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Primary Bone Tumors . Courtney Gleason September 27, 2007. Bone Tumors. Bone tumors can be primary or secondary. Secondary (metastasis) tumors are the most common malignancy of bone. Primary bone tumors are divided into benign and malignant.

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primary bone tumors

Primary Bone Tumors

Courtney Gleason

September 27, 2007

bone tumors
Bone Tumors
  • Bone tumors can be primary or secondary.
  • Secondary (metastasis) tumors are the most common malignancy of bone.
  • Primary bone tumors are divided into benign and malignant.
  • Benign primary bone tumors are much more common than malignant primary bone tumors.
imaging
Imaging
  • Primary bone tumors, both benign and malignant often have specific radiographic appearances on plain film.
  • MRI is used for local staging and to assess the position of the tumor in the medullary canal, degree of extracortical involvement, and proximity to surrounding structures.
plain radiographs
Plain Radiographs

Assess for:

  • Precise location
  • Underlying bony abnormality
  • Well-defined margin
  • Cortical expansion or destruction
  • Periosteal reaction
  • Soft tissue mass
benign lesions
Radiographic findings:

-Geographic pattern of bone destruction (well defined area of lysis) with a sclerotic rim.

-Sclerotic rim (indicates that the bone has had time to react).

-Solid periosteal reaction displaying focal cortical thickening.

Examples:

-Enchondroma

-Aneurysmal bone cyst

-Simple bone cyst

-Nonossifying fibroma

-Chondroblastoma

Benign Lesions
malignant lesions
Radiographic findings:

-Permeative pattern of bone destruction displays tiny radiolucencies between residual bone trabeculae (characteristic of rapidly growing, poorly defined lesions).

-Poorly defined bone pattern

-Periosteum shows separation from the cortex and formation of new bone.

-codman’s triangle

-onion-skinning

Examples:

-Osteogenic sarcoma

-Ewing’s sarcoma

-Chondrosarcoma

Malignant Lesions
enchondroma
Metaphysis of tubular bones, ie small bones of the hands and feet.

Lytic geographic lesion.

Well-circumscribed oval lucencies. surrounded by a thin rim of radiodense bone.

Enchondroma
simple bone cyst
Proximal humerus and proximal femur

central, well marginated & symmetric

metaphysis is not broader than with width of epiphyseal plate

thin rim of non-reactive bone borders the bone cyst

Simple Bone Cyst
nonossifying fibroma
Metaphyseal or diaphyseal regions of distal femur or tibia.

Eccentrically located, lobulated, surrounded by sclerotic margin.

Nonossifying Fibroma
osteogenic sarcoma
Metaphyseal region of distal femur and proximal tibia.

Destroy surrounding cortices and produce soft tissue masses.

Codman’s triangle

Osteogenic Sarcoma
ewing s sarcoma
Diaphysis of femur

Destructive, lytic lesion with permeative margins

Onion-skinning

Ewing’s Sarcoma
references
References
  • Robbins and Cotran. Pathologic Basis of Disease. 7th Edition.
  • UMDNJ SOM Bone Tumor Pathology website.
  • X-rays obtained on the web.