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Bone tumors of the pelvis
Daniel Vanel Istituto Ortopedico Rizzoli. Bologna (Italia)
Benign Tumors 864 (25.4%)
Bone Metastasis 846 (24.9%)
Systemic Tumors 306 (9.0%) Primary
Malignant Tumors 1.382 (40.7%)
3.398 cases of Bone Tumors of pelvis (Istituto ortopedica RIZZOLI 1900/2012)
RIZZOLI TUMORS
Total BENIGN tumors : 864 (25.4%)
0
5
10
15
20
25
30
%
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79age
54%46%
Average: 27 - Median: 23 - Range: 0-79
BENIGN TUMORS
BENIGN TUMORS
Total BENIGN tumors : 864 cases (25.4%)
BENIGN TUMORS Case 1: 20 year old man; pain
DESMOID FIBROMA non calcified and low signal on T2 è fibrous tissue
BENIGN TUMORS Case 2: 18 year old man; pain
ANEURISMAL BONE CYST fluid fluid levels è embolisation
After embolisation
BENIGN TUMORS Case 3: 17 year old man; pain
OSTEOID OSTEOMA small nidus, huge inflammatory reaction. è Radio frequency treatment
BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain
T1 FSE T2 fs T1 gd
1. metastasis
2. normal variant (red marrow) 3. angioma 4. other
?
BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain
1. biopsy
2. follow up 3. ignore
BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain
?
1. metastasis
2. normal variant (red marrow) 3. angioma 4. other
BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain
1. biopsy
2. follow up 3. ignore
BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
Skeletal Radiol 2008.
Yamaguchi et al
100 spines (cadavers)
26 BNCT / 20 patients (M:F 2:1)
· same location as chordoma
Skeletal Radiol 2008.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
MRI : hypoT1 et hyperT2
Location: bone
Immuno: + CK18 and vimentin, S-100 protein, EMA, CAM5.2, AE1/AE3, brachyury
SIMILARITIES between BNCT and chordoma
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
BNCT Chordoma Growth minimal; sclerosis
Slow but aggressive Sft tissues
Histologiy Thick bone trabeculae
myxoïd component
Rx and CT sclerotic normal cortex and soft tissues
Lytic Soft tissues invaded
MRI no cm uptake
Uptake after injection
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
DIFFERENCES between BNCT and chordoma
BNCT and Chordoma
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
T1
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
After biopsy
T1
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
BNCT invading the soft tissues !
BNCT a still moving entity!
29 year old man, pain for 9 months.
BENIGN TUMORS Benign notochordal cell tumor (BNCT)
HEMOPATHIES
59%
41%
Total systemic bone tumors : 306 cases (9%)
0
2
4
6
8
10
12
14
16
18
20
%
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age
Average: 48 - Median: 49 - Range: 1-84
HEMOPATHIES
149
140
17
0 25 50 75 100 125 150
149
140
17
0 25 50 75 100 125 150
Myeloma
Hodgkin Lymphoma
Non Hodgkin Lymphoma
Total systemic bone tumors : 306 cases (9%)
LLC
HEMOPATHIES
B cell high grade LYMPHOMA
HEMOPATHIES
MYELOMA
HEMOPATHIES
62 year old woman
HEMOPATHIES
MYELOMA
T1FSE
MYELOMA
69 year old man
HEMOPATHIES
MALIGNANT TUMORS METASTASES
59%
41%
0
5
10
15
20
25
30
%
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age
Average 57 - Median: 59 - Range: 1-88
Total metastasis bone tumors : 846 cases (24.9%) Including 11 cases from neuroblastoma
Lytic or sclerotic
MALIGNANT TUMORS METASTASES
PROSTATE BREAST
MALIGNANT TUMORS METASTASES
THYROID
MALIGNANT TUMORS PRIMARY TUMORS
60%
40%
0
5
10
15
20
25
%
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age
Average: 38 - Median: 35 - Range: 2-87
Total primary tumors : 1.382 cases (40.7%)
MALIGNANT TUMORS PRIMARY TUMORS
Total primary tumors : 1.382 cases
Adults : CHONDROSARCOMA Children : EWING
Surgical classification
MALIGNANT TUMORS PRIMARY TUMORS
CHONDROSARCOMA
MALIGNANT TUMORS PRIMARY TUMORS
60 year old man, pain
MALIGNANT TUMORS PRIMARY TUMORS
60 year old man, pain
MALIGNANT TUMORS PRIMARY TUMORS
60 year old man, pain
MALIGNANT TUMORS PRIMARY TUMORS
60 year old man, pain
MALIGNANT TUMORS PRIMARY TUMORS
CHONDROSARCOMA normal SI and acetabulum
MALIGNANT TUMORS PRIMARY TUMORS
Missed CHONDROSARCOMA Prothesis.
MALIGNANT TUMORS PRIMARY TUMORS
OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years
MALIGNANT TUMORS PRIMARY TUMORS
OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years
OSTEOSARCOMA
MALIGNANT TUMORS PRIMARY TUMORS
MALIGNANT TUMORS PRIMARY TUMORS
CHONDROSARCOMA Zone I and nerve
EWING Pregnant Zone I, ½ sacrum, ½ zone II
MALIGNANT TUMORS PRIMARY TUMORS
MALIGNANT TUMORS PRIMARY TUMORS
EWING Pregnant Zone I, ½ sacrum, ½ zone II
15 years follow up
MALIGNANT TUMORS PRIMARY TUMORS
EWING Pregnant Zone I, ½ sacrum, ½ zone II
MALIGNANT TUMORS PRIMARY TUMORS
CHONDROSARCOMA 70 year old man
MALIGNANT TUMORS PRIMARY TUMORS
CHONDROSARCOMA 70 year old man
10 years follow up
Gilles Missenard
� BNCT
� Frequent metastases
� Local staging for primary malignant tumors: CT , MRI
Bone tumors of the pelvis KEY POINTS