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Bone tumors
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BONE TUMORSBONE TUMORSBONE TUMORSBONE TUMORS
• Clues by Appearance of Lesion • Clues by Location of Lesion• Clues by Density of Lesion• Other Clues
Clues by Appearance of Lesion
• Patterns of Bone Destruction • Periosteal Reactions• Tumor Matrix • Expansile Lesions of Bone
Clues by Appearance of Lesion
• Patterns of Bone Destruction– Geographic– Moth-eaten– Permeative
Geographic Bone Destruction
• Destructive lesion with sharply defined border
• Implies a less-aggressive, more slow-growing, benign process
• Narrow transition zone
Patterns of Bone Destruction
– Geographic– Moth-eaten– Permeative
Non-ossifying fibroma
Geographic Bone Destruction
Examples:• Non-ossifying fibroma• Chondromyxoid fibroma• Eosinophilic granuloma
Moth-eaten Bone Destruction
• Areas of destruction with ragged borders
• Implies more rapid growth• Probably a malignancy
Patterns of Bone Destruction
– Geographic– Moth-eaten– Permeative
Multiple Myeloma
Examples:• Myeloma• Metastases• Lymphoma• Ewing’s sarcoma
Moth-eaten Bone Destruction
Permeative Bone Destruction
• Ill-defined lesion with multiple “worm-holes”
• Spreads through marrow space• Wide transition zone• Implies an aggressive malignancy
• Round-cell lesions
Patterns of Bone Destruction
– Geographic– Moth-eaten– Permeative
Leukemia
Examples:• Lymphoma, leukemia • Ewing’s Sarcoma• Myeloma• Osteomyelitis• Neuroblastoma
Permeative Bone Destruction
Patterns of Bone Destruction
Geographic Moth-eaten Permeative
Less malignant More malignant
Periosteal Reactions• Benign
– None– Solid
• More aggressive or malignant– Lamellated or onion peel– Sunburst– Codman’s triangle
Periosteal Reactions
• Benign– None– Solid
• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle
Non-ossifying fibroma
Periosteal Reactions
• Benign– None– Solid
• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle
Chronic osteomyelitis
Periosteal Reactions
• Benign– None– Solid
• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle
Ewing sarcoma
Periosteal Reactions
• Benign– None– Solid
• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle
Osteo-sarcoma
Periosteal Reactions
• Benign– None– Solid
• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle
Osteo-sarcoma
Periosteal Reactions
Solid onion-peelSunburst Codman’s
triangle
Less malignant More malignant
Tumor Matrix• Osteoblastic
– Fluffy, cotton-like or cloud-like densities
– Osteosarcoma• Cartilaginous
– Comma-shaped, punctate, annular, popcorn-like– Enchondroma, chondrosarcoma, chondromyxoid fibroma
Tumor Matrix
• Osteoblastic
• Cartilaginous
• Osteoblastic– Fluffy, cotton-like or cloud-like densities
as Osteosarcoma
• Cartilaginous– Comma-shaped, punctate,
annular, popcorn-likeas Enchondroma,
chondrosarcoma, chondromyxoid fibroma
Tumor Matrix
• Osteoblastic• Cartilagino
us
Tumor Matrix
Chondrosarcoma
• Multiple myeloma • Mets• Brown tumor• Enchondroma• Aneurysmal bone cyst• Fibrous dysplasia
Expansile Lesions of Bone
Expansile Lesions of Bone
Multiple myeloma
MetsBrown tumorEnchondromaAneurysmal bone
cystFibrous dysplasia
Multiple myeloma
MetsBrown tumorEnchondromaAneurysmal bone
cystFibrous dysplasia
Expansile Lesions of Bone
Renal cell carcinoma
Multiple myeloma Mets
Brown tumorEnchondromaAneurysmal bone
cystFibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma MetsBrown tumor
EnchondromaAneurysmal bone
cystFibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma MetsBrown tumorEnchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma MetsBrown tumorEnchondromaAneurysmal bone
cyst
Fibrous dysplasia
Expansile Lesions of Bone
Clues by Location of Lesion
• In the Transverse Plane• In the Longitudinal Plane• Characteristic Locations by tumors• Characteristic Tumors by Body
Site– Pelvic Lesions– Expansile Rib Lesions– Lesions of the Spine
In the Transverse Plane
.
.
.
• EpiphysealGCT, chondroblastoma
• MetaphysealOsteomyelitis, osteo-and chondrosarcoma
• DiaphysealRound cell lesions, ABC, enchondroma
In the longitudinal Plane
Characteristic Locations
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
Characteristic Locations
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
Characteristic Locations
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
Characteristic Locations
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
Characteristic Locations
• Simple bone cystProximal humerus
• ChondroblastomaEpiphyses
• Giant Cell tumorEpiphyses
• AdamantinomaTibia
• ChordomaSacrum, clivus
• OsteoblastomaSpine, posterior
Characteristic Locations
Clues by Density of Lesion
• Sclerotic Cortical Lesions• Lytic Lesions in Children• Lytic Lesions in Adults• Blastic Lesions in Children • Blastic Lesions in Adults
Sclerotic Cortical Lesions
• Osteoid osteoma
• Brodie’s abscess
• Osteoid osteoma
• Brodie’s abscess
Sclerotic Cortical Lesions
Lytic Lesions in Children
• Eosinophilic
granuloma• Leukemia
Lytic Lesions in Children
• Eosinophilic granuloma
• Leukemia
Lytic Lesions in Adults
• Metastatic lesions– Lung– Renal– Thyroid
• Multiple myeloma• Primary bone tumor
Metastatic thyroid carcinoma
• Metastatic lesions– Lung– Renal– Thyroid
• Multiple myeloma
• Primary bone tumor
Lytic Lesions in Adults
• Metastatic lesions– Lung– Renal– Thyroid
• Multiple myeloma
• Primary bone tumor
Chondrosarcoma
Lytic Lesions in Adults
• Lymphoma
Blastic Lesions in Children
• Metastatic disease
•Breast –female
•Prostate –male
• Lymphoma• Paget’s disease• Fluorosis
Prostatic Ca.
Blastic Lesions in Adults
• Metastatic disease• Breast –female• Prostate –male
• Lymphoma• Paget’s disease• Fluorosis
Blastic Lesions in Adults
• Metastatic disease• Breast –female• Prostate –male
• Lymphoma
• Paget’s disease
• Fluorosis
Blastic Lesions in Adults
• Metastatic disease• Breast –female• Prostate –male
• Lymphoma• Paget’s disease
• Fluorosis
Blastic Lesions in Adults
Other Clues
• Soft Tissue Extension• Benign vs. Malignant
Soft Tissue Extension
• Usually implies malignancy• More likely to form discrete soft tissue
mass
• Benign conditions with soft tissue extension
• Osteomyelitis– Usually infiltration of fat
lymphoma
Soft Tissue Extension
Benign vs. Malignant
Thank You
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