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

Patterns of Bone Destruction
Geographic Moth-eaten Permeative

Geographic Bone Destruction

Destructive lesion with sharply defined border Implies a less-aggressive, more slowgrowing, benign process Narrow transition zone

Patterns of Bone Destruction

Geographic Moth-eaten Permeative

Non-ossifying fibroma

Examples: Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma

Geographic Bone Destruction

Moth-eaten Bone Destruction

Areas of destruction with ragged borders Implies more rapid growth
Probably a malignancy

Patterns of Bone Destruction

Geographic Moth-eaten Permeative

Multiple Myeloma

Moth-eaten Bone Destruction

Examples: Myeloma Metastases Lymphoma Ewings sarcoma

Permeative Bone 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 Destruction

Geographic Moth-eaten Permeative

Leukemia

Permeative Bone Destruction

Examples: Lymphoma, leukemia Ewings Sarcoma Myeloma Osteomyelitis Neuroblastoma

Patterns of Bone Destruction

Geographic

Moth-eaten

Permeative

Less malignant

More malignant

Periosteal Reactions
Benign
None Solid

More aggressive or malignant

Lamellated or onion peel Sunburst Codmans triangle

Periosteal Reactions
Benign
None Solid

Aggressive/malignant
onion-peel Sunburst Codmans triangle

Non-ossifying fibroma

Periosteal Reactions
Benign
None Solid

Aggressive/malignant
onion-peel Sunburst Codmans triangle

Chronic osteomyelitis

Periosteal Reactions
Benign
None Solid

Aggressive/malignant
onion-peel Sunburst Codmans triangle

Ewing sarcoma

Periosteal Reactions
Benign
None Solid

Aggressive/malignant
onion-peel Sunburst Codmans triangle

Osteo-sarcoma

Periosteal Reactions
Benign
None Solid

Aggressive/malignant
onion-peel Sunburst Codmans triangle

Osteo-sarcoma

Periosteal Reactions

Solid

Sunburst

onion-peel

Codmans triangle

Less malignant

More malignant

Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities Osteosarcoma
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

Cartilaginous Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma

Tumor Matrix
Osteoblastic Cartilaginous

Chondrosarcoma

Expansile Lesions of Bone

Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma
Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma

Mets
Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Renal cell carcinoma

Expansile Lesions of Bone

Multiple myeloma Mets

Brown tumor
Enchondroma Aneurysmal bone cyst Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma Mets Brown tumor

Enchondroma
Aneurysmal bone cyst Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma Mets Brown tumor Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst

Fibrous dysplasia

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 Plane

Epiphyseal
GCT, chondroblastoma

Metaphyseal Diaphyseal

Osteomyelitis, osteo-and chondrosarcoma

Round cell lesions, ABC, enchondroma

 Simple bone cyst

Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

Characteristic Locations
Proximal humerus

Characteristic Locations

Chondroblastoma
Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

Simple bone cyst Proximal humerus

Epiphyses

Characteristic Locations

Giant Cell tumor

Simple bone cyst Proximal humerus Chondroblastoma Epiphyses

Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

Epiphyses

Characteristic Locations

Adamantinoma

Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses

Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

Tibia

Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia

Chordoma
Osteoblastoma Spine, posterior

Sacrum, clivus

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

Sclerotic Cortical Lesions Lytic Lesions in Children Lytic Lesions in Adults Blastic Lesions in Children Blastic Lesions in Adults

Sclerotic Cortical Lesions

Osteoid osteoma
Brodies abscess

Sclerotic Cortical Lesions

Osteoid osteoma

Brodies abscess

Lytic Lesions in Children

Eosinophilic granuloma
Leukemia

Lytic Lesions in Children

Eosinophilic granuloma

Leukemia

Lytic Lesions in Adults

Metastatic lesions Lung Renal Thyroid
Multiple myeloma Primary bone tumor

Metastatic thyroid carcinoma

Lytic Lesions in Adults

Metastatic lesions Lung Renal Thyroid

Multiple myeloma
Primary bone tumor

Lytic Lesions in Adults

Metastatic lesions Lung Renal Thyroid Multiple myeloma

Primary bone tumor

Chondrosarcoma

Blastic Lesions in Children

Lymphoma

 Metastatic disease Breast female Prostate male

Lymphoma Pagets disease Fluorosis

Blastic Lesions in Adults

Prostatic Ca.

Blastic Lesions in Adults

Metastatic disease Breast female Prostate male

Lymphoma
Pagets disease Fluorosis

Blastic Lesions in Adults

Metastatic disease Breast female Prostate male Lymphoma

Pagets disease
Fluorosis

Blastic Lesions in Adults

Metastatic disease Breast female Prostate male Lymphoma Pagets disease

Fluorosis

Other Clues
Soft Tissue Extension Benign 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

Soft Tissue Extension

lymphoma

Benign vs. Malignant

Thank You