COMMON BONE TUMORS

BENIGN BONE TUMORS

CLASSIFICATION :
1.CHONDROID TUMORS
2.OSTEOID TUMORS
3.CYSTS
4.FIBROUS TUMORS
5.VASCULAR TUMORS

1.CHONDROID TUMORS:

A. OSTEOCHONDROMA
B. ENCHONDROMA
C.CHONDROBLASTOMA
 A. OSTEOCHONDROMA

MOST COMMON SOLITARY BENIGN BONE TUMOR

OCCURS IN THE DISTAL FEMUR, PROXIMAL HUMERUS, PROXIMAL
TIBIA OF LONG BONES AND ILIUM AND SCAPULA OF FLAT BONES

ARISES FROM THE CORTEX OF BONE

CONTINUOUS WITH CORTEX
PEDUNCULTED OR SESSILE
MEDULLA GROWS INTO THE OUTGROWING TUMOR

CHARACTERISTIC FEATURE IS AN ACTIVELY GROWING

CARTILAGE CAP SEEN WELL WITH USG, CT AND MRI BUT NOT
WITH PLAIN XRAY
WITH AGE CAP BECOMES CALCIFIED IN A PUNCTATE OR
NODULAR FASHION
MRI T2W IMAGE SHOWS HYPERINTENSE CAP SURROUNDED BY
HYPOINTENSE MUSCLE.
MULTIPLE OSTEOCHONDROMA / DIAPHYSEAL ACASIS IS A RARE
CONDITION

IMPORTANT D/D IS CHONDROSARCOMA WHICH SHOWS

CHARACTERISTICS OF MALIGNANT TUMOR
 ENCHONDROMA

SECOND MOST COMMON BENIGN CARTILAGE LESION

BENIGN INTRAMEDULLARY NEOPLASM MADE UP OF LOBULES OF

HYALINE CARTILAGE

MOST COMMONLY AFFECTS THE METAPHYSES OR DIAPHYSES OF

TUBULAR BONES OF HANDS AND FEET- 40 – 65 %

PROXIMAL PHALANGE > METACARPAL > MIDDLE PHALANX

FEMUR, TIBIA,HUMERUS – 25%

RADIOLOGICAL FEATURES :
ECCENTRICALLY LOCATED METAPHYSIAL OR DIAPHYSEAL MASS

SOLITARY MASS , LYTIC LESIONS

WELL CIRCUMSCRIBED LOBULATED OR SMOOTH WALLED

MAY EXPAND THE CORTEX

CHONDRAL TYPE CALCIFICATION

ENCHONDROMA PROTUBERANCE – ECCENTRIC MASS ARISING

FROM SLENDER BONES SUCH AS RIBS OR FIBULA

MRI – T1W – INTERMEDIATE SIGNAL INTENSITY

T2W – HIGH SIGNAL INTENSITY
 CALCIFICATION OCCURS AS AREAS OF SIGNAL VOID
SEPTATIONS IF PRESENT OCCUR AS SIGNAL VOID

LESS COMMON VARIETIES : PERIOSTEAL ENCHONDROMA

MULTIPLE ENCHONDROMA(OLLIER'S DISEASE) AND MUFFUCI
SYNDROME (ENCHONDROMATOIS + HEMANGIOMA)

CHONDROBLASTOMA

EPIPHYSEAL TUMOR
OCCURS BETWEEN 5 & 25 YEARS , RARE AFTER 30 YRS
MOST COMMON SITE – PROXIMAL FEMUR AND AROUND KNEE
JOINT
FEET- CALCANEOUS AND TALUS MOST COMMONLY INVOLVED

STARTS IN EPIPHYSES BUT AS THE PLATES CLOSE EXTENDS INTO

THE METAPHYSES

RADIOLOGICAL FEATURES

SPHERICAL , LOBULAR LESION WITH THIN SCLEROTIC MARGIN

LINEAR PERIOSTEAL REACTION IS PRESENT

ASSOCIATED WITH ANEURYSMAL BONE CYST IN 15% CASES

MRI – VARIABLE SIGNAL INTENSITY ON T2W IMAGES, INCLUDING

HYPOINTENSITY AND FLUID LEVELS
THIS IS INVARIABLY SURROUNDED BY EDEMA AND JOINT
EFFUSION WHICH APPEAR WITH HIGH SIGNAL INTENSITY

OSTEOID BONE TUMOR

A. ENOSTOSIS
B. OSTEOMA
C.OSTEOID OSTEOMA

A. ENOSTOSIS (BONE ISLAND)

FOCUS OF CORTICAL BONE LOCATED WITHIN THE MEDULLA

INCIDENTAL FINDINGS MOST COMMONLY SEEN IN FEMUR AND
OTHER LONG BONES
MULTIPLE BONE ISLANDS ARE SEEN IN OSTEOPOIKILOSIS AND
OSTEOPTHIA STRIATA

RADIOLOGICAL FEATURES :
DENSE SCLEROTIC FOCUS WITH CHARACTERISTIC SPICULATED
MARGINS WHICH BLENDS WITH THE TRABECULAE OF HOST
BONES

MRI – LOW SIGNAL INTENSITY AS THAT OF NORMAL CORTICAL

BONES

BONE SCINTIGRAPHY – LOW UPTAKE AND THUS DIFFERS FROM

METASTATIC SECONDARIES

OSTEOMA

CONSISTS OF CORTICAL OR CANCELLOUS BONES

CORTICAL OSTEOMA – COMMON , AKA IVORY OSTEOMA

MOST COMMONLY ARISES FROM PARANASAL SINUSES.
LONG BONES AND SPINES ARE ALSO INVOLVED

RADIOLOGICAL FEATURES : DENSE HOMOGENOUS LESIONS WITH

SMOOTH OR LOBULTED MARGINS

MULTIPLE CORTICAL OSTEOMAS ARE FOUND IN GARDNER'S

SYNDROME

CANCELLOUS OSTEOMAS ARE RARE

OSTEOID OSTEOMA
ESSENTIALLY A HAMARTOMA

CHARACTERIC CLINICAL PICTURE : NIGHT PAIN RLIEVED BY

ASPIRIN
MIMICS NEROLOGICAL LESION WITH SLUGGISH REFLEXES ,
OSTEOPOROSIS AND MUSCLE WASTING

AFFECTS ALL SKELETAL SITES LIKE CORTEX ,MEDULLA AND

SUBPERIOSTEAL REGION

DIAPHYSIS AND METAPHYSIS OF FEMUR AND TIBIA – 50% OF

CASES
IN SPINE – NEURAL ARCHINVOLVEMENT 90% OF TIME

RADIOLOGICAL FEATURES:

PLAIN FILM: CHARACTERISTIC FEATURE NIDUS WHICH MAY BE

LYTIC, SCLEROTIC, OR MIXED DENSITY

NIDUS – USUALLY MEASURES 5MM OR LESS, BUT MAY GROW UPTO

15MM.
NIDUS IS SURROUNDED BY MEDULLARY SCLEROSIS AND
PERIOSTEAL REACTION
REACTIVE CHANGES MAY OBSCURE THE NIDUS IN PLAIN FILM

BONE SCINTIGRAPHY : DOUBLE DENSITY SIGN,AN AREA OF

INTENSE ACTIVITY SURROUNDED BY AREA OF LESS INTENSE
ACTIVITY

CT : NEED 2-3 MM SLICES TO IDENTIFY NIDUS

SHOWS MEDULLARY SCLEROSIS AND PERIOSTEAL REACTION
PERIOSTEAL REACTION ABSENT WITH INTRA ARTICULAR LESION ,
LESIONS IN THE TERMINAL PHALANGES AND THOSE DEEP IN
MEDULLARY BONE AND MEDULLARY OR AT TENDINOUS OR
LIGAMENTOUS INSERTIONS

MRI – CANNOT DEMOSTRATE NIDUS AND GIVES A CONFUSING

PICTURE

CYSTIC BENIGN TUMORS

A. SIMPLE BONE CYSTS
B. ANEURYSMAL BONE CYST
C. GIANT CELL TUMOR

A.SIMPLE BONE CYST

AKA UNICAMERAL BONE CYST
SOLITARY BUT NOT ALWAYS UNILOCULAR
AGES GR : 5- 15 YRS
MOST COMMON LOCATION :
PROXIMALHUMERUS(60%) FOLLOWED BY PROXIMAL
FEMUR (30%)
INITIALLY LOCATED IN THE PROXIMAL METAPHYSES
THEN PROGRESSES INTO DIAPHYSES WITH SKELETAL
GROWTH AND THEN THEY REACH THE MIDDLE AND
DISTAL THRD OF THE SHAFT
 RADIOLOGICAL FEATURES
PLAIN FILM
SBC COMMONLY LOCATED CENTRALLY IN THE SHAFT
EXPANSILE
THINNING THE CORTEX
THE LESION IS TYPICALLY 6 – 8 CM IN SIZE
TRABECULATION IS COMMON
PERIOSTEAL REACTION NOT SEEN
FRACTURE RESULTS IN FALLING FRAGMENT SIGN AND
PERIOSTEAL REACTION

MRI FEATURES :
T1W – LOW TO INTERMEDIATE INTENSITY
T2W OR STIR – HYPERINTENSITY
FRACTURES RESULT IN HEMORRHAGE AND FLUID FLUID
LEVELS AND OEDEMA

ANEURYSMAL BONE CYST

TRUE NEOPLASM
AGE – 1ST AND 2ND DECADE
LONG BONES – 50 %
SPINE – 20%
FLAT BONES – MOST COMMON IN PELVIS

SPINAL LESIONS CAN CAUSE SCOLIOSIS AND PARAPARESIS

RADIOLOGICAL FEATURES
PURELY LYTIC
EXPANSILE
INTRAMEDULLARY
ARISING FROM THE METAPHYSIS OF LONG BONES
EXTENDS TO THE GROWTH PLATE

MORE COMMONLY LOCATED ECCENTRICALLY BUT MAY

BE CENTRAL
SPINAL LESIONS ARISE IN NEURAL ARCH WITH
UNILATERAL COLLAPSE AND STRUCTURAL SCOLIOSIS

CT : OTHER THAN THOSE MENTIONED ABOVE CT SHOWS

FINE SEPTAL OSSIFICATION , FLUID LEVELS, THIN RIM AND
INTERNAL SEPTA
MRI : MEDULLARY EDEMA , FLUID LEVELS , THIN RIM AND
INTERNAL SEPTA, WHICH MAY ENHANCE FOLLOWING
GADOLINIUM
MOST COMMON D/D IS TELANGIECTATIC OSTEOSARCOMA

GIANT CELL TUMOR

AGGRESSIVE BENIGN NEOPLASM
MALIGNANT CHANGE OCCURS
BENIGN LESIONS MAY UNDERGO METASTASIS
AGE -18 TO 44 YEARS OF AGE
LOCATION : SUBARTICULAR OR SUBCORTICAL
MOST COMMON SITES : KNEE , DISTAL RADIUS AND
PROXIMAL HUMERUS BEING COMMONEST SITES
SACRUM MOST COMMONLY AFFECTED SITE IN SPINE AND
VERTEBRAL BODY IS AFFECTED WITH VERTEBRAL
INVOLVEMENT

RADIOLOGICAL FEATURE
CLASSICALLY
SUBARTICULAR
ECCENTRIC
LYTIC
GEOGRAPHIC , NON SCLEROTIC MARGINS
AGGRESSIVE LESIONS – POORLY DEFINES MARGINS
TRABECULATION AND CORTICAL EXPANSION COMMON
FEATURES
CORTICAL DESTRUCTION WITH EXTRA OSSEUS
EXTENSION MAY OCCUR IN UPTO 50% OF CASES
PERIOSTEAL REACTION PRESENT IN CASES WITH
FRACTURES

MRI – ISO /HYPO INTENSE SIGNAL

HYPERINTENSE SIGNAL WITH HEMORRAHGE / BLOOD
HYPOINTENSE SIGNAL T2W IMAGES DUE TO HEMOSIDERIN
DEPOSITION DUE TO CHRONIC HEMORRHAGE

FLUID-FLUID LEVELS INDICATE SECONDARY ABC CHANGE

COMMON D/D : LYTIC OSTEOSARCOMA , LYTIC

METASTASIS FROM PRIMARY RENAL TUMORS

FIBROUS BENIGN BONE TUMORS

A. NON OSSIFYING FIBROMA
B. FIBROUS CORTICAL DEFECT
C.FIBROUS DYSPLASIA

A.NON OSSIFYING FIBROMA

BENIGN NEOPLASM
AGE – 2ND DECADE
LOWER LIMB INVOLVEMENT – 90% AT TIBIA AND DISTAL
END OF FEMUR
MULTIPLE LESIONS FAMILIAL AND ASSOCIATED WITH
NEUROFIBROMATOSIS
USUALLY DIAGNOSED RADIOLOGICALLY

RADIOLOGICAL FEATURES :

PLAIN FILM – DIAGNOSTIC

LESIONS METAPHYSEAL , DIAMETAPHYSEAL
ESSENTAILLY CORTICAL
LOBULATED
SOAP BUBBLE APPEARANCE
ENLARGING INTO MEDULLA IS CLASSICAL
TUMOR OVAL IN SHAPE WITH LONG AXIS IN THE LINE OF
THE BONE
PERIOSTEAL REACTION SEEN ONLY AFTER FRACTURE

MRI : T1W – INTERMEDIATE SI , T2W – HYPOINTENSE 80%

 B.FIBROUS DYSPLASIA
DEVELOPMENTAL DISORDER OF BONE
MONOSTOTIC AND POLYOSTOTIC TYPE

RADIOLOGICAL FEATURE

GEOGRAPHIC LESION WITH BONE EXPANSION AND

DEFORMITY
DIFFUSE GROUND GLASS MATRIX MINERALIZATION
PRESENT
PERIOSTEAL RECTION NOT PRESENT WITHOUT FRACTURE
VARUS DEFORMITY OF PROXIMAL FEMUR CALLED
SHEPHERD'S CROOK APPEARANCE IS A LATE FINDING

SYNTIGRAPHY – BEST FOR IDENTIFYING MUTIPLE LESION

MRI
T1W – HYPOINTENSE, HEMORRHAGE – MILD
HYPERINTENSITY.

T2W – HYPO/HYPERINTENSE
INTERNAL SEPTATIONS WITH CYSTIC CHANGE AND FLUID
LEVELS ARE SEEN
IV CONTRAST PRODUCES – SEPTAL ENHANCEMENT

PRESENCE OF CHONDROID CALCIFICATION INDICATES

FIBROCARTILAGENOUS DYSPLASIA

C. FIBROUS CORTICAL DEFECT

COMMON IN CHILDHOOD
NORMAL VARIENT
COMMONLY SEEN IN DISTAL FEMORAL AND PROXIMAL
TIBIAL METAPHYSES
RADIOLOGICALLY SAME AS NON OSSIFYING FIBROMA
DIFFERING ONLY IN SIZE MEASURING ABOUT 1- 1.5 CM IN
MAXIMAL DIMENSION
 VASCULAR TUMORS
HEMANGIOMA
TYPES : CAPILLARY , CAVERNOUS ,ARTERIOVENOUS OR
VENOUS
OSSEOUS CAPILLARY HEMANGIOMA AFFECT VERTEBRAL
BODY
OSSEOUS CAVERNOUS HEMANGIOMA AFFECTS SKULL
VAULT

RADIOLOGICAL FEATURES:
PLAIN FILM – VERTEBRAL BODIES- COARSE VERTICAL
TRABECULATIONS DUE TO HYPRTROPHY OF PRIMARY
TRABECULAE
AND DESTRUCTION OF SECONDARY TRABECULAE

LONG BONES: STRIATED LESIONS ARE FOUND IN

EPIPHYSES AND METAPHYSES WITH THE DIRECTION OF
THE STRIATIONS ALONG THE LONG AXIS OF THE BONE.

CT : DENSE DOTS (THICKENED TRABECULATIONS) WITH IN

FATTY MATRIX

MRI – INCREASED SIGNAL INTENSITY ON T1W AND T2W

IMAGES
VASCULAR HEMANGIOMAS – CT CAN SHOW THICKENED
TRABECULAE AND MRI SHOWS REDUCED SIGNAL
INTENSITY ON T1W IMAGES

FLAT BONES: MULTIPLE , WELL DEFINED LYTIC LESIONS

PRODUCE A SOAP BUBBLE EFFECT
SKULL – SUN BURST APPEARANCE CAN BE SEEN