BONE TUMORS

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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
• Ewings 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
• Ewings Sarcoma
• Myeloma
• Osteomyelitis
• Neuroblastoma

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Patterns of Bone Destruction
Moth-eaten
Permeative
Geographic
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Periosteal Reactions

• Benign
• None
• Solid
• More aggressive or malignant
• Lamellated or onion peel
• Sunburst
• Codmans triangle

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Periosteal Reactions

• Benign
• None
• Solid
• Aggressive/malignant
• onion-peel
• Sunburst
• Codmans triangle

Non-ossifying fibroma
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Periosteal Reactions

• Benign
• None
• Solid
• Aggressive/malignant
• onion-peel
• Sunburst
• Codmans triangle

Chronic osteomyelitis
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Periosteal Reactions

• Benign
• None
• Solid
• Aggressive/malignant
• onion-peel
• Sunburst
• Codmans triangle

Ewing sarcoma
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Periosteal Reactions

• Benign
• None
• Solid
• Aggressive/malignant
• onion-peel
• Sunburst
• Codmans triangle

Osteo-sarcoma
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Periosteal Reactions

• Benign
• None
• Solid
• Aggressive/malignant
• onion-peel
• Sunburst
• Codmans triangle

Osteo-sarcoma
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Periosteal Reactions
Solid
onion-peel
Sunburst
Codmans triangle
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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

• 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 Ane
urysmal bone cyst Fibrous dysplasia
Renal cell carcinoma
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Ane
urysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Ane
urysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Ane
urysmal bone cyst Fibrous dysplasia
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Expansile Lesions of Bone
Multiple myeloma Mets Brown tumor Enchondroma Ane
urysmal 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
• Epiphyses
• Adamantinoma
• Tibia
• Chordoma
• Sacrum, clivus
• Osteoblastoma
• Spine, posterior

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Characteristic Locations

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

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Characteristic Locations

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

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Characteristic Locations

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

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Characteristic Locations

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

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Characteristic Locations

• Simple bone cyst
• Proximal humerus
• Chondroblastoma
• Epiphyses
• Giant Cell tumor
• Epiphyses
• 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
• Brodies abscess

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Sclerotic Cortical Lesions

• Osteoid osteoma
• Brodies 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
• Pagets disease
• Fluorosis

Prostatic Ca.
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Blastic Lesions in Adults

• Metastatic disease
• Breast female
• Prostate male
• Lymphoma
• Pagets disease
• Fluorosis

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Blastic Lesions in Adults

• Metastatic disease
• Breast female
• Prostate male
• Lymphoma
• Pagets disease
• Fluorosis

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Blastic Lesions in Adults

• Metastatic disease
• Breast female
• Prostate male
• Lymphoma
• Pagets 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