Osteoma Benign lesion of bone Age: 30-60 Location: m/c frontal sinuses Margin: narrow Periosteal...

OsteomaOsteomaBenign lesion of boneBenign lesion of bone

Age: 30-60Age: 30-60

Location: m/c frontal Location: m/c frontal sinusessinuses

Margin: narrowMargin: narrow

Periosteal Rxn: nonePeriosteal Rxn: none

Soft Tissue Mass: Soft Tissue Mass: abscentabscent

OsteopoikilosiOsteopoikilosissBenign lesion of boneBenign lesion of bone

Age: rare before 3Age: rare before 3

Location: scattered Location: scattered diffusely through diffusely through out metaepiphyseal out metaepiphyseal regions of long regions of long bones, pelvic bones, pelvic region, region, carpals/tarsalscarpals/tarsals

(think dots on a (think dots on a Dalmatian) Dalmatian)

Osteoid OsteomaOsteoid OsteomaAge: 10-25Age: 10-25

Nocturnal pain relieved by Nocturnal pain relieved by aspirinaspirin

Location: 50-60% in femur Location: 50-60% in femur (esp intertrochanteric (esp intertrochanteric region/neck) and tibiaregion/neck) and tibia

20% bones of hands/feet 20% bones of hands/feet

Lumbar spine neural Lumbar spine neural archarch

Oval/Round nidus <1cm Oval/Round nidus <1cm surrounded bysurrounded by uniform uniform sclerosissclerosis

OsteoblastomaOsteoblastomaAge: 10-30Age: 10-30

Location: spine, Location: spine, lumbar region m/c lumbar region m/c pedicale/lamina l/c pedicale/lamina l/c TVP/SP, may involve TVP/SP, may involve long bones m/c long bones m/c lower extremitieslower extremities

Expansile, mixed Expansile, mixed lytic/blastic lytic/blastic appearance cortical appearance cortical thinning (eggshell) thinning (eggshell) Nidus >2cmNidus >2cm

More photos of Osteoblastoma at the More photos of Osteoblastoma at the following linkfollowing link

http://www.bluestormstudios.com/http://www.bluestormstudios.com/clientsites/bonecancer/index.php?clientsites/bonecancer/index.php?db=content/db=content/Bonecancer&tbl=Bone_Tumors&id=12Bonecancer&tbl=Bone_Tumors&id=12

OsteosarcomaOsteosarcoma22ndnd m/c primary malignancy of m/c primary malignancy of

bone!bone!Age: m/c 10-25 Age: m/c 10-25 (has been seen in pt of all ages)(has been seen in pt of all ages)

Location: 50-75% around kneeLocation: 50-75% around knee

40% femur40% femur

16% tibia16% tibia

15% humerus15% humerus

Metaphyseal lesions m/c, permative pattern Metaphyseal lesions m/c, permative pattern of destruction, soft tissue extension, of destruction, soft tissue extension, aggressive periosteal rxn aggressive periosteal rxn (sunburst)(sunburst), , cortical disruption, wide zone of transition, cortical disruption, wide zone of transition, can show mixed pattern of osteolysis & can show mixed pattern of osteolysis & sclerosis (cumulus cloud appearance)sclerosis (cumulus cloud appearance)

Osteochondroma Osteochondroma (cartilage (cartilage forming tumors)forming tumors)

M/C benign tumor of boneM/C benign tumor of boneAge: 70-80% encountered before 20 YOAAge: 70-80% encountered before 20 YOA

Location: any bone that develops by endochondral Location: any bone that develops by endochondral ossification ossification

30% femur30% femur

20% humerus20% humerus

17% tibia17% tibia

spine/ribs can be involvedspine/ribs can be involved

Metaphyseal/diametaphyseal osteocartilaginous out Metaphyseal/diametaphyseal osteocartilaginous out growth withgrowth with

a pedunculated or sessile base and a cartilage cap a pedunculated or sessile base and a cartilage cap

(think cauliflower) oriented away from joint (think cauliflower) oriented away from joint articulationarticulation

Note the broad, Note the broad, flatflat

base, sessile base, sessile

AP ViewAP View Lateral View Lateral View (tibia)(tibia)

AP view AP view T2 weighted MRIT2 weighted MRI

EnchondromaEnchondroma

M/C benign tumor of the handM/C benign tumor of the handAge: 10-30Age: 10-30

Location: 40-65% in the hand, proximal phalanges, Location: 40-65% in the hand, proximal phalanges, met headsmet heads

25% long bones, more often in lower extremity25% long bones, more often in lower extremity

Well defined/geographic, expansile, medullary lz, Well defined/geographic, expansile, medullary lz, with somewith some

Calcification, endosteal erosion causing cortical Calcification, endosteal erosion causing cortical thinning.thinning.

Calcification usually appears stippled or punctate.Calcification usually appears stippled or punctate.

PA view (note fx)PA view (note fx) LateralLateral

Note fxNote fx

Ollier’s DiseaseOllier’s Disease

Maffucci’s SyndromeMaffucci’s Syndrome

ChondroblastomaChondroblastomaHas to involve EPIPHESIS! May span growth plateHas to involve EPIPHESIS! May span growth plate

22ndnd M/C benign tumor of patella M/C benign tumor of patellaAge: 10-25Age: 10-25

Location:Location:

Poximal & distal ends of femur & trochantersPoximal & distal ends of femur & trochanters

Proximal tibiaProximal tibia

Proximal humerusProximal humerus

IliaIlia

medullary based epiphyseal lz, can show metaphyseal medullary based epiphyseal lz, can show metaphyseal extensionextension

Round/oval shaped geographic, lytic lz, can have stippled Round/oval shaped geographic, lytic lz, can have stippled oror

punctuate calcifications (50%) & periostitis (30-50%)punctuate calcifications (50%) & periostitis (30-50%)

Note this one spans growth plateNote this one spans growth plate

ChondrosarcomaChondrosarcoma33rdrd M/C primary malignancy of bone M/C primary malignancy of boneAge: 40-60Age: 40-60

Location: Location:

50% of cases pelvis or proximal femur50% of cases pelvis or proximal femur

Bones around kneeBones around knee

HumerusHumerus

scapula & ribsscapula & ribs

Large, aggressive, expansile metaphyseal lz, with Large, aggressive, expansile metaphyseal lz, with wide zone ofwide zone of

transition, cortical dissolution, erratic calcifications transition, cortical dissolution, erratic calcifications stippled,stippled,

fluffy or arcs & rings in appearance, periosteal rxnfluffy or arcs & rings in appearance, periosteal rxn

laminated/spiculated. laminated/spiculated. Soft tissue massSoft tissue mass

Not the best imageNot the best image

CT of humerus from previous slideCT of humerus from previous slide

Note ‘fluffy’ appearing Note ‘fluffy’ appearing calcificationscalcifications

Soft tissue mass calcificationsSoft tissue mass calcifications

MRI from previous slide of soft tissue MRI from previous slide of soft tissue massmass

Fibrous Cortical DefectFibrous Cortical Defect

FCD common between 4-FCD common between 4-8 yoa8 yoa

Long bones of lower Long bones of lower extremity 90% of cases, extremity 90% of cases, areas around knee areas around knee account for 55% of all account for 55% of all FCD & NOFFCD & NOF

FCD metaphyseal based FCD metaphyseal based but run parallel to long but run parallel to long access of boneaccess of bone

Non-ossifying FibromaNon-ossifying Fibroma

NOF common 8-20 yoaNOF common 8-20 yoa Larger than FCD at 2-Larger than FCD at 2-

7cm usually in 7cm usually in metaphysis region of metaphysis region of tibia with cortical tibia with cortical expansion/thinning, expansion/thinning, bubbly appearancebubbly appearance

FibrosarcomaFibrosarcoma Can occur at any age but Can occur at any age but

m/c 30-50 yoam/c 30-50 yoa 70% of cases involve long 70% of cases involve long

bones, m/c femur 40%, bones, m/c femur 40%, tibia 16%tibia 16%

Meta/diametaphyseal Meta/diametaphyseal moth eaten pattern, moth eaten pattern, cortical dissolution, with cortical dissolution, with soft tissue mass. soft tissue mass. Periosteal rxn is Periosteal rxn is rarerare..

FibrosarcomaFibrosarcoma

Giant Cell TumorGiant Cell Tumor M/C in 20-30 yoa, females M/C in 20-30 yoa, females

m/cm/c 75% long tubular bones, 75% long tubular bones,

50% involve knee region 50% involve knee region or distal radiusor distal radius

M/C tumor of patellaM/C tumor of patella Sacrum (m/c benign tumor Sacrum (m/c benign tumor

of sacrum) & vertebral of sacrum) & vertebral body involvement has body involvement has been seebeen see

Metaphyseal origin with Metaphyseal origin with epiphysis extentionepiphysis extention

GCTGCT

GCTGCT

Simple (Unicameral) Bone CystSimple (Unicameral) Bone Cyst M/C <14 yoaM/C <14 yoa 75% occur in proximal 75% occur in proximal

humerus & femur, upper humerus & femur, upper extremity more commonextremity more common

Active lesions up against Active lesions up against growth plategrowth plate

Latent cyst found in Latent cyst found in diaphysisdiaphysis

Fallen-fragment sign Fallen-fragment sign

SBCSBC

ABCABC I think we all are familiar I think we all are familiar

with ABCwith ABC 5-20 yoa5-20 yoa M/C benign tumor of the M/C benign tumor of the

ClavicalClavical Will show fluid levels on Will show fluid levels on

MRIMRI Spinal Lesions can be Spinal Lesions can be

seenseen Spine Diff Dx: GCT, Spine Diff Dx: GCT,

Osteoblastoma, Osteoblastoma, hemangiomahemangioma

HemangiomaHemangioma m/c >40 yoa femalesm/c >40 yoa females m/c benign tumor of m/c benign tumor of

spinespine Bright on T1 & T2 MRIBright on T1 & T2 MRI Corduroy-cloth Corduroy-cloth

appearance on xrayappearance on xray

HemanogiomaHemanogioma

Left side of the v-Left side of the v-body body

HemangiomaHemangioma

LipomaLipoma

5-70 yoa m/c 45-70 yoa m/c 4thth decade decade Rarest of all primary Rarest of all primary

tumors of bonetumors of bone Fibula, femur, tibia, Fibula, femur, tibia,

calcaneus locations calcaneus locations commoncommon

““Target” sign on plain film Target” sign on plain film central sclerosis central sclerosis surrounded by lucent areasurrounded by lucent area

LipomaLipoma

LipomaLipoma

ChordomaChordoma Notochord remnantsNotochord remnants m/c 40-70 yoam/c 40-70 yoa Only primary malignant Only primary malignant

tumor know to cross tumor know to cross intervetebral disc into intervetebral disc into sequential segmentssequential segments

Sacrococcygeal area m/c Sacrococcygeal area m/c 50-60%50-60%

Spheno-occipital (clivus) Spheno-occipital (clivus) 25-40%25-40%

C2 occasionally involvedC2 occasionally involved Large soft tissue mass, Large soft tissue mass,

cortical distructioncortical distruction

ChordomaChordoma

ChordomaChordoma

Multiple MyelomaMultiple Myeloma

Multiple MyelomaMultiple Myeloma

Multiple MyelomaMultiple Myeloma

EGEG

EGEG

Padget’sPadget’s

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