Slide 1

BONE TUMORS By Dr. Ahmed Hosny Slide 2 Clues by Appearance of Lesion Clues by Location of Lesion Clues by Density of Lesion Other Clues Slide 3 Clues by Appearance of Lesion Patterns of Bone Destruction Periosteal Reactions Tumor Matrix Expansile Lesions of Bone Slide 4 Clues by Appearance of Lesion Patterns of Bone Destruction Geographic Moth-eaten Permeative Slide 5 Geographic Bone Destruction Destructive lesion with sharply defined border Implies a less-aggressive, more slow- growing, benign process Narrow transition zone Slide 6 Patterns of Bone Destruction Geographic Moth-eaten Permeative Non-ossifying fibroma Slide 7 Geographic Bone Destruction Examples: Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma Slide 8 Moth-eaten Bone Destruction Areas of destruction with ragged borders Implies more rapid growth Probably a malignancy Slide 9 Patterns of Bone Destruction Geographic Moth-eaten Permeative Multiple Myeloma Slide 10 Examples: Myeloma Metastases Lymphoma Ewings sarcoma Moth-eaten Bone Destruction Slide 11 Permeative Bone Destruction Ill-defined lesion with multiple worm-holes Spreads through marrow space Wide transition zone Implies an aggressive malignancy Round-cell lesions Slide 12 Patterns of Bone Destruction Geographic Moth-eaten Permeative Leukemia Slide 13 Examples: Lymphoma, leukemia Ewings Sarcoma Myeloma Osteomyelitis Neuroblastoma Permeative Bone Destruction Slide 14 Patterns of Bone Destruction Geographic Moth-eatenPermeative Less malignant More malignant Slide 15 Periosteal Reactions Benign None Solid More aggressive or malignant Lamellated or onion peel Sunburst Codmans triangle Slide 16 Periosteal Reactions Benign None Solid Aggressive/malignant onion-peel Sunburst Codmans triangle Non-ossifying fibroma Slide 17 Periosteal Reactions Benign None Solid Aggressive/malignant onion-peel Sunburst Codmans triangle Chronic osteomyelitis Slide 18 Periosteal Reactions Benign None Solid Aggressive/malignant onion-peel Sunburst Codmans triangle Ewing sarcoma Slide 19 Periosteal Reactions Benign None Solid Aggressive/malignant onion-peel Sunburst Codmans triangle Osteo-sarcoma Slide 20 Periosteal Reactions Benign None Solid Aggressive/malignant onion-peel Sunburst Codmans triangle Osteo-sarcoma Slide 21 Periosteal Reactions Solidonion-peelSunburstCodmans triangle Less malignant More malignant Slide 22 Tumor Matrix Osteoblastic Fluffy, cotton-like or cloud-like densities Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibroma Slide 23 Tumor Matrix Osteoblastic Cartilaginous Slide 24 Osteoblastic Fluffy, cotton-like or cloud-like densities as Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma Tumor Matrix Slide 25 Osteoblastic Cartilaginous Tumor Matrix Chondrosarcoma Slide 26 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Slide 27 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Slide 28 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Renal cell carcinoma Slide 29 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Slide 30 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Slide 31 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Slide 32 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Slide 33 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 Slide 34 In the Transverse Plane... Slide 35 Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo-and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma In the longitudinal Plane Slide 36 Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Slide 37 Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Slide 38 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations Slide 39 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations Slide 40 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations Slide 41 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations Slide 42 Clues by Density of Lesion Sclerotic Cortical Lesions Lytic Lesions in Children Lytic Lesions in Adults Blastic Lesions in Children Blastic Lesions in Adults Slide 43 Sclerotic Cortical Lesions Osteoid osteoma Brodies abscess Slide 44 Osteoid osteoma Brodies abscess Sclerotic Cortical Lesions Slide 45 Lytic Lesions in Children Eosinophilic granuloma Leukemia Slide 46 Lytic Lesions in Children Eosinophilic granuloma Leukemia Slide 47 Lytic Lesions in Adults Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor Metastatic thyroid carcinoma Slide 48 Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor Lytic Lesions in Adults Slide 49 Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor Chondrosarcoma Lytic Lesions in Adults Slide 50 Lymphoma Blastic Lesions in Children Slide 51 Metastatic disease Breast female Prostate male Lymphoma Pagets disease Fluorosis Prostatic Ca. Blastic Lesions in Adults Slide 52 Metastatic disease Breast female Prostate male Lymphoma Pagets disease Fluorosis Blastic Lesions in Adults Slide 53 Metastatic disease Breast female Prostate male Lymphoma Pagets disease Fluorosis Blastic Lesions in Adults Slide 54 Metastatic disease Breast female Prostate male Lymphoma Pagets disease Fluorosis Blastic Lesions in Adults Slide 55 Other Clues Soft Tissue Extension Benign vs. Malignant Slide 56 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 Slide 57 lymphoma Soft Tissue Extension Slide 58 Benign vs. Malignant Slide 59 Thank You