This document discusses diagnostic imaging of pediatric soft tissue sarcomas. It begins by defining sarcomas and their subtypes, noting that while most sarcomas occur in adults, approximately 1 in 10 occur in children. The most common pediatric soft tissue sarcomas are rhabdomyosarcoma and non-rhabdomyosarcomatous sarcomas such as synovial sarcoma. MRI is typically the preferred imaging method due to its excellent soft tissue contrast. While imaging cannot usually determine a specific diagnosis, it can characterize lesions and identify features that suggest malignancy. Staging with imaging also helps determine appropriate treatment.
1. Malignant bone tumors are aggressive cancers that rapidly destroy tissue and commonly spread to other areas. They make up about 0.5% of all cancers.
2. The most common malignant bone tumors are metastases from other primary cancers, which account for 70% of cases. Primary bone cancers include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.
3. Diagnosis involves imaging like x-rays, CT, and MRI to identify bone destruction and tumor extent. Biopsy is needed for histological examination to determine the tumor type and grade. Treatment depends on the cancer but commonly involves surgery along with chemotherapy and radiation.
Bone sarcomas are rare cancers that can be curable if treated properly. The main types are osteosarcoma, Ewing sarcoma, and chondrosarcoma. Staging involves imaging and biopsy to determine tumor size, location, and spread. Multidisciplinary teams are needed for optimal care. Chemotherapy is important for osteosarcoma and Ewing sarcoma but not usually effective for chondrosarcoma. Neoadjuvant chemotherapy followed by surgery improves outcomes for osteosarcoma over surgery alone. Short and long chemotherapy regimens appear equally effective for operable osteosarcoma. Ifosfamide added to standard regimens improves outcomes for non-metastatic and
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
This document discusses bone tumors and physiotherapy. It begins with an introduction to bone tumors, classifying them as either primary or secondary and noting the most common types are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. It then covers the pathophysiology of bone tumors, including inherited genetic risk factors. The document outlines the assessment process for bone tumors, from patient history to range of motion and muscle testing. It concludes by discussing medical treatments for bone tumors and considerations for physiotherapy interventions.
This document provides an overview of sarcomas, including:
- Sarcomas are rare tumors accounting for less than 1% of cancers. They arise from embryonic mesoderm tissue.
- The document discusses the epidemiology, types, clinical presentation, investigation, and histopathology of sarcomas. It focuses on some of the most common subtypes like malignant fibrous histiocytoma, liposarcoma, and leiomyosarcoma.
- Evaluation of sarcoma involves clinical examination, imaging such as MRI or CT, and biopsy for histopathological diagnosis. Proper investigation is important for staging and determining the best treatment approach.
The new 5th edition of the WHO Classification of Soft Tissue Tumors was published in 2020, updating the classification with contemporary knowledge of clinicopathologic and molecular features of soft tissue tumors. Key changes include the addition of newly described entities, outcome data, updated prognostic information, and genetic studies that resulted in some tumors being split into separate entities. The classification emphasizes the continued importance of morphology while also incorporating expanding genetic contributions to understanding pathogenesis.
1. Malignant bone tumors are aggressive cancers that rapidly destroy tissue and commonly spread to other areas. They make up about 0.5% of all cancers.
2. The most common malignant bone tumors are metastases from other primary cancers, which account for 70% of cases. Primary bone cancers include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.
3. Diagnosis involves imaging like x-rays, CT, and MRI to identify bone destruction and tumor extent. Biopsy is needed for histological examination to determine the tumor type and grade. Treatment depends on the cancer but commonly involves surgery along with chemotherapy and radiation.
Bone sarcomas are rare cancers that can be curable if treated properly. The main types are osteosarcoma, Ewing sarcoma, and chondrosarcoma. Staging involves imaging and biopsy to determine tumor size, location, and spread. Multidisciplinary teams are needed for optimal care. Chemotherapy is important for osteosarcoma and Ewing sarcoma but not usually effective for chondrosarcoma. Neoadjuvant chemotherapy followed by surgery improves outcomes for osteosarcoma over surgery alone. Short and long chemotherapy regimens appear equally effective for operable osteosarcoma. Ifosfamide added to standard regimens improves outcomes for non-metastatic and
Malignant Bone Tumours - A lecture for undergraduate students and demonstrators / Tutors featuring general aspects and three common malignant bone tumours viz. Osteosarcoma, Ewing's Sarcoma and Multiple Myeloma
Soft tissue sarcomas are rare malignant tumors that can arise in any soft tissue of the body. They are characterized by their genetic alterations and histological grade. Diagnosis is made through biopsy and imaging is used to stage the tumor. Treatment typically involves complete surgical resection with negative margins, along with possible adjuvant radiation and chemotherapy depending on tumor grade and size. Prognosis depends on factors like tumor size, grade, depth, and completeness of resection. Recurrence rates remain high, especially for retroperitoneal and visceral soft tissue sarcomas.
This document discusses bone tumors and physiotherapy. It begins with an introduction to bone tumors, classifying them as either primary or secondary and noting the most common types are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. It then covers the pathophysiology of bone tumors, including inherited genetic risk factors. The document outlines the assessment process for bone tumors, from patient history to range of motion and muscle testing. It concludes by discussing medical treatments for bone tumors and considerations for physiotherapy interventions.
This document provides an overview of sarcomas, including:
- Sarcomas are rare tumors accounting for less than 1% of cancers. They arise from embryonic mesoderm tissue.
- The document discusses the epidemiology, types, clinical presentation, investigation, and histopathology of sarcomas. It focuses on some of the most common subtypes like malignant fibrous histiocytoma, liposarcoma, and leiomyosarcoma.
- Evaluation of sarcoma involves clinical examination, imaging such as MRI or CT, and biopsy for histopathological diagnosis. Proper investigation is important for staging and determining the best treatment approach.
The new 5th edition of the WHO Classification of Soft Tissue Tumors was published in 2020, updating the classification with contemporary knowledge of clinicopathologic and molecular features of soft tissue tumors. Key changes include the addition of newly described entities, outcome data, updated prognostic information, and genetic studies that resulted in some tumors being split into separate entities. The classification emphasizes the continued importance of morphology while also incorporating expanding genetic contributions to understanding pathogenesis.
The document discusses various pediatric retroperitoneal masses. It begins by noting that abdominal masses are most common in children under 5 years old and retroperitoneal masses in neonates are often kidney-related and benign. It then characterizes the retroperitoneal space and lists common retroperitoneal organs. Several pathologies are discussed in detail, including neuroblastoma, Wilms tumor, nephroblastomatosis, and renal cell carcinoma. Imaging findings for many conditions are provided. The document serves as an overview of pediatric retroperitoneal masses and their imaging appearances.
Orthopaedics - Bone tumor (compiled cases)Afiqi Fikri
1. A 60-year-old man presented with worsening back pain for one month without any history of trauma.
2. Blood tests showed a monoclonal gammopathy and elevated ESR of 100mm.
3. The main differential diagnosis is multiple myeloma, which commonly affects patients around age 45-65 and presents with bone pain due to lytic bone lesions caused by plasma cell infiltration and monoclonal protein production. Further investigations such as skeletal survey, serum and urine protein electrophoresis, and bone marrow biopsy are needed to confirm the diagnosis.
Spinal tumors can be classified based on their point of origin as being intramedullary, intradural-extramedullary, or extradural. Common intramedullary tumors include ependymomas, astrocytomas, gangliogliomas, and hemangioblastomas. Ependymomas typically appear as well-circumscribed lesions on MRI and may contain intratumoral or polar cysts. Astrocytomas tend to infiltrate the spinal cord eccentrically and demonstrate heterogeneous enhancement. Gangliogliomas commonly involve multiple vertebral segments and may contain calcifications. Hemangioblastomas are highly vascular tumors that can be either intramedullary or intradural-extra
This patient is a 13-year-old girl presenting with right thigh pain and elevated markers. Imaging shows erosion of the tumor through the cortex with no metastases. Biopsy reveals malignant spindle cells producing osteoid. This represents Stage IIb osteosarcoma - a high grade tumor with extra-compartmental growth and no metastases. The next steps are neoadjuvant chemotherapy followed by wide excision and reconstruction with adjuvant chemotherapy to treat micrometastatic disease.
Externalbeam rt in ews3.12.20 - frida yseminar-finallllPRARABDH95
1) Ewing sarcoma and osteosarcoma are rare bone cancers that typically affect children and young adults. Ewing sarcoma is the second most common primary bone cancer while osteosarcoma most commonly presents as a primary bone malignancy.
2) Both cancers are diagnosed through imaging, biopsy and staging workup. Management involves chemotherapy along with local therapy through surgery and/or radiation therapy.
3) Radiation therapy planning aims to adequately cover the tumor volume while sparing nearby organs at risk. Techniques such as 3D conformal radiation therapy and intensity modulated radiation therapy (IMRT) allow for improved dose distribution over conventional radiation.
This document discusses primary retroperitoneal masses and provides an overview of mesodermal tumors, which constitute 47-57% of primary retroperitoneal tumors. It describes key imaging findings and pathological characteristics of common mesodermal tumors including liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Well-differentiated liposarcoma, dedifferentiated liposarcoma, and myxoid liposarcoma are subtypes of liposarcoma discussed in detail, outlining their imaging appearance on CT, MRI, and PET scans as well as histological features. Complete surgical excision is important but recurrence is common, necessitating long-term imaging follow-up.
This is a powerpoint(case presentation) for radiology and imaging resident.There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Soft tissue sarcomas are rare cancers that arise from connective tissues. They most commonly occur in the extremities and abdominal cavity. Diagnosis involves biopsy and imaging such as MRI or CT. Treatment is primarily surgical resection with clear margins, sometimes combined with radiation therapy or chemotherapy. Prognostic factors include tumor size, grade, and margin status. Complete surgical removal with negative margins improves local control and survival outcomes for soft tissue sarcomas.
This document provides an overview of osteosarcoma and Ewing's sarcoma, including their genetic basis, clinical presentation, radiological findings, biopsy, management, and prognosis. Osteosarcoma is the second most common primary bone cancer and most commonly affects the metaphysis of long bones in adolescents and young adults. Presentation includes pain, swelling, and sometimes pathological fractures. Diagnosis involves imaging such as X-ray, CT, MRI and biopsy. Treatment typically involves neoadjuvant chemotherapy, surgical resection with wide margins, and additional chemotherapy. Prognosis depends on stage and response to treatment, with 5-year survival rates ranging from 60-80% for localized disease.
This document summarizes soft tissue sarcomas (STS), a rare type of cancer. It discusses that STS can occur anywhere in the body and there are over 100 subtypes. Surgery is the main treatment but chemotherapy and radiation therapy may also be used. Prognosis depends on factors like tumor size, grade, and whether it has metastasized. Recurrence is common and occurs in up to 50% of cases. Specific types discussed include gastrointestinal stromal tumor (GIST) and retroperitoneal sarcomas, which have poorer outcomes compared to extremity STS. Liposarcoma and leiomyosarcoma are two of the most common STS subtypes.
This document discusses chest wall tumors. It begins with the epidemiology, noting that primary chest wall tumors are rare but metastasis to the chest wall is more common. It then covers the clinical presentation, workup including imaging and biopsy, and classification of both benign and malignant chest wall tumors. For treatment, it states that surgery is used for benign tumors and pain management. For malignant tumors like osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma, neoadjuvant chemotherapy and surgery with radiation are used. Wide local excision with margins of 1-5 cm is recommended depending on grade. Reconstruction techniques after resection include meshes, neo-ribs, pedicled and free flaps depending on
Osteosarcoma is the most common type of primary bone cancer that typically affects the long bones of children and young adults. It originates in the bone and spreads aggressively. Symptoms can include pain, swelling, and limited movement near the affected bone. Diagnosis involves physical exams, x-rays showing bone destruction and tumor formation, and biopsies. Treatment consists of several months of chemotherapy before surgery to remove the tumor and surrounding tissue, followed by additional chemotherapy or radiation, with 5-year survival rates of 60-80% when treated.
Osteosarcoma is a highly malignant bone tumor that is most common in adolescents and young adults. It involves spindle-shaped cells that produce osteoid or bone-like tissue. Treatment involves biopsy to confirm the diagnosis, preoperative chemotherapy, surgical resection of the tumor with wide margins, and additional postoperative chemotherapy. New approaches using combinations of drugs like gemcitabine and genistein show promise in enhancing the antitumor effects for osteosarcoma by downregulating pathways like Akt and NF-κB that can lead to chemotherapy resistance.
Osteosarcoma is a type of bone cancer that arises from bone-forming cells. It is most common in children and older adults. The cause is unknown, but family history is a risk factor. It tends to occur in the large bones around the knee, thigh, or shoulder. Symptoms include bone pain, swelling, and fractures. Diagnostic tests include biopsy, imaging scans, and blood tests. Treatment involves chemotherapy before surgery to remove the tumor, with the goal of preserving the affected limb through limb-sparing surgery. Complications can include amputation, cancer spread to the lungs, and side effects from chemotherapy.
Ewing's sarcoma is a rare type of cancer that develops in bone or soft tissue. It is the second most common primary bone cancer in children and adolescents between 10-20 years old. The cancer presents with local swelling and tenderness at the affected site, most commonly the diaphysis of long bones. Metastasis is often present at diagnosis, with the lungs being the most common site. Diagnosis is confirmed through histopathological or cytogenetic testing. Treatment involves neoadjuvant chemotherapy followed by local tumor control through surgery or radiation therapy, along with adjuvant chemotherapy. Five-year survival rates have improved to around 70% with current multi-agent chemotherapy regimens.
This document provides a classification of tumors and tumorous conditions of the hand. It begins by explaining that hand tumors can arise from any tissue, including skin, subcutaneous tissue, tendons, nerves, blood vessels and bone. It then classifies tumors into three main types: benign tumors, malignant tumors, and tumorous conditions. Within each type, tumors are further classified based on the specific tissue of origin, such as bone tumors, soft tissue tumors, and skin tumors. Numerous specific tumor examples are listed and briefly described under each tissue of origin classification. The document concludes by defining tumorous conditions as usually non-cancerous lesions, separating them into cystic and non-cystic conditions with representative examples.
1. The document discusses various white matter disorders that can be seen on MRI imaging. It focuses on demyelinating diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and other related conditions.
2. MS is characterized by well-defined white matter lesions that are often ovoid or perpendicular to the ventricles. Lesions can also be seen in the corpus callosum, brainstem, spinal cord, and optic nerves. MRI is important for diagnosis and monitoring of MS.
3. NMO preferentially affects the spinal cord and optic nerves. Lesions are often longitudinally extensive in the spinal
This document discusses the classification, presentation, diagnosis and treatment of primary bone tumors. It focuses on osteosarcoma, chondrosarcoma, giant cell tumor and Ewing sarcoma. Key points include:
1) Osteosarcoma is the most common primary malignant bone tumor, typically affecting teenagers, with localized pain and swelling and characteristic x-ray findings.
2) Chondrosarcoma arises from cartilage and commonly involves the pelvis, spine or shoulder. Giant cell tumor contains multinucleated giant cells and often affects the epiphysis of long bones.
3) Diagnosis involves imaging, biopsy and staging. Treatment consists of preoperative chemotherapy, surgical resection with reconstruction
Malignant bone tumors can be primary (arising in bone) or metastatic (spread from elsewhere). The most common primary malignant bone tumors are multiple myeloma, osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Clinical presentation includes pain, swelling, pathological fracture. X-rays can show features like bone destruction, new bone formation, periosteal reaction. Diagnosis requires biopsy. Treatment involves surgery such as wide excision or radical excision combined with chemotherapy and/or radiotherapy. The goal of treatment is to remove the tumor while preserving limb function through techniques like bone grafts or prosthetics.
The document discusses various pediatric retroperitoneal masses. It begins by noting that abdominal masses are most common in children under 5 years old and retroperitoneal masses in neonates are often kidney-related and benign. It then characterizes the retroperitoneal space and lists common retroperitoneal organs. Several pathologies are discussed in detail, including neuroblastoma, Wilms tumor, nephroblastomatosis, and renal cell carcinoma. Imaging findings for many conditions are provided. The document serves as an overview of pediatric retroperitoneal masses and their imaging appearances.
Orthopaedics - Bone tumor (compiled cases)Afiqi Fikri
1. A 60-year-old man presented with worsening back pain for one month without any history of trauma.
2. Blood tests showed a monoclonal gammopathy and elevated ESR of 100mm.
3. The main differential diagnosis is multiple myeloma, which commonly affects patients around age 45-65 and presents with bone pain due to lytic bone lesions caused by plasma cell infiltration and monoclonal protein production. Further investigations such as skeletal survey, serum and urine protein electrophoresis, and bone marrow biopsy are needed to confirm the diagnosis.
Spinal tumors can be classified based on their point of origin as being intramedullary, intradural-extramedullary, or extradural. Common intramedullary tumors include ependymomas, astrocytomas, gangliogliomas, and hemangioblastomas. Ependymomas typically appear as well-circumscribed lesions on MRI and may contain intratumoral or polar cysts. Astrocytomas tend to infiltrate the spinal cord eccentrically and demonstrate heterogeneous enhancement. Gangliogliomas commonly involve multiple vertebral segments and may contain calcifications. Hemangioblastomas are highly vascular tumors that can be either intramedullary or intradural-extra
This patient is a 13-year-old girl presenting with right thigh pain and elevated markers. Imaging shows erosion of the tumor through the cortex with no metastases. Biopsy reveals malignant spindle cells producing osteoid. This represents Stage IIb osteosarcoma - a high grade tumor with extra-compartmental growth and no metastases. The next steps are neoadjuvant chemotherapy followed by wide excision and reconstruction with adjuvant chemotherapy to treat micrometastatic disease.
Externalbeam rt in ews3.12.20 - frida yseminar-finallllPRARABDH95
1) Ewing sarcoma and osteosarcoma are rare bone cancers that typically affect children and young adults. Ewing sarcoma is the second most common primary bone cancer while osteosarcoma most commonly presents as a primary bone malignancy.
2) Both cancers are diagnosed through imaging, biopsy and staging workup. Management involves chemotherapy along with local therapy through surgery and/or radiation therapy.
3) Radiation therapy planning aims to adequately cover the tumor volume while sparing nearby organs at risk. Techniques such as 3D conformal radiation therapy and intensity modulated radiation therapy (IMRT) allow for improved dose distribution over conventional radiation.
This document discusses primary retroperitoneal masses and provides an overview of mesodermal tumors, which constitute 47-57% of primary retroperitoneal tumors. It describes key imaging findings and pathological characteristics of common mesodermal tumors including liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Well-differentiated liposarcoma, dedifferentiated liposarcoma, and myxoid liposarcoma are subtypes of liposarcoma discussed in detail, outlining their imaging appearance on CT, MRI, and PET scans as well as histological features. Complete surgical excision is important but recurrence is common, necessitating long-term imaging follow-up.
This is a powerpoint(case presentation) for radiology and imaging resident.There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Soft tissue sarcomas are rare cancers that arise from connective tissues. They most commonly occur in the extremities and abdominal cavity. Diagnosis involves biopsy and imaging such as MRI or CT. Treatment is primarily surgical resection with clear margins, sometimes combined with radiation therapy or chemotherapy. Prognostic factors include tumor size, grade, and margin status. Complete surgical removal with negative margins improves local control and survival outcomes for soft tissue sarcomas.
This document provides an overview of osteosarcoma and Ewing's sarcoma, including their genetic basis, clinical presentation, radiological findings, biopsy, management, and prognosis. Osteosarcoma is the second most common primary bone cancer and most commonly affects the metaphysis of long bones in adolescents and young adults. Presentation includes pain, swelling, and sometimes pathological fractures. Diagnosis involves imaging such as X-ray, CT, MRI and biopsy. Treatment typically involves neoadjuvant chemotherapy, surgical resection with wide margins, and additional chemotherapy. Prognosis depends on stage and response to treatment, with 5-year survival rates ranging from 60-80% for localized disease.
This document summarizes soft tissue sarcomas (STS), a rare type of cancer. It discusses that STS can occur anywhere in the body and there are over 100 subtypes. Surgery is the main treatment but chemotherapy and radiation therapy may also be used. Prognosis depends on factors like tumor size, grade, and whether it has metastasized. Recurrence is common and occurs in up to 50% of cases. Specific types discussed include gastrointestinal stromal tumor (GIST) and retroperitoneal sarcomas, which have poorer outcomes compared to extremity STS. Liposarcoma and leiomyosarcoma are two of the most common STS subtypes.
This document discusses chest wall tumors. It begins with the epidemiology, noting that primary chest wall tumors are rare but metastasis to the chest wall is more common. It then covers the clinical presentation, workup including imaging and biopsy, and classification of both benign and malignant chest wall tumors. For treatment, it states that surgery is used for benign tumors and pain management. For malignant tumors like osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma, neoadjuvant chemotherapy and surgery with radiation are used. Wide local excision with margins of 1-5 cm is recommended depending on grade. Reconstruction techniques after resection include meshes, neo-ribs, pedicled and free flaps depending on
Osteosarcoma is the most common type of primary bone cancer that typically affects the long bones of children and young adults. It originates in the bone and spreads aggressively. Symptoms can include pain, swelling, and limited movement near the affected bone. Diagnosis involves physical exams, x-rays showing bone destruction and tumor formation, and biopsies. Treatment consists of several months of chemotherapy before surgery to remove the tumor and surrounding tissue, followed by additional chemotherapy or radiation, with 5-year survival rates of 60-80% when treated.
Osteosarcoma is a highly malignant bone tumor that is most common in adolescents and young adults. It involves spindle-shaped cells that produce osteoid or bone-like tissue. Treatment involves biopsy to confirm the diagnosis, preoperative chemotherapy, surgical resection of the tumor with wide margins, and additional postoperative chemotherapy. New approaches using combinations of drugs like gemcitabine and genistein show promise in enhancing the antitumor effects for osteosarcoma by downregulating pathways like Akt and NF-κB that can lead to chemotherapy resistance.
Osteosarcoma is a type of bone cancer that arises from bone-forming cells. It is most common in children and older adults. The cause is unknown, but family history is a risk factor. It tends to occur in the large bones around the knee, thigh, or shoulder. Symptoms include bone pain, swelling, and fractures. Diagnostic tests include biopsy, imaging scans, and blood tests. Treatment involves chemotherapy before surgery to remove the tumor, with the goal of preserving the affected limb through limb-sparing surgery. Complications can include amputation, cancer spread to the lungs, and side effects from chemotherapy.
Ewing's sarcoma is a rare type of cancer that develops in bone or soft tissue. It is the second most common primary bone cancer in children and adolescents between 10-20 years old. The cancer presents with local swelling and tenderness at the affected site, most commonly the diaphysis of long bones. Metastasis is often present at diagnosis, with the lungs being the most common site. Diagnosis is confirmed through histopathological or cytogenetic testing. Treatment involves neoadjuvant chemotherapy followed by local tumor control through surgery or radiation therapy, along with adjuvant chemotherapy. Five-year survival rates have improved to around 70% with current multi-agent chemotherapy regimens.
This document provides a classification of tumors and tumorous conditions of the hand. It begins by explaining that hand tumors can arise from any tissue, including skin, subcutaneous tissue, tendons, nerves, blood vessels and bone. It then classifies tumors into three main types: benign tumors, malignant tumors, and tumorous conditions. Within each type, tumors are further classified based on the specific tissue of origin, such as bone tumors, soft tissue tumors, and skin tumors. Numerous specific tumor examples are listed and briefly described under each tissue of origin classification. The document concludes by defining tumorous conditions as usually non-cancerous lesions, separating them into cystic and non-cystic conditions with representative examples.
1. The document discusses various white matter disorders that can be seen on MRI imaging. It focuses on demyelinating diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and other related conditions.
2. MS is characterized by well-defined white matter lesions that are often ovoid or perpendicular to the ventricles. Lesions can also be seen in the corpus callosum, brainstem, spinal cord, and optic nerves. MRI is important for diagnosis and monitoring of MS.
3. NMO preferentially affects the spinal cord and optic nerves. Lesions are often longitudinally extensive in the spinal
This document discusses the classification, presentation, diagnosis and treatment of primary bone tumors. It focuses on osteosarcoma, chondrosarcoma, giant cell tumor and Ewing sarcoma. Key points include:
1) Osteosarcoma is the most common primary malignant bone tumor, typically affecting teenagers, with localized pain and swelling and characteristic x-ray findings.
2) Chondrosarcoma arises from cartilage and commonly involves the pelvis, spine or shoulder. Giant cell tumor contains multinucleated giant cells and often affects the epiphysis of long bones.
3) Diagnosis involves imaging, biopsy and staging. Treatment consists of preoperative chemotherapy, surgical resection with reconstruction
Malignant bone tumors can be primary (arising in bone) or metastatic (spread from elsewhere). The most common primary malignant bone tumors are multiple myeloma, osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Clinical presentation includes pain, swelling, pathological fracture. X-rays can show features like bone destruction, new bone formation, periosteal reaction. Diagnosis requires biopsy. Treatment involves surgery such as wide excision or radical excision combined with chemotherapy and/or radiotherapy. The goal of treatment is to remove the tumor while preserving limb function through techniques like bone grafts or prosthetics.
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.
This document discusses bone tumors, including:
- Risk factors include genetic syndromes, radiation exposure, and injuries.
- Types include benign (osteochondroma, bone cysts) and malignant (osteosarcoma, chondrosarcoma, Ewing's sarcoma) tumors.
- Diagnosis involves imaging (X-rays, CT, MRI), biopsy, and TNM staging.
- Treatment depends on tumor type but may include chemotherapy, radiation therapy, surgery, and targeted therapy.
This document discusses bone tumors, including:
- Bone tumors can be benign or malignant and develop from uncontrolled cell division in bones. Common types include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.
- Risk factors include genetic disorders, radiation exposure, and other cancers. Symptoms include bone pain, swelling, limited mobility, and pathological fractures.
- Diagnosis involves imaging like X-rays, CT, MRI and PET scans. Biopsies are also used to identify the tumor type and stage. Staging uses the TNM classification system to assess tumor size, spread to lymph nodes and distant organs.
Primary bone tumors are rare, accounting for only 0.2-0.5% of all tumors. The majority of bone tumors are secondary metastases rather than primary tumors. Primary bone tumors are classified based on the cell of origin and can be benign or malignant. Benign bone tumors are more common in children and adolescents while malignant tumors typically present in older age groups. Diagnosis involves clinical presentation, imaging studies such as x-ray and biopsy. Treatment depends on whether the tumor is benign or malignant and the specific type and stage of tumor.
This document discusses bone tumors, including:
- Types of bone tumors include benign (e.g. osteochondroma) and malignant (e.g. osteosarcoma, chondrosarcoma).
- Risk factors, signs/symptoms, diagnostic tests (e.g. x-rays, biopsy), TNM classification, and management approaches are described.
- Management may involve chemotherapy, radiation therapy, surgery, and targeted therapy depending on the type and stage of bone tumor. The goal is to remove the tumor while minimizing damage to healthy tissue.
This document discusses bone tumors. It begins by defining normal bone anatomy and physiology. It then discusses the various types of bone tumors, including benign and malignant primary bone tumors as well as secondary metastatic bone tumors. Risk factors, clinical manifestations, diagnostic studies such as x-rays, biopsy, and the TNM classification system are explained. Finally, management approaches are covered, including chemotherapy, radiation therapy, surgical procedures like limb salvage versus amputation, and postoperative care.
This document discusses bone tumors, including classification, clinical features, diagnosis, and treatment. It covers both benign and malignant tumors. Benign tumors are more common and often asymptomatic, while primary malignant tumors are rare but can be aggressive. Diagnosis involves medical history, physical exam, radiological imaging like X-ray and MRI, and biopsy. Treatment depends on tumor type, grade, and stage, and may include surgical excision, chemotherapy, or limb salvage versus amputation for malignant tumors. The goal is wide excision for local control while minimizing damage and recurrence risks.
Bone tumors can be benign or malignant. Benign tumors are encapsulated and compress surrounding tissue, while malignant tumors invade tissue and metastasize. Bone tumors are classified based on the type of tissue they form (e.g. bone, cartilage), their location in the bone, and whether they are primary or metastatic. Staging systems evaluate tumor grade, size, and spread to determine prognosis and guide treatment. Imaging including x-rays and MRI are used to identify tumor location, effects on bone, and presence of metastases to aid diagnosis.
The document discusses several types of primary bone cancers. It focuses on chondrosarcoma, which arises from cartilage and most commonly affects the pelvis and femur in older adults. The document outlines diagnostic evaluation, staging, histologic grading, and treatment approaches including wide local excision and adjuvant therapies for chondrosarcoma. Prognosis depends on tumor grade and location. Ewing's sarcoma and osteosarcoma are also discussed as well as giant cell tumor of bone.
The document discusses retroperitoneal masses. It notes that primary retroperitoneal masses originate in the retroperitoneum outside major organs. CT and MRI are important imaging modalities. Retroperitoneal masses can be solid or cystic neoplastic or non-neoplastic tumors. The majority are malignant. Common solid neoplastic masses include mesodermal tumors like liposarcomas, neurogenic tumors, and germ cell tumors. Imaging findings of common tumor types are described.
Bone tumors can be benign or malignant. Common benign bone tumors include osteochondroma and osteoid osteoma, while common malignant bone tumors are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Bone tumors are classified based on their location, histologic type, and other characteristics. Diagnostic evaluation involves imaging like x-rays, CT, MRI and biopsy. Staging systems evaluate tumor grade, size, and metastasis status. Treatment depends on tumor type, stage, and other factors.
Primary tumors of the spine require special treatment considerations due to the biomechanical and neurological structures of the spine. Common benign primary spine tumors include osteoid osteoma, osteoblastoma, aneurysmal bone cyst, and Langerhans cell histiocytosis. Osteoid osteoma typically presents as a painful lytic lesion best seen on CT. Osteoblastoma and aneurysmal bone cyst are expansile lesions that can be locally aggressive. Treatment involves complete surgical excision or embolization with the goal of preventing recurrence. Langerhans cell histiocytosis commonly affects children and adolescents, presenting as vertebral flattening with self-limited symptoms in many cases.
Soft tissue tumors are a heterogeneous group of lesions that arise from nonepithelial, extraskeletal tissues including adipose tissue, muscles, tendons, blood vessels and lymphatics. Imaging plays an important role in evaluating these tumors. There are nine major groups of soft tissue tumors including adipocytic tumors, vascular tumors, fibroblastic tumors, fibrohistiocytic tumors, smooth muscle tumors, skeletal muscle tumors, pericytic tumors, chondro-osseous tumors and tumors of uncertain differentiation. Lipoma is the most common benign adipocytic tumor while liposarcoma is a malignant adipocytic tumor. Hemangioma is a common benign vascular tumor and angiosarcoma is the most common
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Bone tumour , enchondroma , osteochondromaSagar Savsani
The document provides information on neoplasia and the differences between benign and malignant tumors. It discusses the classification, clinical presentation, investigations, and radiographic evaluation of bone tumors. Some key points include:
- Benign tumors are usually encapsulated, compress surrounding tissue, and have low growth rates, while malignant tumors are poorly circumscribed, invade tissue, and have rapid growth rates.
- Bone tumors are classified based on the WHO system, site of origin, and Enneking's staging which considers grade, tumor size, and metastasis.
- Common presentations are pain, localized swelling, and laboratory findings such as elevated alkaline phosphatase. Imaging like x-rays help identify tumor location, borders, bone destruction
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. Radiology plays a key role in detecting melanoma and its metastases.
2. The presentation summarizes cases of melanoma metastases to various locations including the small bowel, stomach, pancreas, spleen, adrenals, peritoneum, and breasts to highlight important imaging characteristics.
3. Identifying melanoma metastases early through imaging allows for improved patient management including surgical resection or immunotherapy treatment.
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1. Diagnostic Imaging of Pediatric
Soft Tissue Sarcomas
G. Scott Stacy, MD
Department of Radiology
University of Chicago Medicine
2. Learning Objectives
• Become familiar with common soft tissue sarcomas that
occur in children
• Understand the role of appropriate imaging in the
diagnosis, staging and management of pediatric soft
tissue sarcomas
3. Introduction
• What is a sarcoma?
– Malignant tumor arising from “solid” connective tissues
of mesenchymal origin
– 2 basic types: bone sarcomas and soft tissue sarcomas
– <1% of all cancers
• C/W carcinoma:
– Malignant tumor of epithelial origin
– ~90% of all cancers
• Other cancers: leukemia, lymphoma, myeloma; mixed
4. Introduction
• ~11,000 new cases of STS per year in the U.S.
• Compared with:
– ~3,000 new cases of bone sarcoma
– ~50,000 new cases of leukemia*
– ~70,000 new cases of non-Hodgkin lymphoma*
– ~240,000 new cases of prostate carcinoma*
*Considered “common” cancers (>40,000 annual incidence) by the American Cancer Society
www.cancer.gov/cancertopics/types/commoncancers
5. Introduction
• Most STS are encountered in adults >20y of age
– Most common soft tissue sarcomas in older adults:
• Pleomorphic sarcoma (“malig. fibrous
histiocytoma”)
• Liposarcoma
• Leiomyosarcoma
• ~1 in 10 STS are encountered in patients <20y of age
– ~5% of childhood malignancies (<leukemia, CNS
tumors)
– The common STS seen in older adult patients are
relatively uncommon in children
www.cancer.gov/cancertopics/types/commoncancers
6. Classifying Pediatric Soft Tissue
Sarcomas
“Pediatric Type” STS
• Median incidence in 1st two
decades of life
• Commonly small round blue
cell tumors (e.g.,
rhabdomyosarcoma, Ewing
sarcoma family of tumors)
• High response rates to chemo
(+ surgery and/or RT for local
control)
“Adult Type” STS
• Occur most often beyond 3rd
decade of life
• Spindle cell (or other)
differentiation
• Surgery = mainstay of
treatment +/- RT;
chemoresistance often
predominates
7. Classifying Pediatric Soft Tissue
Sarcomas
• More “typical” classification:
– Rhabdomyosarcoma (~50%): most children <6y of
age; 2nd peak between 15 & 19y
– Nonrhabdomyosarcomatous sarcomas (~50%): most
occur in adolescents and young adults
• Synovial sarcoma
• Fibrosarcoma
• Malignant peripheral nerve sheath tumors
(MPNST)
• Ewing sarcoma family of tumors (ESFT)
8. Clinical Presentation and
Evaluation
• Most common symptom:
mass increasing in size;
usually NOT painful
• Important: majority of soft
tissue masses that present
to physician are benign
• Vascular lesions
• Fibrous and
fibrohistiocytic tumors
• Pseudotumors
9. Clinical Presentation and
Evaluation
• Is imaging necessary?
• Depends on H&P
• May observe lesion if <5
cm, soft, superficial, not
enlarging
• Imaging should be
considered in other cases
10. Role of Imaging
• Detection
• Imaging not as important for detection of ST masses
as for bone lesions
• Exception: use of whole body imaging (MRI, PET) to
detect “occult” primary soft tissue tumor in patients
with disseminated disease
• Characterization of the mass
• Staging and post-treatment assessment
• Guiding biopsy
11. Role of Imaging
• Detection
• Characterization of the mass
• Is it a neoplasm? If not, what is it?
• If so, are there imaging features that suggest a
particular diagnosis, and therefore suggest whether
the mass is benign or malignant?
• Staging and post-treatment assessment
• Intervention (if necessary)
12. Imaging Studies
• Radiography
• Ultrasonography
• Computed Tomography
• Positron Emission Tomography (role developing)
• Magnetic Resonance Imaging
– Technique of choice for evaluation of soft tissue
masses due to excellent soft tissue contrast
13. Radiographs Remain an Important First Study!
• Often unrewarding,
BUT…
• May reveal:
– Bone involvement by a
soft tissue mass
– Lesion projecting from
bone that presents as
a deep soft tissue
mass clinically
– Mineralization or fat
that assists diagnosis
14. Ultrasonography
• Simple first-line
examination, esp. for young
children
– Cyst versus solid, non-
vascular versus
vascular, vessel density
– Pseudotumors: synovial
cyst, foreign body
– Benign tumors:
hemangioma,
fibromatosis colli
– Vascular malformations
15. Computed Tomography
• Largely replaced by MRI
for evaluation of ST
tumors
• Indications:
– Patients with
contraindication to
MRI
– Lesions of chest &
anterior abdominal
wall
– Better characterization
of mineralization
T2
T1+C
T1
“Myositis Ossificans”
16. Positron Emission Tomography
• Role still developing:
– High-grade
malignancies higher
rates of glycolysis/FDG
uptake (overlap)
– Intensity of uptake and
identification of necrosis
on pre-treatment staging
studies prognostic
markers
– Direct biopsy to
metabolically active area
of tumor
ES
MPNST
17. MRI
• Accepted as modality of
choice for evaluating ST
masses
– Superior soft tissue
contrast
– Lack of ionizing
radiation
• Sedation usu. needed for
young children
18. MRI
• Standard “anatomic” technique:
– At least 2 orthogonal planes
– T1W and fluid-sensitive images
+/- fat suppression
– Gd-enhanced imaging
• Identifies viable tumor
(versus necrosis) for biopsy,
demonstrates enhancement
in myxoid lesions with
pseudocystic appearance
T1
T2
T1FS+C
20. MRI
• Lesion characterization includes assessment of
• Signal intensity: often “nonspecific”; can detect fat,
fluid, blood products, fibrous tissue
• Morphology: fusiform, lobulated
• Location
• Subcutaneous v. deep
• Intra- v. inter-muscular
• Intra- v. juxta-articular
• Adjacent structures
• Size
• Patient age and lesion prevalence
22. MRI
• Pitfalls:
– Both benign and
malignant soft tissue
tumors often have
“well-defined margins”
– Superficial sarcomas
often appear less
“aggressive” than
deep sarcomas
(smaller)
– Gadolinium
enhancement is seen
in both benign &
malignant tumors
(overlap)
23. MRI
• Emerging techniques:
– Dynamic contrast-enhanced MR imaging: evaluates
enhancement patterns (wash in, wash out) over time
– Diffusion-weighted MR imaging: evaluates random
motion of water molecules (restricted diffusion implies
higher cellularity)
– MR spectroscopy: can characterize lesions based on
metabolic constituents, including choline, a marker for
membrane turnover
-----------------Increasing b values---------------
(stronger diffusion weighting)
Viable
tumor
Necrosis (free motion ↓SI)
PRESS, single voxel
OVERLAP
24. Key Information From Imaging Studies that the Treatment
Team Needs to Know
• Character of lesion (benign, malignant, indeterminate)
• Size of the lesion (+ reactive zone of edema)
• Location
– Compartment(s)
– Relationship of lesion to neurovascular structures,
joints
– Relationship to palpable or fluoroscopically
identifiable anatomic landmark
• Other lesions on field-of-view (lymph nodes, mets)
• Recommendation (orthopaedic oncology consultation
versus biopsy)
25. Selected Sarcomas
• Rhabdomyosarcoma
• Synovial sarcoma
• Fibrosarcoma
• Dermatofibrosarcoma protuberans
• Malignant peripheral nerve sheath tumor
• Ewing sarcoma family of tumors
• Liposarcoma (myxoid)
• Most of these tumors have no specific imaging features
(hypointense on T1WI, hyperintense on T2WI)
26. Rhabdomyosarcoma
Most common soft tissue sarcoma in children
Tumor with cells showing features of skeletal muscle, but
does not necessarily arise from skeletal muscle
28. Rhabdomyosarcoma
• Three subtypes
• Embryonal
• 2/3 of cases
• Children typically <10y of age
• ~50% in the head and neck, followed by GU
system (~30%); <10% arise within skeletal
musculature of extremities
• Alveolar
• Pleomorphic
*
*
*
*
29. Rhabdomyosarcoma
• Three subtypes
• Embryonal
• Alveolar
• 1/3 of cases
• More common in adolescents and young adults
• Usu. intramuscular
• Lesions in extremities are typically alveolar
• Worse prognosis than embryonal type (esp. if
assoc. w/ translocation)
• Pleomorphic
30. Rhabdomyosarcoma
• Radiographs: no specific features
(mass, occ. bone involvement)
• MRI: no specific features
– T1WI: usually isointense to muscle
– T2WI: usually hyperintense
– Enhancement with Gd
– Intralesional hemorrhage not
unusual
– High-flow vessels described with
alveolar subtype
T1
+C
T1
T2FS
T1FS+C
31. Rhabdomyosarcoma
• Metastases detectable in 10-20% of patients at dx (most
common to lungs and pleura; also: bone & bone marrow)
• Lymph node involvement not uncommon; frequency
dependent on site (GU>extremity>orbit)
32. Synovial Sarcoma
• Common NRSTS in children
Most common STS of lower extremity in patients 6-35y of
age (most common b/t 15 & 35y)
• Upper extremity, head and neck, and other sites may be
involved
• Microscopic resemblance to developing synovial tissue
BUT
• Does NOT arise from nor differentiate toward synovium
• Rarely originates within a joint or bursa
• “Tumor of uncertain differentiation” (WHO)
33. Synovial Sarcoma
• Radiographs
– Normal in 50%
– When abnormal:
• Mass
• Calcifications in up to
1/3 (relatively rare in
other STS)
• Adjacent bone
involvement in 20%
34. Synovial Sarcoma
• MRI
– Usu. nonspecific large heterogeneous
deep mass arising near joint capsules,
tendon sheaths or bursae
– Hemorrhage in up to ¾: high SI on
T1WI, cyst-like appearance, fluid levels
– “Triple signal” on T2WI in up to 1/3:
hyperintense, isointense and
hypointense areas relative to fat due to
necrosis, hemorrhage, solid elements *
*
*
35. Synovial Sarcoma
• MRI
– Smaller lesions may be encountered
• May be homogeneous
• Notorious mimics of benign lesions
T2T2FST2FS
T1FS-C
T1FS+C
36. Synovial Sarcoma
Mets in up to 25% at
presentation (most
commonly lung); may
develop many yrs after dx
Lymph node involvement in
5-15%
Local recurrence common;
may be late
37. Epithelioid Sarcoma*
Most common malignant STS of hand
and wrist in adolescents/young adults
“Proximal” variant – more aggressive
MRI spectrum: sm. subq. nodule to large
infiltrative mass
Tends to grow slowly in nodular manner
along fascia/tendons, often w/ ulceration
Lymph node involvement common
Lung metastases common (up to 40%)
Recurrence/mets can occur up to 25yrs
after resection
* “Tumor of uncertain differentiation”
38. Alveolar Soft Part Sarcoma*
• Rare; usu. affects thigh,
buttock, head & neck of
adolescents/young adults
• Slow growing, hypervascular
(may be pulsatile w/ bruit)
• MRI: signal intensity often
greater than that of skeletal
muscle on T1WI; flow voids
particularly at periphery
• Mets in up to 20% of
patients (lung, brain, bone)
at dx, with late recurrences
* “Tumor of uncertain differentiation”
39. Fibrosarcoma
• 2 histologically identical forms:
– Infantile fibrosarcoma (a.k.a. “congenital”
fibrosarcoma)
• Infants and young children
• Favorable prognosis (5-year survival rate ~85%)
– Adult fibrosarcoma
• Usu. in middle-aged/older adults; but occ.
encountered in childhood (peaks in 10-15-year-
olds)
• Unfavorable prognosis (5-year survival rate 40-
55%)
40. Infantile Fibrosarcoma
Almost always occurs in 1st 2 years of life (congenital in
40-80%)
Location: extremities (50-70%) > trunk, head/neck
Tends to be large, grows rapidly
Overlying skin discoloration may lead to misdiagnosis of
hemangioma; analysis of translocation t(12;15)(p13;q25)
important
Complete resection curative
Local recurrence common, but metastases rare
41. Infantile Fibrosarcoma
• Nonspecific ST mass on
imaging studies
– Bone deformity/erosion >
destruction
– Heterogeneous on MRI
(hemorrhage/necrosis)
– High-flow vascular
structures (may mimic
vascular lesion)
42. Infantile Fibrosarcoma
• DDx soft tissue malignancies in infancy
• Infantile fibrosarcoma
• Rhabdomyosarcoma (5-10% diagnosed in 1st year)
• Rarely MPNST, PNET
• Undifferentiated
• Benign etiologies
• Vascular tumors (most common ST/subq. neoplasms
in infants)
• Infantile myofibromatosis (most common fibrous
tumor of infancy)
43. Dermatofibrosarcoma Protuberans
• Arises from dermis, typically trunk,
proximal extremities, head/neck
• Usu. occurs in 3rd-5th decades of
life; pediatric involvement not
uncommon
• Local recurrence common (up to
50%; less w/ Mohs resection)
• Rate of distant mets low (~5%)
• May have areas of transformation
to higher-grade tumor
44. Dermatofibrosarcoma Protuberans
• Unmineralized protuberant mass
involving skin & subcut. tissue
• MRI:
– Nonspecific signal
– Hypervascular
– Linear extensions along skin
surface
– Satellite nodules
45. Malignant Peripheral Nerve Sheath
Tumor
• Usu. affects adults but can occur as
early as infancy
• May be assoc. w/ NF1
– Mets (usually lung) more
common
• May arise in pre-existent plexiform
neurofibromas or de novo
• Prognosis generally poor, although
better with extremity lesions
46. Peripheral Nerve Sheath Tumors
• MRI of PNSTs (benign &
malignant)
– Nonspecific mass
– Fusiform mass with
entering/exiting nerve
– “Split fat” sign
(intermuscular location)
– Target sign on T2WI,
fascicular sign (more
typical of BPNSTs)
47. Malignant Peripheral Nerve Sheath
Tumor
• MRI features suggestive of
MALIGNANT PNST:
– Large (5-10cm) w/ rapid
growth
– Heterogeneity w/ central
necrosis
– Prominent peripheral/patchy
enhancement
– Infiltrative margins &
perilesional edema
• PET: may offer some utility in
distinction of MPNSTs in patients
with NF (cutoff SUVmax ~3.5)
48. Ewing Sarcoma Family of Tumors
• Includes ES of bone, extraskeletal ES, PNET, Askin
tumor
• Previously considered distinct neoplasms
• Most are associated with a chromosomal
translocation (usually t(11;22))
• Common locations: paravertebral, chest wall (Askin
tumor), retroperitoneum, lower extremities
• Mets (lung/bone) & local recurrence common
49. Ewing Sarcoma Family of Tumors
• Imaging findings
nonspecific
– Intermediate signal
intensity on long TR
images due to high
cellularity
– Heterogeneous
enhancement
– High-flow vascular
channels described
50. Liposarcoma
• Common in adults, rare in children
• Most fatty tumors in children >3y of age are lipomas
• Most fatty tumors in children <3y of age are
lipoblastomas
51. Liposarcoma
• 4 subtypes: well-differentiated, dedifferentiated, myxoid,
pleomorphic
• Almost all cases in children are of the myxoid subtype
– Usu. late childhood/teen years
– Usually extremities
– Mets unusual in children
52. Liposarcoma
• Myxoid liposarcoma
– May simulate cyst on
nonenhanced MRI
– Foci of amorphous or
lacy fat in most cases
(may be small)
– Complete or
heterogeneous
enhancement in most
cases
53. Role of Imaging
Detection
Characterization of the mass
Staging and post-treatment assessment
Guiding biopsy
54. Staging
• No well-accepted staging system applicable to all
childhood sarcomas
• American Joint Committee on Cancer (AJCC) system used
for adults not validated in pediatric studies
www.cancer.gov/cancertopics/pdq/treatment/child-soft-tissue-sarcoma
55. Rhabdomyosarcoma
• Staging is complex
• Involves several variables:
Risk Group Histology Stage Group
Low risk Embryonal
Embryonal
1
2, 3
I, II, III
I, II
Intermediate risk Embryonal
Alveolar
2, 3
1, 2, 3
III
I, II, III
High risk Embryonal or
alveolar
4 IV
http://www.cancer.gov/cancertopics/pdq/treatment/childrhabdomyosarcoma/HealthProfessional/page3
Soft Tissue Sarcoma Committee
of the Children's Oncology Group:
Rhabdomyosarcoma Risk Group Classification
PRE-treatment
staging
TNM-based
POST-surgical
group based on
completeness of
resection
56. Rhabdomyosarcoma
• Features of importance for radiologists:
– Location: favorable site (e.g., orbit) or unfavorable site
(e.g., extremity)
– Invasiveness of tumor (confined or not confined to
anatomic site)
– Size (greater than or less than 5cm)
– Regional lymph node involvement
– Metastatic disease Stage 4
57. Rhabdomyosarcoma
• Accepted workup of patients with RMS includes:
– Clinical examination
– MRI or CT of 1o tumor w/ local-regional nodal basin
– CT lungs
– Bone scan
– Bilateral bone marrow aspirates & biopsies
– Lumbar puncture / lymph node biopsy (select patients)
• PET-CT performs better than conventional imaging in
identifying nodal, bone, marrow & soft tissue disease (may
replace bone scan, help direct lymph node biopsies)
58. Nonrhabdomyosarcoma Soft Tissue
Sarcomas
• No pediatric NRSTS staging system validated
• Staging workup more variable than with RMS
• MRI (or CT) of the primary tumor
• CT of chest
• In select patients:
• Bone scan
• FDG-PET
• Roberge et. al.: routine use of FDG-PET/CT as
part of the initial staging of adult soft tissue
sarcomas unlikely to alter management
www.cancer.gov/cancertopics/pdq/treatment/child-soft-tissue-sarcoma
59. Post-Treatment Assessment
• Determination of extent of lesion and treatment response
after neoadjuvant chemotherapy and/or radiation therapy
(e.g., before surgery)
• Assessment of postsurgical site for recurrent/residual
disease
• Post-treatment assessment of metastases
60. Treatment Response Before
Surgery
• MRI – Anatomic techniques
– Size of tumor not necessarily
a robust measure of
treatment necrosis:
• Stable: unknown response
• Increase in size:
nonresponse, hemorrhage
– Static contrast-enhanced MRI
may not be able to
differentiate enhancing viable
tumor from fibrosis and
granulation tissue
50% necrosis
Pre-chemo Pre-chemo
Post-chemo
Post-chemo
61. Treatment Response Before
Surgery
• MRI – Functional
techniques may help
predict response (require
further investigation)
– Dynamic contrast-
enhanced MRI: use
change in enhancement
patterns (slope)
– MR spectroscopy: use
decline in choline levels
– DWI: use diffusion
properties (minimum
ADC changes)
Pre-chemo DWI (b=800)
Post-chemo DWI (b=800)
Post-chemo ADC map
Tumor
necrosis
loss of cell
membrane
integrity
greater
diffusion
62. Treatment Response Before
Surgery
• PET: can evaluate
response to chemotherapy
by evaluating changes in
glucose tumor metabolism
(more accurate than size
decrease in assessment of
response)
Pre-chemo DWI b=800 Post-chemo DWI b=800 Post-chemo ADC map
Pre-chemo
Pre-chemo
Post-chemo
Post-chemo
63. Assessment of Postsurgical Site
• No controlled studies
• Most sarcomas recur w/in 2yrs of primary treatment
• ACR recommendation:
• MRI -/+ contrast
• Alternatively: baseline US + MRI, follow-up with US
(MRI if US inconclusive)
• FDG-PET/CT: as a problem-solving tool
• Detect local recurrence in cases where MR is
equivocal
• Distant metastases (vs. whole body MRI)
64. Assessment of Postsurgical Site
• MRI – Anatomic techniques
– T2WI:
• No high signal intensity or mass usually not tumor
• High signal intensity mass tumor (or seroma,
hematoma, postoperative inflammation or RT changes)
– T1WI: architectural distortion (mass) vs. normal
muscle; blood
– Contrast-enhanced images: smaller/subtle
recurrences; tumor versus seroma
– Postoperative inflammation/fibrosis may appear
masslike
T2 T1FST1FS+CT1
65. Assessment of Postsurgical Site
• MRI – Functional techniques (need further exploration)
– MR spectroscopy: can analyze choline content (no choline
if no recurrent tumor is present)
– Dynamic contrast-enhanced MRI: tumor enhances
early/rapidly; inflammation/fibrosis enhances gradually
– DWI: characterize diffusion properties for
confirmation/exclusion of recurrent tumor (low ADC)
T1 T2 DWI b=50 DWI b=800 ADC map
66. Post-Treatment Assessment of
Metastases
• ACR recommendation:
– Surveillance for pulmonary metastases:
• CT scan of the chest without contrast q3-6 months
– Osseous metastatic disease
• Image only if symptomatic
67. Role of Imaging
• Detection
• Characterization of the mass
• Staging and post-treatment assessment
• Guiding biopsy
• Planning is important!
• Poor biopsy planning may lead to:
• Errors in diagnosis
• Limitations in treatment options
• Unnecessary amputation
68. Intervention - Biopsy
Imaging should be performed before biopsy
Enhancing or metabolically active areas of the tumor
should be targeted (nonenhancing or metabolically inactive
areas are more likely to yield nondiagnostic specimens)
69. Intervention - Biopsy
• If surgical resection of the tumor is definite or even a
possibility, then communication with the orthopaedic
oncologist who will be primarily responsible for the
definitive surgical resection of the neoplasm is key
• Biopsy should be directed so that the potentially
contaminated/seeded biopsy tract may be removed at
definitive surgery
• Compartments uninvolved by neoplasm should not be
violated; avoid neurovascular bundles
• Simplest/most direct route not necessarily the most
appropriate route!
70. Intervention - Biopsy
• Adequate tissue needed for diagnostic pathology as well
as molecular testing by fluorescence in situ hybridization or
reverse transcription-polymerase chain reaction for specific
translocations
• Open biopsy or core biopsy (18-14G)
• FNA may not yield sufficient tissue for histology,
cytogenetics, & molecular testing; however:
• May be obtained prior to planning a biopsy
• Can be considered for highly vascularized lesions
(hemangioma versus highly vascularized sarcomas)
71. Conclusions
• Accurate diagnosis of pediatric soft tissue sarcomas
requires a fundamental knowledge of relative tumor
prevalence by age
• Imaging plays multiple roles, including characterization,
staging and post-therapy assessment of soft tissue
sarcomas
• The management of soft tissue sarcomas, particularly in
pediatric patients, is challenging, and patients should be
referred to tertiary centers with multidisciplinary teams
experienced in the diagnosis and treatment of these
tumors
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