Bone tumors
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
Aneurysmal bone cyst Causes:- Clinical pain or swelling and tenderness Trauma and vascular disturbance Clinical pain or swelling and tenderness Rapid progression
Aneurysmal bone cyst Benign tumor. Male = female. 80% occur before the age of 20. Common sites :- Spine , long bones, pelvis .
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
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
Role of MRI in ABC MRI can confirm the multiple fluid-fluid levels and the non-homogeneity of the lesion.
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.
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.
Aneurysmal bone cyst
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
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
Giant cell tumor Radiographic appearance:- Lytic Subarticular lesion ( metaphysis ) Expanding destructive lesion No sclerotic margin May erode into the joint Pathological fracture in 30%
Giant cell tumor
Giant cell tumor
Giant cell tumor
Giant cell tumor
Giant cell tumor
Giant cell tumor
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.
Osteosarcoma (osteogenic sarcoma) Clinical picture:- Pain , swelling Soft tissue extension
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.
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
Osteosarcoma
Osteosarcoma
Osteosarcoma
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.
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.
Metastasis
Metastasis
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.
Metastasis
Metastasis
Metastasis
Metastasis
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)
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 disc 2- Vertebral pedicles 3- Mandible 4- Soft tissue mass