bone tumors clues and cues bone tumors clues and cues
TRANSCRIPT
Bone TumorsClues and CuesBone Tumors
Clues and Cues
William Herring, M.D. © 2002
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Geographic Bone Destruction
Destructive lesion with sharply defined border
Implies a less-aggressive, more slow-growing, benign process
Narrow transition zone
Non-ossifying fibroma
Geographic
Moth-eaten
Permeative
Patterns of Bone DestructionPatterns of Bone Destruction
© R3, 2000
Moth-eaten Appearance
Areas of destruction with ragged borders
Implies more rapid growthProbably a malignancy
Multiple Myeloma
Patterns of Bone DestructionPatterns of Bone Destruction
Geographic
Moth-eaten
Permeative
© R3, 2000
Permeative Pattern
Ill-defined lesion with multiple “worm-holes”
Spreads through marrow space
Wide transition zone
Implies an aggressive malignancy
Round-cell lesions
Permeative PatternRound cell lesions
Lymphoma, leukemia
Ewing’s Sarcoma
Myeloma
Osteomyelitis
Neuroblastoma
Periosteal Reactions
BenignNoneSolid
More aggressive or malignantLamellated or onion-skinningSunburstCodman’s triangle
Non-ossifying fibroma
BenignNoneSolid
Aggressive/malignantOnion-skinningSunburstCodman’s triangle
Periosteal Reactions
© R3, 2000
Chronic osteomyelitis
BenignNoneSolid
Aggressive/malignantOnion-skinningSunburstCodman’s triangle
Periosteal Reactions
© R3, 2000
BenignNoneSolid
Aggressive/malignantOnion-skinningSunburstCodman’s triangle
Periosteal Reactions
Ewing’s sarcoma© Greenspan, 2000
Osteosarcoma
BenignNoneSolid
Aggressive/malignantOnion-skinningSunburstCodman’s triangle
Periosteal Reactions
© Greenspan, 2000
Ewing’s-Codman’striangle
BenignNoneSolid
Aggressive/malignantOnion-skinningSunburstCodman’s triangle
Periosteal Reactions
© R3, 2000
Tumor Matrix
OsteoblasticFluffy, cotton-like or cloud-like densities
Osteosarcoma
CartilaginousComma-shaped, punctate, annular, popcorn-like
Enchondroma, chondrosarcoma, chondromyxoid fibroma
Expansile Lesions of Bone
Multiple myeloma Brown tumor
Mets Enchondroma
Aneurysmal bone cyst Lymphoma
Fibrous dysplasia
Multiple Myeloma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
Renal Cell Carcinoma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
Aneurysmal Bone Cyst
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
Fibrous Dysplasia
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
Brown Tumor
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma © R3, 2000
Enchondroma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma© R3, 2000
Lymphoma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma © R3, 2000
In the Transverse Plane
CentralEnchondroma
EccentricGCT, osteosarcoma, chondromyxoid fibroma
CorticalNon-ossifying fibroma, osteoid osteoma
ParostealParosteal osteosarcoma, osteochondroma
In the Longitudinal Plane
EpiphysealGCT, chondroblastoma
MetaphysealOsteomyelitis, osteo- and chondrosarcoma
DiaphysealRound cell lesions, ABC, enchondroma
Tumor TypesCharacteristic Locations
Simple bone cystProximal humerus
ChondroblastomaEpiphyses
Giant Cell tumorEpiphyses
Simple bone cystProximal humerus
ChondroblastomaEpiphyses
Giant Cell tumorEpiphyses
Characteristic locations
© R3, 2000
Chondroblastoma
Simple bone cystProximal humerus
ChondroblastomaEpiphyses
Giant Cell tumorEpiphyses
Characteristic locations
© R3, 2000
Giant Cell Tumor
Simple bone cystProximal humerus
ChondroblastomaEpiphyses
Giant Cell tumorEpiphyses
Characteristic locations
© R3, 2000
Tumor TypesCharacteristic Locations
AdamantinomaTibia
ChordomaSacrum, clivus
OsteoblastomaSpine, posterior
AdamantinomaTibia
ChordomaSacrum, clivus
OsteoblastomaSpine, posterior
Characteristic locations
Adamantinoma© R3, 2000
AdamantinomaTibia
ChordomaSacrum, clivus
OsteoblastomaSpine, posterior
Chordoma
Characteristic locations
© R3, 2000
Osteoblastoma
AdamantinomaTibia
ChordomaSacrum, clivus
OsteoblastomaSpine, posterior
Characteristic locationsCharacteristic locations
© R3, 2000
Expansile Rib Lesions
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
Thyroid Carcinoma
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
© R3, 2000
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
© R3, 2000
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
© R3, 2000
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
© R3, 2000
Lesions of the Spine
OsteoblastomaExpansile, with punctate densities within
Chordoma
ABC
Metastatic disease
Brodie’s abscess
Osteoid osteoma
Brodie’s abscess
Stress fracture
Sclerotic cortical lesions
© R3, 2000
Healing Stress Fracture
Osteoid osteoma
Brodie’s abscess
Stress fracture
Sclerotic cortical lesionsSclerotic cortical lesions
Eosinophilic granuloma
Neuroblastoma
Leukemia
Lytic Lesions in Children
Eosinophilic granuloma© R3, 2000
Medulloblastoma
Medulloblastoma
Lymphoma
Blastic Lesions in ChildrenBlastic Lesions in Children
© R3, 2000
Blastic Lesions in Adults
Metastatic diseaseBreast – female
Prostate – male
Lymphoma
Paget’s disease
Etcetera-mastocytosis, fluorosis
Benign LesionsWithout Sclerotic Boarders
Giant Cell tumor
Brown tumor
Osteolytic phase of Paget’s Disease
Benign Lesions without Sclerotic Benign Lesions without Sclerotic BordersBorders
Giant cell tumor
Brown tumor
Osteolytic Paget’s
Giant Cell Tumor© R3, 2000
Brown Tumor
Benign Lesions without Sclerotic Benign Lesions without Sclerotic BordersBorders
Giant cell tumor
Brown tumor
Osteolytic Paget’s
© R3, 2000
Osteolytic Paget’s
Benign Lesions without Sclerotic Benign Lesions without Sclerotic BordersBorders
Giant cell tumor
Brown tumor
Osteolytic Paget’s
© R3, 2000
Soft Tissue Extension
Usually implies malignancyMore likely to form discrete soft tissue mass
Benign conditions with soft tissue extension
OsteomyelitisUsually infiltration of fat
Multiple Lesions
More often benign
Malignancies with multiple lesionsMetastatic disease
Multiple myeloma
Lymphoma
Ewing’s sarcoma (rarely)
Osteosarcoma (rarely)
Mets from Ca of Prostate
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
© R3, 2000
Osteosarcomatosis
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
Osteosarcomatosis
© R3, 2000