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1.EWING’S SARCOMA
2.SIMPLE BONE CYST
1.EWING’S SARCOMA
Age of Incidence
Age of incidence 5 to 30 years
Peak incidence b/w 5 to 17 years
Rarely occurs after 30 years
Presenting complaints
Localized pain and swelling
Fever anemia and weight loss
Sign and symptoms stimulate Hodgkin's
lymphoma and osteomylitis
LOCATIONS
Involves Metadiaphysis
Arise in medullary cavity
Long bones 60%
Axial skeleton 40%
Conventional Radiography Poorly marginated lytic lesion
Permeative or mottled type
Soft Tissue mass or infiltration with
or without cortical break
Soft tissue mass ( saucerization)
Periosteal Reaction
Periosteal reaction
Lamellar type( onion skinning)
Sun burst or spiculated
Codman triangle
Less common findings
Thickened cortex
Bone expansion
Pathologic fracture
Mottled, osteolytic lesion (blue circle) with poorly marginated edges in the diaphysisof the bone.Sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white arrows).
Mixed lytic sclerotic lesion in diaphysis with permeativedestructive pattern spiculated periosteal reaction soft tissue extension
X ray femur lateral view showing Well defined expansile lesion with mottled appearance is visualized in diaphysis of femur. No calcification seen. cortical break is seen anteriorly. no soft tissue extension seen
MRI
Method of choice for stagging
Assess intra and extra osseous
involvement
Helps in evaluation of chemotherapy
response
MRI
T1
Low intensity with heterogeneous
contrast enhancement
T2
High signal intensity
MR coronal image both thigh T1 Post contrast showing heterogeneously enhancing mass in diaphyseas in medulary cavity of RT femur with cortical break fracture. edema is also seen
X ray femur showing subtle cortical thickening in diaphyseas but T1 post contrast image shows homogenously enhancing soft tissue mass in medial aspect of femur in proximal diaphyseas
CT Scan
Evaluate
Bone destruction
Extra osseous involvement
Bone scan
Increased uptake in areas of
destruction
Whole body scan for detecting
metastatic disease
PET Scan
PET Scan with FDG
Recommended for early detection of
changes in tumor metabolism
Angiography
Not standard for Ewing's sarcoma
Differential diagnosis
Osteosarcoma
Osteomylitis
Eosinophilic granuloma
Osteosarcoma
Osteomyelitis
Shorter duration less aggressive
periosteal reaction
Predictors of Prognosis
Size of tumor
Resectibility of tumor
Treatment
Depends upon extension and stage
Chemotherapy
Radiation therapy
Surgical resection
2.SIMPLE BONE CYST
Common in 10 to 20 years age
Solitary benign bone lesion
Male to female ratio 3. 1
Location Intra medullary
Involves Metaphysis
Abut growth plate
Proximal ends of tibia fibula and
humerus
May involve iliac and calcaneus over
2o yrs
Clinical features
Asymptomatic
Pain and swelling of adjacent joint
May present with fracture
Conventional radiography
Well defined solitary lytic lesion
Narrow zone of transition
Thin sclerotic margins
Some times expansile
No periosteal reaction
Long axis parallel to bone
Fallen fragment sign
Single well defined lytic lesion in metadiphysis with sharp zone of transition and pathological fracture
X ray femur frontal projection showing well defined rounded lytic lesion with sclerotic margins in greater trochantor of femur
Well defined expansile lytic lesion with sclerosis and fracture seen in metadiaphyseas
MRI FINDINGS
Un complicated SBC
T1 Low signal intensity
T2 High signal intensity
Complicated SBC
Heterogeneous signal
intensity on T1 T2
Gadolilnium- Peripheral enhancement
CT SCAN
Air fluid or Fluid fluid Levels
Bone scan
Photopenic / cold spot
Diffrential diagnosis
Giant cell tumor
Aneurysmal bone cyst
Chondromyxoid tumor
Aneurysmal bone cyst
Treatment
Curettage and bone grafting
Nailing
Inj of bone marrow
Cryotherapy
Methyl prednisolone inj to promote
healing
Thank you