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BONE TUMORS By Dr. Ahmed Hosny
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Clues by Appearance of Lesion
Clues by Location of Lesion Clues by Density of Lesion Other Clues
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Clues by Appearance of Lesion
Patterns of Bone Destruction Periosteal Reactions Tumor Matrix Expansile Lesions of Bone
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Clues by Appearance of Lesion
Patterns of Bone Destruction Geographic Moth-eaten Permeative
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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
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Patterns of Bone Destruction
Geographic Moth-eaten Permeative Non-ossifying fibroma
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Geographic Bone Destruction
Examples: Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma
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Moth-eaten Bone Destruction
Areas of destruction with ragged borders Implies more rapid growth Probably a malignancy
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Patterns of Bone Destruction
Geographic Moth-eaten Permeative Multiple Myeloma
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Moth-eaten Bone Destruction
Examples: Myeloma Metastases Lymphoma Ewing’s sarcoma
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Permeative Bone Destruction
Ill-defined lesion with multiple “worm-holes” Spreads through marrow space Wide transition zone Implies an aggressive malignancy Round-cell lesions
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Patterns of Bone Destruction
Geographic Moth-eaten Permeative Leukemia
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Permeative Bone Destruction
Examples: Lymphoma, leukemia Ewing’s Sarcoma Myeloma Osteomyelitis Neuroblastoma
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Patterns of Bone Destruction
Geographic Moth-eaten Permeative Less malignant More malignant
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Periosteal Reactions Benign More aggressive or malignant None Solid
Lamellated or onion peel Sunburst Codman’s triangle
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Periosteal Reactions Benign Aggressive/malignant None Solid onion-peel
Sunburst Codman’s triangle Non-ossifying fibroma
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Periosteal Reactions Benign Aggressive/malignant Chronic osteomyelitis
None Solid Aggressive/malignant onion-peel Sunburst Codman’s triangle Chronic osteomyelitis
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Periosteal Reactions Benign Aggressive/malignant None Solid onion-peel
Sunburst Codman’s triangle Ewing sarcoma
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Periosteal Reactions Benign Aggressive/malignant Osteo-sarcoma None
Solid Aggressive/malignant onion-peel Sunburst Codman’s triangle Osteo-sarcoma
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Periosteal Reactions Benign Aggressive/malignant Osteo-sarcoma None
Solid Aggressive/malignant onion-peel Sunburst Codman’s triangle Osteo-sarcoma
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Periosteal Reactions Solid Sunburst onion-peel Codman’s triangle
Less malignant More malignant
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Tumor Matrix Osteoblastic Fluffy, cotton-like or cloud-like densities
Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibroma
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Tumor Matrix Osteoblastic Cartilaginous
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Tumor Matrix Cartilaginous
Osteoblastic Fluffy, cotton-like or cloud-like densities as Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like as Enchondroma, chondrosarcoma, chondromyxoid fibroma
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Tumor Matrix Osteoblastic Cartilaginous Chondrosarcoma
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia Renal cell carcinoma
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Aneurysmal bone cyst Fibrous dysplasia
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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
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In the Transverse Plane
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In the longitudinal Plane
Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo-and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Characteristic Locations
Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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Clues by Density of Lesion
Sclerotic Cortical Lesions Lytic Lesions in Children Lytic Lesions in Adults Blastic Lesions in Children Blastic Lesions in Adults
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Sclerotic Cortical Lesions
Osteoid osteoma Brodie’s abscess
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Sclerotic Cortical Lesions
Osteoid osteoma Brodie’s abscess
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Lytic Lesions in Children
Eosinophilic granuloma Leukemia
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Lytic Lesions in Children
Eosinophilic granuloma Leukemia
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Lytic Lesions in Adults
Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor Metastatic thyroid carcinoma
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Lytic Lesions in Adults
Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor
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Lytic Lesions in Adults
Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor Chondrosarcoma
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Blastic Lesions in Children
Lymphoma
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Blastic Lesions in Adults
Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis Prostatic Ca.
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Blastic Lesions in Adults
Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis
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Blastic Lesions in Adults
Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis
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Blastic Lesions in Adults
Metastatic disease Breast –female Prostate –male Lymphoma Paget’s disease Fluorosis
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Other Clues Soft Tissue Extension Benign vs. Malignant
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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
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Soft Tissue Extension lymphoma
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Benign vs. Malignant
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Thank You
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