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

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• 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

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