Bone tumorsBone tumors

Aneurysmal bone cyst Is a solitary, expansile and erosive lesion of boneIs a solitary, expansile and erosive lesion of bone An ABC is like a Soft, fibrous walls separate spaces filled An ABC is like a Soft, fibrous walls separate spaces filled

with friable blood clotwith friable blood clot

Aneurysmal bone cyst

Causes:-

Trauma and vascular disturbance

Clinical Clinical

pain or swelling and tenderness

Rapid progression

Aneurysmal bone cystAneurysmal bone cyst Benign tumor.Benign tumor.

Male = female.Male = female.

80% occur before the age of 20.80% occur before the age of 20.

Common sites :- Spine , long bones, pelvis .Common sites :- Spine , long bones, pelvis .

Aneurysmal bone cystAneurysmal bone cyst

Radiological picture :-Radiological picture :- Expandile osteolytic lesion 2-20 cm ( soap bubble Expandile osteolytic lesion 2-20 cm ( soap bubble

appearance ).appearance ). Well defined margin.Well defined margin. Metaphysis of long bone (Eccentric location ).Metaphysis of long bone (Eccentric location ). Thin maintained cortexThin maintained cortex

Role of CT in ABCRole of CT in ABC CT scan can help delineate lesions in the pelvis or spine CT scan can help delineate lesions in the pelvis or spine

where plain film imaging may be inadequate.where plain film imaging may be inadequate.

CT scan can narrow the differential dignosis of ABC by CT scan can narrow the differential dignosis of ABC by demonstrating multiple fluid-fluid levels within the cystic demonstrating multiple fluid-fluid levels within the cystic spacesspaces

Role of MRI in ABCRole of MRI in ABC MRI can confirm the multiple fluid-fluid levels and the non-MRI can confirm the multiple fluid-fluid levels and the non-

homogeneity of the lesion.       homogeneity of the lesion.      

Aneurysmal bone cystAneurysmal bone cystAn expansile lytic lesion involving the metaphysis of the distal ulna.

The margins are well-defined and there are multiple internal septations.

Aneurysmal bone cystAneurysmal bone cystLarge expansile lytic lesion involving the posterior elements of the L3

vertebra. A large expansile component extends into the left paraspinal muscles.

Fine septations are seen within the expansile portion of the mass. The borders are lobulated.

Aneurysmal bone cystAneurysmal bone cyst

Giant cell tumorGiant cell tumor Benign tumor Equal sex incidence Equal sex incidence 20 to 40 years (after epiphyseal closure )20 to 40 years (after epiphyseal closure ) Malignant changes in 20% Site :- Around the knee, at the ankle , at the wristSite :- Around the knee, at the ankle , at the wrist

Giant cell tumorGiant cell tumor

Clinical picture :- The first symptom is pain in the area of the tumor. Pain generally increases with activity and decreases

with rest. Pain is usually mild at first, but it progressively

increases. Swelling at the affected area

Giant cell tumorGiant cell tumorRadiographic appearance:-Radiographic appearance:- Lytic Subarticular lesion ( metaphysis )Lytic Subarticular lesion ( metaphysis ) Expanding destructive lesionExpanding destructive lesion No sclerotic marginNo sclerotic margin May erode into the jointMay erode into the joint Pathological fracture in 30%

Giant cell tumorGiant cell tumor

Giant cell tumorGiant cell tumor

Giant cell tumorGiant cell tumor

Giant cell tumorGiant cell tumor

Giant cell tumorGiant cell tumor

Giant cell tumorGiant cell tumor

Osteosarcoma (osteogenic Osteosarcoma (osteogenic sarcoma)sarcoma)

Malignant tumor.Malignant tumor. More common in malesMore common in males 50 % around the knee joint, humerus and pelvis.50 % around the knee joint, humerus and pelvis. 5-20 years old age.5-20 years old age. May occur in eldery as a complication of paget’s disease.May occur in eldery as a complication of paget’s disease.

Osteosarcoma Osteosarcoma (osteogenic sarcoma)(osteogenic sarcoma)

Clinical picture:-Clinical picture:- Pain , swelling Pain , swelling Soft tissue extensionSoft tissue extension

Osteosarcoma (osteogenic Osteosarcoma (osteogenic sarcoma)sarcoma)

Radiographic picture:-Radiographic picture:- Destructive lesion. Destructive lesion. Arises in the medulla of the metaphysis of long bonesArises in the medulla of the metaphysis of long bones The disease usually extends from the metaphysis to the The disease usually extends from the metaphysis to the

epiphysisepiphysis

Malignant radiographic features are:-Malignant radiographic features are:-Codman’s triangle .Codman’s triangle .

Sun ray appearance.Sun ray appearance.

Osteosarcoma Osteosarcoma (osteogenic sarcoma)(osteogenic sarcoma)

Role of MRIRole of MRIDetermine the distribution of tumor within the bone and Determine the distribution of tumor within the bone and

extend of any associated soft tissue mass.extend of any associated soft tissue mass.

Note :- CT is less sensetive than MRI to detect the tumor but Note :- CT is less sensetive than MRI to detect the tumor but used to detect chest metastasis used to detect chest metastasis

OsteosarcomaOsteosarcoma

OsteosarcomaOsteosarcoma

OsteosarcomaOsteosarcoma

MetastasisMetastasis

Radiological appearance of Radiological appearance of metastasismetastasis

Sclerotic :-Sclerotic :- Prostatic and Breast carcinoma. Prostatic and Breast carcinoma. Lytic :-Lytic :- Neuroblastoma, leukaemia in the Neuroblastoma, leukaemia in the

children ,Prostatic and Breast carcinoma.children ,Prostatic and Breast carcinoma. Mixed lytic and sclerotic :-Mixed lytic and sclerotic :- may be seen in may be seen in

carcinoma of thecarcinoma of the breast.breast.

The commonest malignant bone tumorThe commonest malignant bone tumor

Metastasis Metastasis Sites of affection:-Sites of affection:-

•Spine, skull, ribs , pelvis, humerus and femor.Spine, skull, ribs , pelvis, humerus and femor.•In the long bones , arise in the medulla and as they grow In the long bones , arise in the medulla and as they grow , elnarge and destroy the cortex., elnarge and destroy the cortex.

MetastasisMetastasis

MetastasisMetastasis

MetastasisMetastasis Periosteal reaction is uncommon with metastasis Periosteal reaction is uncommon with metastasis

except with neuroblastoma.except with neuroblastoma.

Radionuclide bone scan is better in cases of Radionuclide bone scan is better in cases of metastasis than plain films as :-metastasis than plain films as :-

It is much more sensetive for detecting It is much more sensetive for detecting metastasis.metastasis.

Easier examination for the patient to do skeletal Easier examination for the patient to do skeletal survey.survey.

30% of metastasis seen on a bone scan will not 30% of metastasis seen on a bone scan will not be visible on plain films.be visible on plain films.

MetastasisMetastasis

MetastasisMetastasis

MetastasisMetastasis

Metastasis

Multiple myeloma

Primary malignant tumor of bone marrow, the marrow spaces has been replaced by a diffuse gelatenous red brown tissue

Location :- Skull, spine, pelvis, ribs , scapula . The disease may occur in the disseminated form

or as a localized solitary enlarging mass (plasmacytoma)

Multiple myeloma

Clinical presentation:- Male predominance Over 40 years old Weight loss Malaise Bone pain Backache Fracture

Multiple myeloma

Radiological features :- Generalised osteoprosis. Pathological fracture. Scattered “punched –out lytic lesions with well

defined margins . Bone expansion with extension through the

cortex producing soft tissue masses. No sclerotic margin

Multiple myeloma

Numerous lytic lesions, which are typical for the appearance of widespread myeloma.

How can you differentiate between multiple myeloma and metastasis ???

1- Intervertebral disc2- Vertebral pedicles3- Mandible 4- Soft tissue mass