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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.

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Presentation on theme: "BONE TUMORS By Dr. Ahmed Hosny. Clues by Appearance of Lesion Clues by Location of Lesion Clues by Density of Lesion Other Clues."— Presentation transcript:

1 BONE TUMORS By Dr. Ahmed Hosny

2 Clues by Appearance of Lesion Clues by Location of Lesion Clues by Density of Lesion Other Clues

3 Clues by Appearance of Lesion Patterns of Bone Destruction Periosteal Reactions Tumor Matrix Expansile Lesions of Bone

4 Clues by Appearance of Lesion Patterns of Bone Destruction –Geographic –Moth-eaten –Permeative

5 Geographic Bone Destruction Destructive lesion with sharply defined border Implies a less-aggressive, more slow- growing, benign process Narrow transition zone

6 Patterns of Bone Destruction –Geographic –Moth-eaten –Permeative Non-ossifying fibroma

7 Geographic Bone Destruction Examples: Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma

8 Moth-eaten Bone Destruction Areas of destruction with ragged borders Implies more rapid growth Probably a malignancy

9 Patterns of Bone Destruction –Geographic –Moth-eaten –Permeative Multiple Myeloma

10 Examples: Myeloma Metastases Lymphoma Ewing’s sarcoma Moth-eaten Bone Destruction

11 Permeative Bone Destruction Ill-defined lesion with multiple “worm-holes” Spreads through marrow space Wide transition zone Implies an aggressive malignancy Round-cell lesions

12 Patterns of Bone Destruction –Geographic –Moth-eaten –Permeative Leukemia

13 Examples: Lymphoma, leukemia Ewing’s Sarcoma Myeloma Osteomyelitis Neuroblastoma Permeative Bone Destruction

14 Patterns of Bone Destruction Geographic Moth-eatenPermeative Less malignant More malignant

15 Periosteal Reactions Benign –None –Solid More aggressive or malignant –Lamellated or onion peel –Sunburst –Codman’s triangle

16 Periosteal Reactions Benign –None –Solid Aggressive/malignant –onion-peel –Sunburst –Codman’s triangle Non-ossifying fibroma

17 Periosteal Reactions Benign –None –Solid Aggressive/malignant –onion-peel –Sunburst –Codman’s triangle Chronic osteomyelitis

18 Periosteal Reactions Benign –None –Solid Aggressive/malignant –onion-peel –Sunburst –Codman’s triangle Ewing sarcoma

19 Periosteal Reactions Benign –None –Solid Aggressive/malignant –onion-peel –Sunburst –Codman’s triangle Osteo-sarcoma

20 Periosteal Reactions Benign –None –Solid Aggressive/malignant –onion-peel –Sunburst –Codman’s triangle Osteo-sarcoma

21 Periosteal Reactions Solidonion-peelSunburstCodman’s triangle Less malignant More malignant

22 Tumor Matrix Osteoblastic –Fluffy, cotton-like or cloud-like densities –Osteosarcoma Cartilaginous –Comma-shaped, punctate, annular, popcorn-like –Enchondroma, chondrosarcoma, chondromyxoid fibroma

23 Tumor Matrix Osteoblastic Cartilaginous

24 Osteoblastic –Fluffy, cotton-like or cloud-like densities as Osteosarcoma Cartilaginous –Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma Tumor Matrix

25 Osteoblastic Cartilaginous Tumor Matrix Chondrosarcoma

26 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone

27 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia

28 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone Renal cell carcinoma

29 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone

30 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone

31 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone

32 Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Expansile Lesions of Bone

33 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

34 In the Transverse Plane...

35 Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo-and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma In the longitudinal Plane

36 Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

37 Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior

38 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations

39 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations

40 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations

41 Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Characteristic Locations

42 Clues by Density of Lesion Sclerotic Cortical Lesions Lytic Lesions in Children Lytic Lesions in Adults Blastic Lesions in Children Blastic Lesions in Adults

43 Sclerotic Cortical Lesions Osteoid osteoma Brodie’s abscess

44 Osteoid osteoma Brodie’s abscess Sclerotic Cortical Lesions

45 Lytic Lesions in Children Eosinophilic granuloma Leukemia

46 Lytic Lesions in Children Eosinophilic granuloma Leukemia

47 Lytic Lesions in Adults Metastatic lesions –Lung –Renal –Thyroid Multiple myeloma Primary bone tumor Metastatic thyroid carcinoma

48 Metastatic lesions –Lung –Renal –Thyroid Multiple myeloma Primary bone tumor Lytic Lesions in Adults

49 Metastatic lesions –Lung –Renal –Thyroid Multiple myeloma Primary bone tumor Chondrosarcoma Lytic Lesions in Adults

50 Lymphoma Blastic Lesions in Children

51 Metastatic disease Breast – female Prostate – male Lymphoma Paget’s disease Fluorosis Prostatic Ca. Blastic Lesions in Adults

52 Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis Blastic Lesions in Adults

53 Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis Blastic Lesions in Adults

54 Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis Blastic Lesions in Adults

55 Other Clues Soft Tissue Extension Benign vs. Malignant

56 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

57 lymphoma Soft Tissue Extension

58 Benign vs. Malignant

59 Thank You


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