Primary malignant bone tumors are rare. Imaging such as radiography, CT, and MRI play an important role in detecting, characterizing, staging, and following up on bone tumors. The document discusses several specific bone tumors - osteosarcoma commonly affects children and young adults and presents as a metaphyseal lesion with soft tissue extension. Chondrosarcoma typically affects older adults and presents as an eccentric diaphyseal lesion with popcorn calcifications. Ewing's sarcoma commonly affects children and adolescents and presents as a permeative diaphyseal lesion with onion skin periosteal reaction.
In this presentation imaging properties of primary bone tumors of the spinal column and sacrum are discussed in detail: Including ABC, plasmacytoma, giant cell tumor, etc.
Presentation on bone tumors for undergraduate 2nd year MBBS medical students. The information for this presentation has been taken from texbook of Robbins & Cotran Pathologic Basis of Disease 8th ed.
benign and malignant tumors of cartilage radiology and general.
helpful for radiology and general medicine and orthopedician.
consie yet sufficient for basic approach to cartilage tumors.
In this presentation imaging properties of primary bone tumors of the spinal column and sacrum are discussed in detail: Including ABC, plasmacytoma, giant cell tumor, etc.
Presentation on bone tumors for undergraduate 2nd year MBBS medical students. The information for this presentation has been taken from texbook of Robbins & Cotran Pathologic Basis of Disease 8th ed.
benign and malignant tumors of cartilage radiology and general.
helpful for radiology and general medicine and orthopedician.
consie yet sufficient for basic approach to cartilage tumors.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. • Primary malignant bone tumours are relatively rare .
• The determination of the nature and extent of the tumour is
crucial .
• Conventional radiography , CT and MRI play an important role in
the detection , establishing the nature , assessing the extent and
in follow up in all suspected case of bone tumours .
3.
4. Age in
years
Tumour
<1 Neuroblastoma
1-10 Ewing sarcoma-tubular bones
10-30 Osteosarcoma, Ewing sarcoma-flat bones
30-40 Fibrosarcoma,malignant fibrous histiocytoma,lymphoma,Malignant
GCT
>40 Chondrosarcoma,chordoma,multiple myeloma
AGE OF ONSET
5. SITE OF ORIGIN
EPIPHYSIS MALIGNANT GCT
METAPHYSIS OSTEOSARCOMA
CHONDROSARCOMA
FIBROSARCOMA
DIAPHYSIS EWING’S SARCOMA
MULTIPLA MYELOMA
ADAMANTINOMA
MFH
8. IMAGING MODALITIES
• Conventional radiographic techniques still remain the mainstay in initial
diagnosis and work up of a patient suspected to have any bony pathology .
• Demonstrate the location,pattern of bone destruction, size and shape of the
lesion, presence and nature of the visible tumor matrix, trabeculation,
periosteal response and the presence and characteristics of the adjacent soft
tissue mass.
• Due to its excellent contrast resolution and multiplanar capabilities, MRI has
now virtually replaced CT as the imaging modality for assessing the local
extent .
• Non specific in differentiating benign from malignant tumours .
9. • Dynamic contrast enhanced MRI – to determine response to chemotherapy .
•
• MR spectroscopy – Molecular characterisation of the tumours
• DWI – In assessing tumour response to therapy .
-Effective therapy in bone tumours leads to breakdown of tumour cell
membranes resulting in increased diffusion of water in the tumour on Diffusion
weighted images .
CT – Remains superior to MRI in the detection and characterisation of matrix
mineralisation , in assessment of cortical involvement , bone trabeculation and
periosteal reaction .
-Also the investigation of choice for detecting pumonary metastases .
10. • 99mTechnetium methylene diphosphonate bone scan -first additional
investigation in most instances to detect whether the lesion is monostotic or
accompanied by other skeletal lesions.
• The major limitation of bone scanning is its lack of specificity as number of
bone disorders may have similar scintigraphic appearances.
• FDG-PET - Evaluation of skeletal metastatic disease.
• FDG accumulation in skeletal lesions reflects direct uptake by tumor, in
contrast to 99mTc MDP activity on conventional bone scans, which reflects
increased new bone formation in response to destruction of bone by tumor.
11. OSTEOSARCOMA
• Commonest primary malignant bone tumour in the young .
• Characterised by the production of osteoid or bone by tumour cells .
• Malignant cells also retain the potential to form fibrous tissue or
cartilage .
• Constituents of the tumour matrix are highly variable and can include
osteoid tissue , calcification , fibrous tissue ,cartilaginous tissue or a
combination .
13. • Usually presents with localized pain or swelling , particularly
around the knee
• May present with a pathological fracture .
• The lesion commonly arises eccentrically in the medullary cavity ,
with ill defined cortical destruction and soft tissue involvement .
• The pleomorphic nature of the histology may cause misleading
biopsy results .
14. • Conventional radiographs – Eccentric area of permeative bone
destruction in the metaphysis adjacent to the knee joint
• Associated with a cortical erosion and a well defined soft tissue
mass
• CODMAN’S TRIANGLE- Elevation of the periosteum when
associated with new bone formation , formed at the margin of
the lesion .
15. AP and lateral radiographs of the distal femur in a 14-year-old boy showing a classical
osteocarcoma with mixed lytic and sclerotic areas, extraosseus mass with tumor bone
formation, and Codman’s triangles at the upper and lower margins of the lesion
16. OSTEOSARCOMA OF THE METADIAPHYSEAL REGION OF TIBIA
- MIXED LESION WITH A LARGE SOFT TISSUE COMPONENT AND THE CHARACTERISTIC
“SUNBURST” OR SPICULATED PERIOSTEAL REACTION
17. • A coronal T1W MR image
shows the large tumor
as a predominantly
hypointense mass with
evidence of cortical destruction
• Axial T2W images show the
cortical disruption with soft
tissue extension of the
tumor mass with loss of fat
planes with the
neurovascular bundle.
• Contrast
enhanced coronal, (C) and axial,
(D) MR images show
heterogeneous enhancement
of the tumor mass
18. • AP radiograph showing a destructive lesion in the distal femur with extensive cloud like
mineralization in the intra- and extraosseous component
(B)A coronal T1W MR image shows the large tumor as a predominantly hypointense mass with
evidence of cortical destruction
(C)An axial T2W image shows a heterogenous mass which is completely encasing the
neurovascular bundle.
(D)T2W (fat suppressed) coronal image shows the intra-articular extension of the tumor into
the knee joint
19. OSTEOBLASTIC VARIETY. (A) AP and lateral radiographs show a purely osteosclerotic lesion of the
proximal metaphysis of the tibia
(B) CT shows mineralization of tumor matrix within the soft tissue component and a spiculated
periosteal reaction
20. TELANGIECTATIC OSTEOSARCOMA. (A) AP radiograph of the distal femur shows a
predominantly lytic lesion in the distal femur with irregular cortical destruction and a large soft
tissue component,
(B) Sagittal T2W fat suppressed MR image shows the characteristic blood-fluid levels within the
tumor,
(C) On contrast enhancement, marked peripheral and septal enhancement is seen
21. • Mestastatic spread occurs by the hematogenous route
• Pulmonary metastasis is associated with an unudually high
incidence of pneumothorax .
• Any lung lesion arising in a patient with osteosarcoma should be
regarded with supicion .
• Lymphatic spread is relatively rare .
22. JUXTACORTICAL/PAROSTEAL OSTEOSARCOMA
• Comprise 1% of all primary
malignant bone tumours and
about 4% of all osteosarcomas .
• The tumous is slow growing by
comparison and has a much
better prognosis .
• Parosteal sarcomas occur most
commonly on the distal femur
and proximal humerus .
23. • Typically dense tumour surrounds a long
bone , particularly a femur or tibia .
• The margins are sharply defined , but
tend to undulate .
• The tumour is denser centrally and at
the base than peripherally .
• Characteristically , there is a radiolucent
zone between the ossified outer margins
of the tumour and adjacent host bone .
25. Plain film
•Lytic (50%)
•Intralesional calcification
•Rings and arcs / popcorn calcification)
•Endosteal scalloping: affecting more than two thirds of the cortical
thickness (c.F. Less than 2/3 in enchondromas)
•Moth eaten /permeative appearance and periosteal
reaction distinguishing between enchondroma and chondrosarcoma
26.
27.
28. Proximal tibia diaphysis.
subtle calcifications,
Endosteal scalloping
hallmark of
chondrosarcoma.
MR better defines the
extension of the lesion.
endosteal scalloping.
29. CHONDROSARCOMA ARISING FROM OSTEOCHONDROMA
CALCIFIED MASS ARISING FROM THE PROXIMAL FIBULA.
HIGH UPTAKE ON THE BONE SCAN
30. CONVENTIONAL CHONDROSARCOMA.
(A)Plain radiograph shows an osteolytic, expansile lesion in the upper end of the fibula with
faint calcification seen within
(B) Coronal T2W Fat suppressed MR image shows the characteristic hyperintense, lobulated
lesion with internal septations.
31. CHONDROSARCOMA.
(A) A large expansile lesion in the anterior end of the left 7th rib
(B) CT shows specks of calcification within the lesion
32. (A)Radiograph of the hemipelvis shows a
mass extending from the left iliac blade
with the characteristic ‘popcorn’
calcification of a cartilaginous matrix
(B)T1W MR image shows the large soft
tissue component of the chondrosarcoma
as a low signal intensity lobulated mass
(C)On a coronal T2W MR image the tumor
is seen as lobulated mass of high signal
intensity with septations of low signal
intensity
(D)After intravenous administration of
gadolinium, a coronal T1W MR image
shows irregular peripheral and septal
enhancement
33. FIBROSARCOMA
• Fibrosarcoma is a tumor of mesenchymal cell origin that is composed of malignant
fibroblastsin a collagen background..
• It can occur as a soft-tissue mass or as a primary or secondary bone tumor
.
• Primary fibrosarcoma - central (arising within the medullary canal) or peripheral
(arising from the periosteum)
• Secondary fibrosarcoma of bone arises from a preexisting lesion or after
radiotherapy to an areaof bone or soft tissue.
• Fibrosarcomas of bone are typically seen between the third and sixth decades of life.
34. Plain Film
Highly destructive with a wide zone of transition and often expansile.Periosteal
reaction is uncommon. Thelesion usually has not matrix mineralization, but may have
areas of sequestedbone. Often associated with a large soft tissue mass.
CT
CT scanning is used to delineate bone involvement, bone destruction, or bone
reaction.
MRI
best modality overall for examining soft-tissue masses and for detecting the
intraosseous and extraosseous extentof many bony sarcomas.
T1WI - Isointense
T2WI - Hyperintense
Shows strong enhancementon contrast images
35. Lateral radiographs of the knee show an osteolytic lesion with a short zone of transition in
the distal femur. Note the absence of a periosteal reaction and tumor matrix mineralization
36. EWINGSSARCOMA
• Ewing sarcoma, a highly malignant primary
bone tumor that is derived from red bone
marrow and second most common primary
bone tumour of childhood.
• This tumor is most frequently observed in
children and adolescents aged 4-15 years and
rarely develops in adults older than 30 years.
• Affected bones include, long bones: 50-60%,
femur: 25%, tibia: 11%, humerus: 10%, flat
bones: 40%, pelvis: 14%, scapula, ribs: 6%
• As far as location within long bones, the tumor
is almost always metaphyseal or diaphyseal.
• It is the most lethal bone tumor. An
association exists between Ewing sarcoma and
primitive peripheral neuroectodermal tumor
(PNET).
37. PLAIN RADIOGRAPHY
• Typical presentation: ill-defined
osteolytic lesion with a moth-eaten or
permeative type of bone destruction,
irregular cortical destruction and
aggressive periostitis.
• Reactive sclerosis,irregular periosteal
reaction and soft tissue mass.
• Ewing sarcomas tend to be large poorly
marginated tumours, with over 80%
demonstrating extension into adjacent
soft tissues.
• Laminated (onion skin) periosteal
reaction: 57%
38. (A) CONVENTIONAL RADIOGRAPH SHOWS A PERMEATIVE LESION IN THE TIBIAL DIAPHYSIS
WITH A SOFT TISSUE COMPONENT WITH SPICULATED PERIOSTEAL REACTION BETTER
APPRECIATED ON THE AXIAL CT SCAN (B)
39. (A)Ewing’s sarcoma of the
femur shows an
illmarginated, lytic-sclerotic
lesion with cortical
irregularity, laminar
periosteal reaction, with a
large soft tissue mass in the
metadiaphyseal region
(B)In another case involving
the femoral diaphysis
“saucerization” is well seen,
with peripheral Codman’s
triangles and a
large soft tissue mass
40. (A) Plain radiograph
(B)Axial CT section of left shoulder shows a dense sclerotic involvement of the scapula with a
large soft tissue mass
41. (A) A T1W coronal scan shows the intramedullary extent of the tumor as low signal intensity of
the marrow with a small “skip” lesion proximally (arrow)
(B) The extraosseous component is better appreciated on the STIR coronal image
(C) The axial T2W image shows the tumor within the femur as high signal intensity with cortical
discontinuity.
42. Ewing’s sarcoma with skeletal metastases
(A) Pelvic radiograph shows the primary tumor as a large predominantly lytic lesion in
the left iliac bone with multiple lytic bony metastases in the right iliac blade and
both the femurs
(B) Humeral shaft
(C) skull
43. PRIMITIVE NEUROECTODERMAL TUMOR OF BONE (PNET)
• These rare tumours of bone resemble Ewings tumours clinically except that
they are commoner in the female sex
• Arise in the metaphyses and diaphyses of the lower limbs,humerus,pelvis and
scapula .
• Radiologically , ill defined neoplasms which readily spread to soft tissues.
• ASKIN TUMOUR – rare PNET of the thoracopulmonary region occring in
children and adults.
•
• A soft tissue mass involving the chest wall in seen in about half the patients
and a subpleural pulmonary mass with pleural involvement in ¼ th .
44. NON-HODGKIN’S LYMPHOMA OF BONE
(LYMPHOSARCOMA, RETICULUM CELL SARCOMA)
• Primary lymphoma of bone is a rare extranodal lymphoma, presenting
intially as a localised solitary bone lesion .
• -20-50 years of age
• Usually presents with localised dull aching pain of long duration . A
palpable mass is often felt .
• Common sites – diaphysis of long bones, femur , tibia , humerus Flat
bones may also be involved .
45. • The osseous destruction in this tumour is usually permeative or moth
eaten in type with an associated soft tissue mass .
• Relative absence of cortical destruction is a characteristic feature .
• Proximal spread within the bone , sometimes with skip areas may be
seen .
• MRI typically shows extensive involvement of the medullary canal with
little cortical destruction but a large soft tissue mass.
• D/D – EWING’S SARCOMA
-(older age group and lack of symptoms )
• Good response to local radiotherapy and adjuvant chemotherapy.
46. Non-Hodgkin’s lymphoma.
(A) AP radiograph of the humerus shows a mixed lytic and sclerotic lesion involving proximal
half of the shaft with little cortical destruction and a large soft tissue component.
(B)Sagittal T2W fat suppressed MR image through the shaft shows the extent of medullary
involvement
47. HODGKIN’S LYMPHOMA OF BONE
• Occurs more commonly as a secondary manifestation of systemic
hodgkin’s disease . Rarely as a orimary bone involvement
• Main site – Vertebral body of the lower thoracic and upper lumbar
spine .
• Radiologically , most lesions are osteolytic .
• Occasionally , a marked sclerotic reaction can be seen as an ivory
vertebra .
• In the lumbar vertebrae , lytic destruction is more common with
exuberant periosteal reaction .
48. IVORY VERTEBRA SEEN AS A HOMOGENEOUS INCREASED DENSITY OF A SOLITARY THORACIC
VERTEBRA
49. CHORDOMA
• Neoplasm which arises from ectopic cellular remnants of the notochord
which have persisted within the nucleus pulposus of the intervertebral
disk .
• Predilection for the sacrococcygeal and spheno occipital regions.
• 90% - occurs in the sacrococcygeal region
• Distant metastases are rare, mainly involving the lymph nodes , liver and
lungs .
50. • Sacral lesions usually show a large area of bone destruction with well
defined , scalloped margins and a large soft tissue mass .
• Amorphous calcification may occur within the mass .
• In the spheno occipital region , the dorsal aspect of the sella and clivus
may be destroyed with a soft tissue mass indenting the
nasopharyngeal air space .
• In the sacrum , the possibility of plasmacytoma or giant cell tumour
should be considered .
51. CHORDOMA OF THE SACRUM. PLAIN RADIOGRAPH (A) AND CT (B) SHOWING A LARGE PELVIC
MASS WITH CALCIFICATION
52. CHORDOMA OF THE SACRUM.
(A)PLAIN RADIOGRAPH SHOWS A LYTIC LESION DESTROYING THE DISTAL HALF OF THE
SACRUM
(B)AND (C) T1W SAGITTAL AND T2W AXIAL MR IMAGES SHOW THE LARGE TUMOR WITH
INHOMOGENEOUS SIGNAL INTENSITY ARISING FROM THE DISTAL SACRUM
53. VASCULAR TUMORS OF THE BONE
• ANGIOSARCOMA
- Rare vascular tumour of bone , affecting all ages
- Any bone may be affected, but the vertebrae and femur are most
commonly involved .
- A multilocular or “soap bubble “ appearance may be seen .
- Reactive sclerosis may be seen at the margins of some tumours .
- Highly malignant tumour usually treated by surgery and radiotherapy
with a 5 year survival rate under 10 % .
54. Adamantinoma
• Rare primary malignant bony tumour,
• Occurs almost exclusively in the long
bones.
• The diaphyseal region is the area most
commonly affected.
• May present as a solitary focus or
multicentric lucencies or slightly
expansile osteolytic lesion
• May extend into the marrow cavity
• An eccentric epicenter and a lack of
periosteal reaction.
• No periosteal reaction
55. MULTIPLE MYELOMA
• Most common primary malignant neoplasm of bone .
• Production of an abnormal paraprotein leading to a wide M band
on plasma electrophoresis .
• Hypercalcemia , hypercalciuria and amyloidosis can occur , but
serum ALK and serum Phosphorus are normal .
• CLASSICAL APPEARANCE - Well defined, osteolytic , punched
out lesions throughout the skeleton, most characteristic in the
skull .
• Generalised osteopenia
• A pathological fracture .
• Involvement of the spine Is usually in the lower thoracic and
upper lumbar regions and is seen as diffuse osteopenia .
56. Multiple myeloma. (A) AP and (B) Lateral skull radiographs showing small, well
defined, ‘punched out’ lesions in the calvarium
57. RADIOGRAPHS OF THE DORSAL SPINE SHOW OSTEOPOROSIS WITH SMALL DISCRETE LESIONS
IN THE FEMUR .
58. Multiple myeloma. T1W (A) and T2W (B) sagittal MR images of the dorsal spine
show complete alteration of the marrow signal in the seventh thoracic vertebra,
hypointense on T1W and hyperintense on T2W images, with evidence of collapse.
59.
60. Metastases
• Metastatic bone tumors are the most common malignant
tumors of the skeleton. Approximately 70% of all malignant
tumors are metastatic in origin.
• Metastases are usually found in: Vertebrae - especially
posterior vertebral body, extending into pedicle, pelvis,
proximal femur, proximal humerus and skull.
• Metastases distal to the elbow and knee are distinctly
uncommon.
Types :
- osteolytic metastases
- sclerotic/osteoblastic metastases
- mixed lytic and sclerotic metastases
61. • Bone involvement in metastases occurs by
means of 3 main mechanisms:
• (1) direct extension
• (2) retrograde venous flow
• (3) seeding with tumor emboli via the blood
circulation which is the most common route of
spread.
62. • Usually no periosteal reaction
• May appear as moth-eaten, permeative or geographic lesions
• Indistinct zones of transition, no sclerotic margins and may be sharply circumscribed or have
indistinct borders
• Lesions distal to elbows and knees - 50% are from lung and breast
• Diffuse skeletal sclerosis or multiple round, well-circumscribed sclerotic lesions - Prostate &
Breast
• Expansile and lytic (soap-bubbly) – RCC
• Cookie-bite lesions of the cortices of long bones – Lung
• Bone scans are extremely sensitive but not very specific
• 10-40% of lesions will not be visible on plain film but will be positive on bone scans
• CT or MRI can be used to show findings in patients with negative conventional radiographs
and positivebone scans
63. SKELETAL METASTASES. LATERAL RADIOGRAPHS OF THE SKULL OF
TWO DIFFERENT PATIENTS SHOW MULTIPLE ILL-DEFINED LYTIC
LESIONS OF VARYING SIZES IN THE CALVARIUM
64. Metastasis from carcinoma
prostate.
AP radiograph of the
femur shows OSTEOBLASTIC
METASTASIS WITH
EXTENSIVE ‘SUNBURST’
PERIOSTEAL REACTION
resembling osteosarcoma
65. SKELETAL SCINTIGRAPHY IN METASTATIC DISEASE OF
THE SKELETON
SHOWS MULTIPLE RANDOMLY DISTRIBUTED FOCAL
LESIONS SCATTERED THROUGHOUT
THE SKELETON, PARTICULARLY THE SPINE, RIBS, AND
PELVIS