Osteoma Benign lesion of bone Age: 30-60 Location: m/c frontal sinuses Margin: narrow Periosteal...
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Transcript of Osteoma Benign lesion of bone Age: 30-60 Location: m/c frontal sinuses Margin: narrow Periosteal...
OsteomaOsteomaBenign lesion of boneBenign lesion of bone
Age: 30-60Age: 30-60
Location: m/c frontal Location: m/c frontal sinusessinuses
Margin: narrowMargin: narrow
Periosteal Rxn: nonePeriosteal Rxn: none
Soft Tissue Mass: Soft Tissue Mass: abscentabscent
OsteopoikilosiOsteopoikilosissBenign lesion of boneBenign lesion of bone
Age: rare before 3Age: rare before 3
Location: scattered Location: scattered diffusely through diffusely through out metaepiphyseal out metaepiphyseal regions of long regions of long bones, pelvic bones, pelvic region, region, carpals/tarsalscarpals/tarsals
(think dots on a (think dots on a Dalmatian) Dalmatian)
Osteoid OsteomaOsteoid OsteomaAge: 10-25Age: 10-25
Nocturnal pain relieved by Nocturnal pain relieved by aspirinaspirin
Location: 50-60% in femur Location: 50-60% in femur (esp intertrochanteric (esp intertrochanteric region/neck) and tibiaregion/neck) and tibia
20% bones of hands/feet 20% bones of hands/feet
Lumbar spine neural Lumbar spine neural archarch
Oval/Round nidus <1cm Oval/Round nidus <1cm surrounded bysurrounded by uniform uniform sclerosissclerosis
OsteoblastomaOsteoblastomaAge: 10-30Age: 10-30
Location: spine, Location: spine, lumbar region m/c lumbar region m/c pedicale/lamina l/c pedicale/lamina l/c TVP/SP, may involve TVP/SP, may involve long bones m/c long bones m/c lower extremitieslower extremities
Expansile, mixed Expansile, mixed lytic/blastic lytic/blastic appearance cortical appearance cortical thinning (eggshell) thinning (eggshell) Nidus >2cmNidus >2cm
More photos of Osteoblastoma at the More photos of Osteoblastoma at the following linkfollowing link
http://www.bluestormstudios.com/http://www.bluestormstudios.com/clientsites/bonecancer/index.php?clientsites/bonecancer/index.php?db=content/db=content/Bonecancer&tbl=Bone_Tumors&id=12Bonecancer&tbl=Bone_Tumors&id=12
OsteosarcomaOsteosarcoma22ndnd m/c primary malignancy of m/c primary malignancy of
bone!bone!Age: m/c 10-25 Age: m/c 10-25 (has been seen in pt of all ages)(has been seen in pt of all ages)
Location: 50-75% around kneeLocation: 50-75% around knee
40% femur40% femur
16% tibia16% tibia
15% humerus15% humerus
Metaphyseal lesions m/c, permative pattern Metaphyseal lesions m/c, permative pattern of destruction, soft tissue extension, of destruction, soft tissue extension, aggressive periosteal rxn aggressive periosteal rxn (sunburst)(sunburst), , cortical disruption, wide zone of transition, cortical disruption, wide zone of transition, can show mixed pattern of osteolysis & can show mixed pattern of osteolysis & sclerosis (cumulus cloud appearance)sclerosis (cumulus cloud appearance)
Osteochondroma Osteochondroma (cartilage (cartilage forming tumors)forming tumors)
M/C benign tumor of boneM/C benign tumor of boneAge: 70-80% encountered before 20 YOAAge: 70-80% encountered before 20 YOA
Location: any bone that develops by endochondral Location: any bone that develops by endochondral ossification ossification
30% femur30% femur
20% humerus20% humerus
17% tibia17% tibia
spine/ribs can be involvedspine/ribs can be involved
Metaphyseal/diametaphyseal osteocartilaginous out Metaphyseal/diametaphyseal osteocartilaginous out growth withgrowth with
a pedunculated or sessile base and a cartilage cap a pedunculated or sessile base and a cartilage cap
(think cauliflower) oriented away from joint (think cauliflower) oriented away from joint articulationarticulation
Note the broad, Note the broad, flatflat
base, sessile base, sessile
AP ViewAP View Lateral View Lateral View (tibia)(tibia)
AP view AP view T2 weighted MRIT2 weighted MRI
EnchondromaEnchondroma
M/C benign tumor of the handM/C benign tumor of the handAge: 10-30Age: 10-30
Location: 40-65% in the hand, proximal phalanges, Location: 40-65% in the hand, proximal phalanges, met headsmet heads
25% long bones, more often in lower extremity25% long bones, more often in lower extremity
Well defined/geographic, expansile, medullary lz, Well defined/geographic, expansile, medullary lz, with somewith some
Calcification, endosteal erosion causing cortical Calcification, endosteal erosion causing cortical thinning.thinning.
Calcification usually appears stippled or punctate.Calcification usually appears stippled or punctate.
PA view (note fx)PA view (note fx) LateralLateral
Note fxNote fx
Ollier’s DiseaseOllier’s Disease
Maffucci’s SyndromeMaffucci’s Syndrome
ChondroblastomaChondroblastomaHas to involve EPIPHESIS! May span growth plateHas to involve EPIPHESIS! May span growth plate
22ndnd M/C benign tumor of patella M/C benign tumor of patellaAge: 10-25Age: 10-25
Location:Location:
Poximal & distal ends of femur & trochantersPoximal & distal ends of femur & trochanters
Proximal tibiaProximal tibia
Proximal humerusProximal humerus
IliaIlia
medullary based epiphyseal lz, can show metaphyseal medullary based epiphyseal lz, can show metaphyseal extensionextension
Round/oval shaped geographic, lytic lz, can have stippled Round/oval shaped geographic, lytic lz, can have stippled oror
punctuate calcifications (50%) & periostitis (30-50%)punctuate calcifications (50%) & periostitis (30-50%)
Note this one spans growth plateNote this one spans growth plate
ChondrosarcomaChondrosarcoma33rdrd M/C primary malignancy of bone M/C primary malignancy of boneAge: 40-60Age: 40-60
Location: Location:
50% of cases pelvis or proximal femur50% of cases pelvis or proximal femur
Bones around kneeBones around knee
HumerusHumerus
scapula & ribsscapula & ribs
Large, aggressive, expansile metaphyseal lz, with Large, aggressive, expansile metaphyseal lz, with wide zone ofwide zone of
transition, cortical dissolution, erratic calcifications transition, cortical dissolution, erratic calcifications stippled,stippled,
fluffy or arcs & rings in appearance, periosteal rxnfluffy or arcs & rings in appearance, periosteal rxn
laminated/spiculated. laminated/spiculated. Soft tissue massSoft tissue mass
Not the best imageNot the best image
CT of humerus from previous slideCT of humerus from previous slide
Note ‘fluffy’ appearing Note ‘fluffy’ appearing calcificationscalcifications
Soft tissue mass calcificationsSoft tissue mass calcifications
MRI from previous slide of soft tissue MRI from previous slide of soft tissue massmass
Fibrous Cortical DefectFibrous Cortical Defect
FCD common between 4-FCD common between 4-8 yoa8 yoa
Long bones of lower Long bones of lower extremity 90% of cases, extremity 90% of cases, areas around knee areas around knee account for 55% of all account for 55% of all FCD & NOFFCD & NOF
FCD metaphyseal based FCD metaphyseal based but run parallel to long but run parallel to long access of boneaccess of bone
Non-ossifying FibromaNon-ossifying Fibroma
NOF common 8-20 yoaNOF common 8-20 yoa Larger than FCD at 2-Larger than FCD at 2-
7cm usually in 7cm usually in metaphysis region of metaphysis region of tibia with cortical tibia with cortical expansion/thinning, expansion/thinning, bubbly appearancebubbly appearance
FibrosarcomaFibrosarcoma Can occur at any age but Can occur at any age but
m/c 30-50 yoam/c 30-50 yoa 70% of cases involve long 70% of cases involve long
bones, m/c femur 40%, bones, m/c femur 40%, tibia 16%tibia 16%
Meta/diametaphyseal Meta/diametaphyseal moth eaten pattern, moth eaten pattern, cortical dissolution, with cortical dissolution, with soft tissue mass. soft tissue mass. Periosteal rxn is Periosteal rxn is rarerare..
FibrosarcomaFibrosarcoma
Giant Cell TumorGiant Cell Tumor M/C in 20-30 yoa, females M/C in 20-30 yoa, females
m/cm/c 75% long tubular bones, 75% long tubular bones,
50% involve knee region 50% involve knee region or distal radiusor distal radius
M/C tumor of patellaM/C tumor of patella Sacrum (m/c benign tumor Sacrum (m/c benign tumor
of sacrum) & vertebral of sacrum) & vertebral body involvement has body involvement has been seebeen see
Metaphyseal origin with Metaphyseal origin with epiphysis extentionepiphysis extention
GCTGCT
GCTGCT
Simple (Unicameral) Bone CystSimple (Unicameral) Bone Cyst M/C <14 yoaM/C <14 yoa 75% occur in proximal 75% occur in proximal
humerus & femur, upper humerus & femur, upper extremity more commonextremity more common
Active lesions up against Active lesions up against growth plategrowth plate
Latent cyst found in Latent cyst found in diaphysisdiaphysis
Fallen-fragment sign Fallen-fragment sign
SBCSBC
ABCABC I think we all are familiar I think we all are familiar
with ABCwith ABC 5-20 yoa5-20 yoa M/C benign tumor of the M/C benign tumor of the
ClavicalClavical Will show fluid levels on Will show fluid levels on
MRIMRI Spinal Lesions can be Spinal Lesions can be
seenseen Spine Diff Dx: GCT, Spine Diff Dx: GCT,
Osteoblastoma, Osteoblastoma, hemangiomahemangioma
HemangiomaHemangioma m/c >40 yoa femalesm/c >40 yoa females m/c benign tumor of m/c benign tumor of
spinespine Bright on T1 & T2 MRIBright on T1 & T2 MRI Corduroy-cloth Corduroy-cloth
appearance on xrayappearance on xray
HemanogiomaHemanogioma
Left side of the v-Left side of the v-body body
HemangiomaHemangioma
LipomaLipoma
5-70 yoa m/c 45-70 yoa m/c 4thth decade decade Rarest of all primary Rarest of all primary
tumors of bonetumors of bone Fibula, femur, tibia, Fibula, femur, tibia,
calcaneus locations calcaneus locations commoncommon
““Target” sign on plain film Target” sign on plain film central sclerosis central sclerosis surrounded by lucent areasurrounded by lucent area
LipomaLipoma
LipomaLipoma
ChordomaChordoma Notochord remnantsNotochord remnants m/c 40-70 yoam/c 40-70 yoa Only primary malignant Only primary malignant
tumor know to cross tumor know to cross intervetebral disc into intervetebral disc into sequential segmentssequential segments
Sacrococcygeal area m/c Sacrococcygeal area m/c 50-60%50-60%
Spheno-occipital (clivus) Spheno-occipital (clivus) 25-40%25-40%
C2 occasionally involvedC2 occasionally involved Large soft tissue mass, Large soft tissue mass,
cortical distructioncortical distruction
ChordomaChordoma
ChordomaChordoma
Multiple MyelomaMultiple Myeloma
Multiple MyelomaMultiple Myeloma
Multiple MyelomaMultiple Myeloma
EGEG
EGEG
Padget’sPadget’s
All images are property of their All images are property of their respective owners.respective owners.