bone tumors or secondary bone tumors from metastasis. Primary bone tumors are further classified based on the WHO system according to the tissue they arise from, such as bone-forming, cartilage-forming, or other miscellaneous tumors. For each tumor type, the document outlines the typical locations, ages affected, diagnostic imaging findings, treatment options, and potential complications. In summary, it comprehensively reviews the etiology, diagnosis, classification and management of various bone tumors.
Primary bone tumors are most common in the first three decades of life during periods of bone growth. Benign tumors are more frequent than malignant ones, with the most common benign tumors being osteochondroma, fibro-osseous lesions, and enchondroma. Osteosarcoma and multiple myeloma have the highest incidence among primary malignant bone tumors. These tumors most often occur in the distal femur and proximal tibia, which have the highest bone growth rates. While many bone tumors are benign, osteosarcoma is a highly malignant tumor with poor prognosis if not treated aggressively with chemotherapy and surgery.
This document provides an overview of bone tumors including:
- Definitions of bone tumors as abnormal bone cell growth that can be benign or malignant
- Classification systems that stage benign and malignant bone tumors based on factors like growth and spread
- Common clinical features of bone tumors like bone pain, lumps, fractures, and weight loss
- Diagnostic tests and treatment options for bone tumors including biopsy, imaging, chemotherapy, radiation, surgery and pain management
- Nursing considerations for patients with bone tumors which involve comprehensive assessment, developing a care plan and providing home care instructions.
This document provides an overview of bone tumors including:
- Definitions of bone tumors as abnormal bone cell growth that can be benign or malignant
- Classification systems that stage benign and malignant bone tumors based on factors like growth and spread
- Common clinical features of bone tumors such as bone pain, lumps, fractures, and weight loss
- Diagnostic tests and treatment options for bone tumors including biopsy, imaging, chemotherapy, radiation, surgery, and pain management
1. The document summarizes investigations for bone tumors including plain radiography, MRI, CT, and isotope bone scans. 2. It describes primary malignant bone tumors like osteosarcoma, chondrosarcoma, fibrosarcoma, Ewing sarcoma, and giant cell tumor based on patient age, location, and radiographic findings. 3. It also discusses benign bone tumors, metastases, multiple myeloma, and generalized decreased bone density conditions like osteoporosis and their radiographic presentations.
1. The document discusses the classification, diagnosis, and imaging appearances of various bone tumors and tumor-like lesions.
2. Key bone tumors discussed include osteosarcoma, giant cell tumor, and bone cyst. Osteosarcoma is classified based on X-ray signs into osteosclerotic, osteolytic, or mixed types.
3. Imaging findings help determine if a bone lesion is benign or malignant based on characteristics such as boundaries, destruction pattern, periosteal reaction, and surrounding soft tissues.
1. The document discusses investigations for bone tumors including plain film radiography, MRI, CT, and isotope bone scans.
2. It describes primary malignant bone tumors such as osteosarcoma, chondrosarcoma, fibrosarcoma, Ewing sarcoma, and giant cell tumor based on their radiological characteristics and features.
3. It also discusses benign bone tumors including enchondroma, fibrous dysplasia, simple bone cyst, aneurysmal bone cyst, and osteoid osteoma according to their common radiological findings.
This document provides an overview of malignant bone tumors, including their classification, occurrence, imaging appearance, and examples. It discusses several primary malignant bone tumors in detail, including osteosarcoma and multiple myeloma. Osteosarcoma most commonly affects teenagers and young adults, presents as aggressive bone destruction with periosteal reaction on x-ray, and has variable appearances on MRI/CT. Multiple myeloma commonly affects older adults, causes lytic lesions scattered throughout the skeleton appearing as "punched out" areas on x-ray, and MRI is most sensitive for detecting its bone involvement. The document outlines radiographic features that can help characterize and differentiate various malignant bone tumors.
A 51-year-old woman presented with knee pain. An MRI revealed a lesion within the fibula that did not breach the cortex. A primary resection was performed without biopsy to allow for a wide marginal excision without contamination of the common peroneal nerve. The lesion proved to be a low-grade chondrosarcoma. The goals of treatment are to make the patient free of disease or minimize pain and preserve function. This may require a combination of radiation therapy, chemotherapy, and/or surgery.
1) Bone tumours can be benign or malignant and are classified based on features seen on imaging such as location within the bone, pattern of bone destruction, and presence of a periosteal reaction.
2) Imaging plays an important role in evaluating bone tumours and includes plain radiographs, CT, MRI, and bone scans. Biopsy is also important to determine the specific diagnosis.
3) Treatment depends on whether the tumour is benign or malignant but may include surgery, chemotherapy, and radiation therapy. The surgical margin taken is a key factor in oncology outcomes.
This document provides an overview of osseous bone tumors, including benign and malignant types. It discusses key benign tumors like osteoid osteoma, osteoblastoma, and bone islands. It also covers osteosarcoma in depth, describing its various subtypes, characteristics, diagnosis involving imaging and biopsy, Enneking staging system, and treatment approaches including chemotherapy, surgery, and prognosis factors. The summary focuses on key details about classification and management of important osseous bone tumors.
- The radiographs show diffusely decreased bone density in the hand of a 40-year-old woman, with multiple subluxed MCP and IP joints and dislocation of the 5th PIP joint that is nearly reduced on the PA view. No erosions or productive changes are seen.
- The most likely diagnosis is rheumatoid arthritis given the diffuse decreased bone density, subluxations, and dislocations seen which are characteristic of rheumatoid arthritis. Gout, SLE, scleroderma, and erosive osteoarthritis are less likely given the lack of findings more characteristic of those conditions such as erosions or productive changes.
This document provides an overview of fibrous osseous lesions of the jaws and their classification and management. It begins with an introduction to fibrous osseous lesions and their classification. It then discusses specific lesions in more detail, including fibrous dysplasia, cemento-osseous dysplasia, ossifying fibroma, and others. For each lesion, it covers clinical features, radiographic patterns, differential diagnosis, and treatment approaches. The goal is to review current knowledge around the diagnosis and management of these complex fibro-osseous lesions of the jaws.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. 4 AJR:200, January 2013
or malignant lesions (e.g., giant cell tumor Fig.
3), aneurysmal bone cyst, aggressive osteoblas-
toma, and low-grade chondrosarcoma). Type
IC margins are ill defined and indistinct, with
a wide zone of transition, corresponding to ag-
gressive bone tumors. Most tumors with type
IC margins are malignant, such as small/early
chondrosarcomas or osteosarcomas (Fig. 4).
Fig. 1—Drawings show margin classification system of primary bone tumors. Type I margins are round or oval and
typically correspond to less-aggressive (benign) or less-advanced malignancies than moth-eaten (type II) or
permeative (type III) fields of osteolysis. Margin classification system provides general guidelines for determining
aggressive from nonaggressive lesions. Information such as patient age, bone affected, and location of tumor in
bone are also critical for assessing identity of primary bone tumors.
Fig. 2—Fibroxanthoma (nonossifying fibroma)
of distal tibial metadiaphysis in 23-year-old man.
Radiograph shows shape of lesion is well-defined
oval (geographic) indicating that margin is type I.
Narrow zone of transition (arrowheads) between
tumor and normal bone indicates least aggressive
margin (IA). Slowly expansile nature of tumor has
resulted in mild bowing of adjacent distal fibula.
Fig. 3—Giant cell tumor of bone of proximal tibial
epiphysis in 28-year-old woman. Radiograph shows
round/oval lesion is geographic (type I) with narrow
zone of transition (arrowheads) but no sclerotic rim
(type IB). Lack of sclerotic rim indicates that lesion
is of indeterminate biologic potential and could be
benign or malignant. Lesions with IB margins can
be subtle in appearance on radiographs. Biopsy
indicated giant cell tumor of bone, which is locally
aggressive benign lesion.
Fig. 4—Osteosarcoma of proximal tibial
metadiaphysis in 15-year-old boy. Radiograph shows
lesion is round/oval and therefore geographic but
wide zone of transition is present between ill-defined
periphery of lesion and normal bone. This type IC
margin is typical of aggressive bone tumors. Cortical
thinning is seen laterally with deceptively mild
periosteal reaction (arrowheads). Osteoid produced
by osteosarcomas is microscopically apparent and
may or may not be appreciable on imaging studies.
Incidental osteochondroma of fibular head is partially
visualized (asterisk).
Fig. 5—Primary Burkett lymphoma of distal femur in
23-year-old woman. Radiograph shows numerous lytic
foci of varying size are seen throughout distal femoral
diaphysis (brackets). They are not round or oval in
distribution and are illustrative of type II (moth-eaten
margin). More severe osteolysis is seen in lateral
femoral condyle and distal epiphysis, showing fine
or fuzzy osteolysis of type III (permeative) margin
(arrowheads). Fracture is present at level of lateral
metaphyseal region.
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3. AJR:200, January 2013 5
Radiography of Primary Bone Tumors
Aggressive benign lesions, such as giant cell
tumors, can also show this appearance.
Type II and III margins are nongeographic
and consist of ill-defined “fields” of bone de-
struction. The type II margin is described as
moth-eaten and is composed of numerous foci
of osteolysis that vary in size and shape on a
background of relatively intact cortex. The type
III margin corresponds to the most highly ag-
gressive appearance and is described as perme-
ative. The margin types can be intermingled.
Margins are the interface of the tumor with the
bone and therefore are typically the most sensi-
tive radiographic indicator of lesion behavior.
The osteolysis represented by these non-geo-
graphic lucent areas is fine or fuzzy in ap-
pearance (Fig. 5). Analysis of the margins is
readily performed on radiographs, which are
inexpensive, easily accessible, and provide
a concise assessment of lesion behavior on a
limited number of images.
Cortical Expansion
Cortical expansion is most commonly seen
with benign tumors that grow slowly enough
to allow the cortex to remain completely or
partially intact. Although not all bone tumors
expand the cortex, the degree of cortical ex-
pansion, when present, is reflective of the
growth rate of the lesion. With a number of
notable exceptions, such as low-grade chon-
drosarcoma (Fig. 6) and some metastases
(e.g., renal cell and thyroid carcinoma), ma-
lignancies are more likely to progress rapid-
ly and destroy rather than expand the cortex.
Lesions that produce mild cortical expansion
are typically well marginated and show IA
margins (e.g., fibrous cortical defect, fibrous
dysplasia). Lesions that produce a larger de-
gree of cortical expansion are more likely to
predispose to pathologic fracture (e.g., non-
ossifying fibromas/fibroxanthomas, unicam-
eral bone cyst; (Fig. 7). Lesions that exhib-
it a marked degree of cortical expansion can
produce severe local bone deformity or de-
struction, even if benign. For example, an an-
eurysmal bone cyst may grow across open
physes (Fig. 8), predisposing the patient to
limb length discrepancy, and giant cell tumor
may destroy the articular surface of bone,
leading to the need for arthroplasty.
Periosteal Reaction
Periosteal reaction can reflect the biologic
potential of tumors [6], but it is less specific
than other radiographic signs. Highly aggres-
sive tumors often result in interrupted or mul-
tilaminar periosteal reactions, and the mass
effect of the tumor can produce a triangular
interface with the periosteum that is termed
a “Codman’s triangle” (Fig. 9). Less-aggres-
sive processes typically produce a unilaminar
periosteal reaction, although high-grade sar-
comas may produce unilaminar or no detect-
able periosteal reaction.
Matrix and Tumor Mineralization
Osteoid, chondroid, and fibrous lesions often
produce characteristic mineralization of ma-
trix, which is a substance that is located in the
extracellular space between tumor cells. Ma-
trix is found in benign and malignant tumors
Fig. 6—Low-grade chondrosarcoma of proximal
femur in 84-year-old woman. Low-grade sarcomas
can mimic benign lesions and low-grade
chondrosarcomas are among most potentially
confusing bone tumors. Thickened cortex does not
always equate with sclerotic rim. Unlike benign
fibroxanthoma in Fig. 1, radiograph shows that entire
circumference of this bone is enlarged by low-grade
chondrosarcoma. Although large fibrous dysplasias
can also enlarge entire circumference of bone,
fibrous dysplasia will typically exhibit sclerotic rim
with possible fibrous matrix mineralization. This
chondrosarcoma has no sclerotic rim and exhibits
cartilaginous matrix mineralization (see Figs. 11 and 12
regarding mineralized matrix). In addition to thickening
of cortex (arrow), endosteal scalloping of cortex by
tumor also thins areas of cortex (arrowhead). Thinning
of large sections of cortex by large cartilaginous bone
tumors can be indicative of malignancy.
Fig. 8—Aneurysmal bone cyst of proximal humerus
in 17-year-old girl. Radiograph shows this large
expansile lesion crosses physis into humeral head
and also thin cortex, resulting in pathologic fracture
(arrow). These features produced bowing deformity
of bone. Physeal involvement can predispose to limb
length discrepancy.
Fig. 7—Unicameral bone cyst of proximal humeral
metaphysis in 16-year-old boy. Large lesions
that expand bone without adequate cortical
reinforcement can result in pathologic fracture.
Radiograph shows this unicameral bone cyst is
slightly expansile, thins cortex, and has resulted in
fracture with subsequent callous formation (arrow).
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4. 6 AJR:200, January 2013
Fig. 12—Fibrous dysplasia of tibia in 30-year-old
woman. Lesion shows spectrum of opacities.
Radiograph shows mineralized fibrous matrix is
dense and mature proximally (arrow), whereas it has
ground-glass appearance distally (arrowheads).
A
Fig. 13—Fibrous cortical defect of proximal tibial metaphysis with fibrous dysplasia in distal diaphysis of
15-year-old girl.
A, Radiograph shows small fibrous cortical defect is markedly eccentric because it is located in lateral cortex
(arrowheads). Nonaggressive lesion shows sclerotic rim (IA margin). Fibrous dysplasia in distal diaphysis
is centered in medullary cavity and expands entire circumference of bone. In some respects, this lesion
resembles low-grade chondrosarcoma in Figure 6. Nevertheless, it shows ground-glass fibrous matrix and
sclerotic distal rim (arrow).
B, Radiograph obtained 3 years later shows fibrous cortical defect (arrowheads) has matured and become
dense. Because of risk of pathologic fracture caused by cortical thinning, fibrous dysplasia was curetted and
packed with dense bone graft, which has incorporated into surgical defect (arrow).
B
Fig. 11—This chondrosarcoma of calcaneus
in 26-year-old male originated from sessile
osteochondroma (not readily identified on
radiograph). Radiograph shows arcs and rings of
mineralized chondroid matrix (arrowhead) throughout
lesion. Mineralized matrix is stippled posteriorly at
periphery of lesion (arrow).
Fig. 9—Osteosarcoma of distal femoral
metadiaphysis in 14-year-old boy. Radiograph
shows multilaminar onionskin periosteal reaction
anteriorly (white arrow). Interrupted periosteal
reaction and Codman’s triangle (black arrow) are
seen posteriorly and proximally, and hair-on-end
or sunburst periosteal reaction (arrowheads) is
seen posteriorly and distally. Although multilaminar
periosteal reactions are commonly seen with Ewing
sarcoma, each type of reaction can be seen in each
type of tumor. Cortical and trabecular margins of this
aggressive tumor are permeative (type III).
Fig. 10—Dedifferentiated parosteal osteosarcoma
of posterior metaphysis of distal femur in 33-year-old
man. Radiograph shows proximal aspect of lesion
is dedifferentiated and shows fluffy or cloudlike
osteoid matrix (arrowhead) within soft-tissue mass.
Distal aspect of lesion is more typical of parosteal
osteosarcoma and shows dense ivory osteoid
(arrow).
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5. AJR:200, January 2013 7
Radiography of Primary Bone Tumors
and therefore does not closely correlate to
malignant potential but may be useful in iden-
tifying the histologic type of the tumor [7].
Each type of matrix mineralization shows a
spectrum of radiographic appearances. Oste-
oid matrix may be fluffy and cloudlike or ivo-
ry and dense (Fig. 10). Cartilaginous matrix
may produce arcs and rings that form around
globular cartilage lobules, or it may be stippled
in appearance (Fig. 11). Fibrous lesions may
show a slightly increased radiographic density,
moderate ground-glass appearance, or dense
mature mineralization that can be uniform or
heterogeneous (Fig. 12). The gradual increase
in mineralization with time is termed “matu-
ration” and can be seen in tumors such as fi-
brous dysplasia, nonossifying fibroma, fibrous
cortical defect (Fig. 13), osteoid osteoma, and
bone island [8]. Maturation is an indolent pro-
cess and should not be confused with the rapid
posttherapeutic response of aggressive lesions
that have responded well to systemic or radi-
ation therapy. Posttherapeutic mineralization
may be most evident peripherally in lesions
Fig. 14—Osteosarcoma of proximal tibial metaphysis
in 31-year-old woman after chemotherapy.
Radiograph shows periphery of lesion has mineralized
after therapy and could be confused with type IA
margin (arrowheads). Nevertheless, focal areas
of moth-eaten osteolysis remain visible centrally
(arrow). Review of medical history is essential for
proper interpretation of primary bone tumors.
such as plasmacytomas or unresectable giant
cell tumors of bone. The rim may become so
solidly mineralized that it can be confused with
a IA margin. The margin classification system
discussed in this article applies only to untreat-
ed primary bone tumors (Fig. 14).
Advantages
Radiography and CT are the two major
imaging modalities used for evaluating min-
eralized structures. The main advantages of
radiography over CT include affordability,
accessibility, and a concise method by which
to assess the lesion on a limited number of
images. It can be argued that cross-sectional
imaging, even with reformations, cannot re-
produce the perceived quality of depth that
results from collapsing a 3D structure onto a
2D image. The margin classification system
described in this article is designed primar-
ily for use with radiography.
Pitfalls
Deficits of radiography include anatomic
overlap that can obscure abnormalities and a
limited capacity to evaluate soft tissue. Al-
though mass effect may be detected on radio-
graphs, they are limited for determining the
degree of extraosseous tumor volume, rela-
tionship of extraosseous tumor to surrounding
structures, and extent of disease in the intact
marrow cavity. MRI is the modality of choice
for simultaneously evaluating these relation-
ships [9–11]. Other considerations include
lower sensitivity for the detection of mineral-
ized matrix when compared with CT or for the
detection of undisplaced fracture when com-
pared with CT or MRI.
Conclusion
Radiography is the single most helpful im-
aging modality when establishing the initial
differential diagnosis of primary bone tumors.
Evaluation of the margins is the greatest con-
tributing factor to radiographic assessment of
the biologic potential of the lesions. Other fea-
tures, such as cortical expansion and periosteal
reaction, provide additional clues as to whether
immediate biopsy is indicated. Identification of
mineralized matrix may help to noninvasively
identify histologic type. Although MRI and CT
provide superior soft-tissue assessment and are
free from structural overlap, the unique infor-
mation afforded by radiography is optimal for
the efficient formation of an initial differential
diagnosis of primary bone tumors.
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