Semey State Medical University BONE TUMORS Prepared by

Semey State Medical University BONE TUMORS Prepared by: Yermek Alma Checked by: Zhanasbayev M. A

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

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

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

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

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

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

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

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

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

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

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

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

Patterns of Bone Destruction Geographic Less malignant Moth-eaten Permeative More malignant

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

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

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

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

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

Periosteal Reactions Solid Sunburst Less malignant onion-peel More malignant Codman’s triangle

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

Tumor Matrix • Osteoblastic • Cartilaginous

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

Tumor Matrix • Osteoblastic • Cartilaginous Chondrosarcoma

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

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

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

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

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

In the Transverse Plane. . .

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

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

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

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

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

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

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

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

Sclerotic Cortical Lesions • Osteoid osteoma • Brodie’s abscess

Lytic Lesions in Children • Eosinophilic granuloma • Leukemia

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

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

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

Blastic Lesions in Children • Lymphoma

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

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

Other Clues • Soft Tissue Extension • Benign vs. Malignant

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

Soft Tissue Extension lymphoma

Benign vs. Malignant

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