1. Bone tumors

2. Aneurysmal bone cyst
Is a solitary, expansile and erosive lesion of bone
An ABC is like a Soft, fibrous walls separate spaces filled with friable blood clot

3. Aneurysmal bone cyst Causes:- Clinical pain or swelling and tenderness
Trauma and vascular disturbance
Clinical
pain or swelling and tenderness
Rapid progression

4. Aneurysmal bone cyst Benign tumor. Male = female.
80% occur before the age of 20.
Common sites :- Spine , long bones, pelvis .

5. Aneurysmal bone cyst Radiological picture :-
Expandile osteolytic lesion 2-20 cm ( soap bubble appearance ).
Well defined margin.
Metaphysis of long bone (Eccentric location ).
Thin maintained cortex

6. Role of CT in ABC
CT scan can help delineate lesions in the pelvis or spine where plain film imaging may be inadequate.
CT scan can narrow the differential dignosis of ABC by demonstrating multiple fluid-fluid levels within the cystic spaces

7. Role of MRI in ABC
MRI can confirm the multiple fluid-fluid levels and the non-homogeneity of the lesion.      

8. Aneurysmal bone cyst
An expansile lytic lesion involving the metaphysis of the distal ulna. The margins are well-defined and there are multiple internal septations.

9. Aneurysmal bone cyst
Large 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.

12. Aneurysmal bone cyst

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

14. Giant 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

15. Giant cell tumor Radiographic appearance:-
Lytic Subarticular lesion ( metaphysis )
Expanding destructive lesion
No sclerotic margin
May erode into the joint
Pathological fracture in 30%

16. Giant cell tumor

17. Giant cell tumor

18. Giant cell tumor

19. Giant cell tumor

20. Giant cell tumor

21. Giant cell tumor

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

23. Osteosarcoma (osteogenic sarcoma)
Clinical picture:-
Pain , swelling
Soft tissue extension

24. Osteosarcoma (osteogenic sarcoma)
Radiographic picture:-
Destructive lesion.
Arises in the medulla of the metaphysis of long bones
The disease usually extends from the metaphysis to the epiphysis
Malignant radiographic features are:-
Codman’s triangle .
Sun ray appearance.

25. Osteosarcoma (osteogenic sarcoma)
Role of MRI
Determine the distribution of tumor within the bone and extend of any associated soft tissue mass.
Note :- CT is less sensetive than MRI to detect the tumor but used to detect chest metastasis

26. Osteosarcoma

28. Osteosarcoma

29. Osteosarcoma

30. Metastasis Radiological appearance of metastasis
The commonest malignant bone tumor
Radiological appearance of metastasis
Sclerotic :- Prostatic and Breast carcinoma.
Lytic :- Neuroblastoma, leukaemia in the children ,Prostatic and Breast carcinoma.
Mixed lytic and sclerotic :- may be seen in carcinoma of the breast.

31. Metastasis Sites of affection:-
Spine, skull, ribs , pelvis, humerus and femor.
In the long bones , arise in the medulla and as they grow , elnarge and destroy the cortex.

32. Metastasis

33. Metastasis

34. Metastasis
Periosteal reaction is uncommon with metastasis except with neuroblastoma.
Radionuclide bone scan is better in cases of metastasis than plain films as :-
It is much more sensetive for detecting metastasis.
Easier examination for the patient to do skeletal survey.
30% of metastasis seen on a bone scan will not be visible on plain films.

35. Metastasis

36. Metastasis

37. Metastasis

38. Metastasis

39. Multiple myeloma Location :-
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)

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

41. 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

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

43. How can you differentiate between multiple myeloma and metastasis ???
1- Intervertebral disc
2- Vertebral pedicles
3- Mandible
4- Soft tissue mass