How to Approach Bone Tumors

1
How to Approach Bone Tumors

• Frank ODea
• December 20, 2002

2
Introduction

• If you try to look at hole/abnormality in bone
  without a system then you will get lost!
• Once you have a system that works and apply it
  every time then the diagnosis becomes self
  apparent or at the very least a rational plan of
  attack develops.

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Dont think like a shot gun!!!!

• Think of the age of the patient.
• Think of where the abnormality is . or isnt.
• Think of the tissue categories of tumors.
• Think in terms of benign, benign aggressive or
  malignant.

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Tumor Tissue types

• Metastatic 90
• Hematologic (Myeloma, Lymphoma, Leukemia 5)
• Primary Mesenchymal Tumors 5

5
Primary Bone Tumors

• Osteogenic
• Fibrous
• Chondroid
• Lipomatous
• Other
• These are the broad categories

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Osteogenic

• Benign Osteoma, Osteoid Osteoma, Bone Islands
• Benign Aggressive Osteoblastoma
• Malignant Osteogenic Sarcoma

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Fibrous Tumours

• Benign Fibrous Cortical Defect, Non-Ossifying
  Fibroma, Fibroma of Bone.
• Benign Aggressive Fibromatosis(desmoid),
  Ossifying Fibroma of bone, Fibrous Dysplasia.
• Malignant Malignant Fibrous Histiocytoma of
  bone, Fibrosarcoma.

8
Chondroid

• Benign Enchondroma, Peri-osteal Chondroma,
  Osteochondroma.
• Benign Aggressive Chondromyxoid Fibroma,
  Chondroblastoma.
• Malignant Chondrosarcoma.

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Other Bone Tumors

• Benign Bone Cyst, Ganglion, Hemangioma.
• Benign Aggressive Giant Cell Tumor, Aneurysmal
  Bone Cyst, EOG.
• Malignant Adamantinoma, Chordoma, Ewings.

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Radiographic Features of the Various Tumors

• Benign well circumscribed, narrow transition, no
  reaction, sclerotic border, does one thing.
• Benign Aggressive neocorticalization, expansion,
  thinning of cortex, usually lytic, /-reaction,
  /- narrow zone of transition.
• Malignant reaction, large, permeative, moth
  eaten, does more than one thing.
• Conditions/Mets more than one bone, symmetry.

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Benign Features
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Benign Aggressive Features
13
Malignant Features
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Radiographic Tissue Identifiers

• Bone, Sclerosis, Calcification.. Osteoid.
• Popcorn, Arc Ring Calcification, Bright on T2,
  Low on T1.chondroid.
• Lytic, Low on T2, Low on T1.Fibrous.
• Lytic, well circumsribed, Bright T2, Dark
  T1Cystic fluid.
• Fluid Fluid Levels.ABC

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Sites of Tumors

• Diaphyseal Ewings, Osteoid Osteoma, Mets,
  Adamantinoma, Fibrous Dysplasia
• Epiphyseal Chondroblastoma, Clear Cell
  Chondrosarcoma, GCT, Ganglion of Bone.
• Metaphyseal Everything!!!!!!

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Age of Tumors

• 20gt..Osteogenic Sarcoma, Ewings.
• 40GCT, Chondrosarcoma, MFH, Lymphoma, Mets.
• 60Mets, Myeloma, Chondrosarcoma, late
  Osteogenic, MFH, Fibrosarcoma.