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BONE TUMORS. By Dr. Ahmed Hosny. Clues by Appearance of Lesion Clues by Location of Lesion Clues by Density of Lesion Other Clues. Clues by Appearance of Lesion. Patterns of Bone Destruction Periosteal Reactions Tumor Matrix Expansile Lesions of Bone. Clues by Appearance of Lesion.

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bone tumors

BONE TUMORS

By

Dr. Ahmed Hosny

slide2
Clues by Appearance of Lesion
  • Clues by Location of Lesion
  • Clues by Density of Lesion
  • Other Clues
clues by appearance of lesion
Clues by Appearance of Lesion
  • Patterns of Bone Destruction
  • Periosteal Reactions
  • Tumor Matrix
  • Expansile Lesions of Bone
clues by appearance of lesion4
Clues by Appearance of Lesion
  • Patterns of Bone Destruction
    • Geographic
    • Moth-eaten
    • Permeative
geographic bone destruction
Geographic Bone Destruction
  • Destructive lesion with sharply defined border
  • Implies a less-aggressive, more slow-growing, benign process
  • Narrow transition zone
patterns of bone destruction
Patterns of Bone Destruction
  • Geographic
  • Moth-eaten
  • Permeative

Non-ossifying fibroma

geographic bone destruction7
Geographic Bone Destruction

Examples:

  • Non-ossifying fibroma
  • Chondromyxoid fibroma
  • Eosinophilic granuloma
moth eaten bone destruction
Moth-eaten Bone Destruction
  • Areas of destruction with ragged borders
  • Implies more rapid growth
      • Probably a malignancy
patterns of bone destruction9
Patterns of Bone Destruction
  • Geographic
  • Moth-eaten
  • Permeative

Multiple Myeloma

moth eaten bone destruction10
Moth-eaten Bone Destruction

Examples:

  • Myeloma
  • Metastases
  • Lymphoma
  • Ewing’s sarcoma
permeative bone destruction
PermeativeBone Destruction
  • Ill-defined lesion with multiple “worm-holes”
  • Spreads through marrow space
  • Wide transition zone
  • Implies an aggressive malignancy
      • Round-cell lesions
patterns of bone destruction12
Patterns of Bone Destruction
  • Geographic
  • Moth-eaten
  • Permeative

Leukemia

permeative bone destruction13
PermeativeBone Destruction

Examples:

  • Lymphoma, leukemia
  • Ewing’s Sarcoma
  • Myeloma
  • Osteomyelitis
  • Neuroblastoma
patterns of bone destruction14

Less malignant

Moremalignant

Patterns of Bone Destruction
  • Moth-eaten

Permeative

Geographic

periosteal reactions
Periosteal Reactions
  • Benign
    • None
    • Solid
  • More aggressive or malignant
    • Lamellated or onion peel
    • Sunburst
    • Codman’s triangle
slide16

Periosteal Reactions

  • Benign
    • None
    • Solid
  • Aggressive/malignant
    • onion-peel
    • Sunburst
    • Codman’s triangle

Non-ossifying fibroma

slide17

Periosteal Reactions

  • Benign
    • None
    • Solid
  • Aggressive/malignant
    • onion-peel
    • Sunburst
    • Codman’s triangle

Chronic osteomyelitis

slide18

Periosteal Reactions

  • Benign
    • None
    • Solid
  • Aggressive/malignant
    • onion-peel
    • Sunburst
    • Codman’s triangle

Ewing sarcoma

slide19

Periosteal Reactions

  • Benign
    • None
    • Solid
  • Aggressive/malignant
    • onion-peel
    • Sunburst
    • Codman’s triangle

Osteo-sarcoma

slide20

Periosteal Reactions

  • Benign
    • None
    • Solid
  • Aggressive/malignant
    • onion-peel
    • Sunburst
    • Codman’s triangle

Osteo-sarcoma

slide21

Less malignant

More malignant

Periosteal Reactions

Solid

  • Sunburst
  • onion-peel
  • Codman’s
  • triangle
tumor matrix
Tumor Matrix
  • Osteoblastic
    • Fluffy, cotton-like or cloud-like densities
    • Osteosarcoma
  • Cartilaginous
    • Comma-shaped, punctate, annular, popcorn-like
    • Enchondroma, chondrosarcoma, chondromyxoid fibroma
tumor matrix23
Tumor Matrix
  • Osteoblastic
  • Cartilaginous
tumor matrix24
Tumor Matrix
  • Osteoblastic
    • Fluffy, cotton-like or cloud-like densities

as Osteosarcoma

  • Cartilaginous
    • Comma-shaped, punctate, annular, popcorn-like

as Enchondroma, chondrosarcoma, chondromyxoid fibroma

tumor matrix25
Tumor Matrix
  • Osteoblastic
  • Cartilaginous

Chondrosarcoma

expansile lesions of bone
Expansile Lesions of Bone
  • Multiple myeloma
  • Mets
  • Brown tumor
  • Enchondroma
  • Aneurysmal bone cyst
  • Fibrous dysplasia
expansile lesions of bone27
Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

slide28

Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

Renal cell carcinoma

slide29

Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

slide30

Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

slide31

Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

slide32

Expansile Lesions of Bone

Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

slide33

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
slide34

.

.

.

In the Transverse Plane

in the longitudinal plane
In the longitudinal Plane
  • Epiphyseal

GCT, chondroblastoma

  • Metaphyseal

Osteomyelitis, osteo-and chondrosarcoma

  • Diaphyseal

Round cell lesions, ABC, enchondroma

characteristic locations
Characteristic Locations
  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

slide37

Characteristic Locations

  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

slide38

Characteristic Locations

  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

slide39

Characteristic Locations

  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

slide40

Characteristic Locations

  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

slide41

Characteristic Locations

  • Simple bone cyst

Proximal humerus

  • Chondroblastoma

Epiphyses

  • Giant Cell tumor

Epiphyses

  • Adamantinoma

Tibia

  • Chordoma

Sacrum, clivus

  • Osteoblastoma

Spine, posterior

clues by density of lesion
Clues by Density of Lesion
  • Sclerotic Cortical Lesions
  • Lytic Lesions in Children
  • Lytic Lesions in Adults
  • Blastic Lesions in Children
  • Blastic Lesions in Adults
sclerotic cortical lesions
Sclerotic Cortical Lesions
  • Osteoidosteoma
  • Brodie’s abscess
sclerotic cortical lesions44
Sclerotic Cortical Lesions
  • Osteoid osteoma
  • Brodie’sabscess
lytic lesions in children
Lytic Lesions in Children
  • Eosinophilicgranuloma
  • Leukemia
lytic lesions in children46
Lytic Lesions in Children
  • Eosinophilic granuloma
  • Leukemia
lytic lesions in adults
Lytic Lesions in Adults
  • Metastaticlesions
    • Lung
    • Renal
    • Thyroid
  • Multiple myeloma
  • Primary bone tumor

Metastatic thyroid carcinoma

lytic lesions in adults48
Lytic Lesions in Adults
  • Metastatic lesions
    • Lung
    • Renal
    • Thyroid
  • Multiplemyeloma
  • Primary bone tumor
lytic lesions in adults49
Lytic Lesions in Adults
  • Metastatic lesions
    • Lung
    • Renal
    • Thyroid
  • Multiple myeloma
  • Primarybonetumor

Chondrosarcoma

blastic lesions in adults
Blastic Lesions in Adults
  • Metastatic disease
      • Breast –female
      • Prostate –male
  • Lymphoma
  • Paget’s disease
  • Fluorosis

Prostatic Ca.

blastic lesions in adults52
Blastic Lesions in Adults
  • Metastatic disease
      • Breast –female
      • Prostate –male
  • Lymphoma
  • Paget’s disease
  • Fluorosis
blastic lesions in adults53
Blastic Lesions in Adults
  • Metastatic disease
      • Breast –female
      • Prostate –male
  • Lymphoma
  • Paget’s disease
  • Fluorosis
blastic lesions in adults54
Blastic Lesions in Adults
  • Metastatic disease
      • Breast –female
      • Prostate –male
  • Lymphoma
  • Paget’s disease
  • Fluorosis
other clues
Other Clues
  • Soft Tissue Extension
  • Benign vs. Malignant
soft tissue extension
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