Bone tumors of the pelvis

Daniel Vanel Istituto Ortopedico Rizzoli. Bologna (Italia)

Benign Tumors 864 (25.4%)

Bone Metastasis 846 (24.9%)

Systemic Tumors 306 (9.0%) Primary

Malignant Tumors 1.382 (40.7%)

3.398 cases of Bone Tumors of pelvis (Istituto ortopedica RIZZOLI 1900/2012)

RIZZOLI TUMORS

Total BENIGN tumors : 864 (25.4%)

0

5

10

15

20

25

30

%

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79age

54%46%

Average: 27 - Median: 23 - Range: 0-79

BENIGN TUMORS

BENIGN TUMORS

Total BENIGN tumors : 864 cases (25.4%)

BENIGN TUMORS Case 1: 20 year old man; pain

DESMOID FIBROMA non calcified and low signal on T2 è fibrous tissue

BENIGN TUMORS Case 2: 18 year old man; pain

ANEURISMAL BONE CYST fluid fluid levels è embolisation

After embolisation

BENIGN TUMORS Case 3: 17 year old man; pain

OSTEOID OSTEOMA small nidus, huge inflammatory reaction. è Radio frequency treatment

BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain

T1 FSE T2 fs T1 gd

1. metastasis

2. normal variant (red marrow) 3. angioma 4. other

?

BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain

1. biopsy

2. follow up 3. ignore

BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain

?

1. metastasis

2. normal variant (red marrow) 3. angioma 4. other

BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain

1. biopsy

2. follow up 3. ignore

BENIGN TUMORS Case 4: 31 year old woman.Thoracic pain

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

Skeletal Radiol 2008.

Yamaguchi  et  al      

100 spines (cadavers)

26 BNCT / 20 patients (M:F 2:1)

· same location as chordoma

Skeletal Radiol 2008.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

MRI : hypoT1 et hyperT2

Location: bone

Immuno: + CK18 and vimentin, S-100 protein, EMA, CAM5.2, AE1/AE3, brachyury

SIMILARITIES between BNCT and chordoma

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

BNCT Chordoma Growth minimal; sclerosis

Slow but aggressive Sft tissues

Histologiy Thick bone trabeculae

myxoïd component

Rx and CT sclerotic normal cortex and soft tissues

Lytic Soft tissues invaded

MRI no cm uptake

Uptake after injection

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

DIFFERENCES between BNCT and chordoma

BNCT and Chordoma

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

T1

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

After biopsy

T1

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

BNCT invading the soft tissues !

BNCT a still moving entity!

29 year old man, pain for 9 months.

BENIGN TUMORS Benign notochordal cell tumor (BNCT)

HEMOPATHIES

59%

41%

Total systemic bone tumors : 306 cases (9%)

0

2

4

6

8

10

12

14

16

18

20

%

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age

Average: 48 - Median: 49 - Range: 1-84

HEMOPATHIES

149

140

17

0 25 50 75 100 125 150

149

140

17

0 25 50 75 100 125 150

Myeloma

Hodgkin Lymphoma

Non Hodgkin Lymphoma

Total systemic bone tumors : 306 cases (9%)

LLC

HEMOPATHIES

B cell high grade LYMPHOMA

HEMOPATHIES

MYELOMA

HEMOPATHIES

62 year old woman

HEMOPATHIES

MYELOMA

T1FSE

MYELOMA

69 year old man

HEMOPATHIES

MALIGNANT TUMORS METASTASES

59%

41%

0

5

10

15

20

25

30

%

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age

Average 57 - Median: 59 - Range: 1-88

Total metastasis bone tumors : 846 cases (24.9%) Including 11 cases from neuroblastoma

Lytic or sclerotic

MALIGNANT TUMORS METASTASES

PROSTATE BREAST

MALIGNANT TUMORS METASTASES

THYROID

MALIGNANT TUMORS PRIMARY TUMORS

60%

40%

0

5

10

15

20

25

%

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89age

Average: 38 - Median: 35 - Range: 2-87

Total primary tumors : 1.382 cases (40.7%)

MALIGNANT TUMORS PRIMARY TUMORS

Total primary tumors : 1.382 cases

Adults : CHONDROSARCOMA Children : EWING

Surgical classification

MALIGNANT TUMORS PRIMARY TUMORS

CHONDROSARCOMA

MALIGNANT TUMORS PRIMARY TUMORS

60 year old man, pain

MALIGNANT TUMORS PRIMARY TUMORS

60 year old man, pain

MALIGNANT TUMORS PRIMARY TUMORS

60 year old man, pain

MALIGNANT TUMORS PRIMARY TUMORS

60 year old man, pain

MALIGNANT TUMORS PRIMARY TUMORS

CHONDROSARCOMA normal SI and acetabulum

MALIGNANT TUMORS PRIMARY TUMORS

Missed CHONDROSARCOMA Prothesis.

MALIGNANT TUMORS PRIMARY TUMORS

OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years

MALIGNANT TUMORS PRIMARY TUMORS

OSTEOSARCOMA ( zone I II, SI) è surgery radiotherapy well at 5 years

OSTEOSARCOMA

MALIGNANT TUMORS PRIMARY TUMORS

MALIGNANT TUMORS PRIMARY TUMORS

CHONDROSARCOMA Zone I and nerve

EWING Pregnant Zone I, ½ sacrum, ½ zone II

MALIGNANT TUMORS PRIMARY TUMORS

MALIGNANT TUMORS PRIMARY TUMORS

EWING Pregnant Zone I, ½ sacrum, ½ zone II

15 years follow up

MALIGNANT TUMORS PRIMARY TUMORS

EWING Pregnant Zone I, ½ sacrum, ½ zone II

MALIGNANT TUMORS PRIMARY TUMORS

CHONDROSARCOMA 70 year old man

MALIGNANT TUMORS PRIMARY TUMORS

CHONDROSARCOMA 70 year old man

10 years follow up

Gilles Missenard

�  BNCT

�  Frequent metastases

� Local staging for primary malignant tumors: CT , MRI

Bone tumors of the pelvis KEY POINTS