Bone tumors muhammad 1
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Transcript of Bone tumors muhammad 1
By
Dr.Muhammad Ben Zulfiqar(PGR-1)
Clues by Appearance of Lesion Clues by Location of LesionClues by Density of LesionOther Clues
Clues by Appearance of LesionPatterns of Bone Destruction Periosteal ReactionsTumor Matrix Expansile Lesions of Bone
Clues by Appearance of Lesion Patterns of Bone Destruction
GeographicMoth-eatenPermeative
Geographic Bone Destruction Destructive lesion with sharply defined
borderImplies a less-aggressive, more slow-growing,
benign processNarrow transition zone
Patterns of Bone Destruction
GeographicMoth-eatenPermeative
Non-ossifying fibroma
Examples:• Non-ossifying fibroma• Chondromyxoid fibroma• Eosinophilic granuloma
Moth-eaten Bone Destruction
Areas of destruction with ragged bordersImplies more rapid growth
Probably a malignancy
Patterns of Bone DestructionGeographicMoth-eatenPermeative
Multiple Myeloma
Moth-eaten Bone Destruction
Examples:MyelomaMetastasesLymphomaEwing’s sarcoma
Permeative Bone Destruction
Ill-defined lesion with multiple “worm-holes”Spreads through marrow spaceWide transition zoneImplies an aggressive malignancy
Round-cell lesions
Patterns of Bone Destruction
GeographicMoth-eatenPermeative
Leukemia
Permeative Bone Destruction
Examples:Lymphoma, leukemia Ewing’s SarcomaMyelomaOsteomyelitisNeuroblastoma
Patterns of Bone Destruction
Geographic Moth-eaten Permeative
Less malignant More malignant
Periosteal ReactionsBenign
NoneSolid
More aggressive or malignantLamellated or onion peelSunburstCodman’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
Periosteal Reactions
Solid onion-peelSunburst Codman’s
triangle
Less malignant More malignant
Tumor MatrixOsteoblastic
Fluffy, cotton-like or cloud-like densitiesOsteosarcoma
Cartilaginous Comma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibroma
Tumor Matrix
Osteoblastic Cartilaginous
Tumor Matrix
Osteoblastic Fluffy, cotton-like or cloud-like densities
as Osteosarcoma
CartilaginousComma-shaped, punctate, annular,
popcorn-likeas Enchondroma, chondrosarcoma,
chondromyxoid fibroma
Tumor Matrix
OsteoblasticCartilaginous
Chondrosarcoma
Expansile Lesions of Bone
• Multiple myeloma • Mets• Brown tumor• Enchondroma• Aneurysmal bone cyst• Fibrous dysplasia
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
.
.
.
In the longitudinal PlaneEpiphyseal
GCT, chondroblastoma
MetaphysealOsteomyelitis, osteo-and chondrosarcoma
DiaphysealRound cell lesions, ABC, enchondroma
Characteristic LocationsSimple bone cyst
Proximal humerus Chondroblastoma
Epiphyses Giant Cell tumor
Epiphyses Adamantinoma
Tibia Chordoma
Sacrum, clivus Osteoblastoma
Spine, 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 LesionSclerotic Cortical LesionsLytic Lesions in ChildrenLytic Lesions in AdultsBlastic Lesions in Children Blastic Lesions in Adults
Sclerotic Cortical Lesions
Osteoid osteoma
Brodie’s abscess
Sclerotic Cortical Lesions
Osteoid osteoma
Brodie’s abscess
Lytic Lesions in ChildrenEosinophilic
granulomaLeukemia
Lytic Lesions in ChildrenEosinophilic granuloma
Leukemia
Lytic Lesions in Adults
Metastatic lesions
LungRenalThyroid
Multiple myelomaPrimary bone tumor
Metastatic thyroid carcinoma
Lytic Lesions in AdultsMetastatic lesions
LungRenalThyroid
Multiple myelomaPrimary bone tumor
Lytic Lesions in AdultsMetastatic lesions
LungRenalThyroid
Multiple myeloma
Primary bone tumor
Chondrosarcoma
Blastic Lesions in Children
Lymphoma
Blastic Lesions in AdultsMetastatic disease
Breast –female
Prostate –male
LymphomaPaget’s diseaseFluorosis
Prostatic Ca.
Blastic Lesions in AdultsMetastatic disease
Breast –female Prostate –male
LymphomaPaget’s diseaseFluorosis
Blastic Lesions in AdultsMetastatic disease
Breast –female Prostate –male
Lymphoma
Paget’s diseaseFluorosis
Blastic Lesions in AdultsMetastatic disease
Breast –female Prostate –male
LymphomaPaget’s disease
Fluorosis
Other CluesSoft Tissue ExtensionBenign 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 Osteosarcoma
Soft Tissue Extension
Benign vs. Malignant
Thank You