Bone Tumors Ger

7/28/2019 Bone Tumors Ger

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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

DestructionExamples: Non-ossifying fibroma

Chondromyxoid fibroma Eosinophilic granuloma


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Moth-eaten Bone Destruction

Areas of destruction with raggedborders

Implies more rapid growth Probably a malignancy


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Geographic

Moth-eaten

Permeative

Multiple Myeloma


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Examples:

Myeloma

Metastases Lymphoma

Ewings sarcoma

Moth-eaten Bone Destruction


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PermeativeBone Destruction

Ill-defined lesion with multipleworm-holes

Spreads through marrow space Wide transition zone

Implies an aggressive malignancy

Round-cell lesions


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Geographic

Moth-eaten

Permeative

Leukemia


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Examples:

Lymphoma, leukemia

Ewings Sarcoma Myeloma

Osteomyelitis

Neuroblastoma

PermeativeBone Destruction


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Geographic Moth-eaten Permeative

Less malignant Moremalignant


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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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Benign None

Solid


Sunburst

Codmans triangle

Chronic osteomyelitis


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Benign None

Solid


Sunburst

Codmans triangle

Ewing sarcoma


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Benign None

Solid


Sunburst

Codmans triangle

Osteo-sarcoma


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Benign None

Solid


Sunburst

Codmans triangle

Osteo-sarcoma


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Solid onion-peelSunburst Codmans

triangle

Less malignant More malignant


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Tumor Matrix

Osteoblastic Cartilaginous


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Osteoblastic

Cartilaginous

Tumor Matrix

Chondrosarcoma


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Multiple myeloma

Mets

Brown tumor Enchondroma

Aneurysmal bone cyst

Fibrous dysplasia

Expansile Lesions of Bone


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Multiple myeloma

MetsBrown tumor

Enchondroma

Aneurysmal bonecyst

Fibrous dysplasia


Renal cell carcinoma


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Multiple myeloma

Mets

Brown tumorEnchondroma

Aneurysmal bonecyst

Fibrous dysplasia



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Multiple myeloma

Mets

Brown tumor

EnchondromaAneurysmal bone

cyst

Fibrous dysplasia



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Multiple myeloma

Mets

Brown tumor

Enchondroma

Aneurysmal bonecyst

Fibrous dysplasia



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Multiple myeloma

Mets

Brown tumor

EnchondromaAneurysmal 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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EpiphysealGCT, chondroblastoma

MetaphysealOsteomyelitis, osteo-and chondrosarcoma

DiaphysealRound cell lesions, ABC, enchondroma

In the longitudinal Plane


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Characteristic Locations

Simple bonecystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumor

Epiphyses Adamantinoma

Tibia Chordoma

Sacrum, clivus Osteoblastoma

Spine, posterior


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Characteristic Locations Simple bone cyst

Proximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia Chordoma


Spine, posterior


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Simple bone cyst

Proximal humerus Chondroblastoma

Epiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia Chordoma


Spine, posterior



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Simple bone cyst


Epiphyses Giant Cell tumor

Epiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior



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Simple bone cyst




Tibia





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Simple bone cyst




Tibia





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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

Osteoidosteoma

Brodies abscess


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Osteoid osteoma

Brodiesabscess

Sclerotic Cortical Lesions


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Lytic Lesions in Children Eosinophilicgranuloma

Leukemia


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Lytic Lesions in Children Eosinophilic granuloma

Leukemia


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Lytic Lesions in Adults

Metastaticlesions

Lung

Renal Thyroid

Multiple myeloma

Primary bone tumor

Metastatic thyroid carcinoma


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Metastatic lesions

Lung

Renal

Thyroid

Multiplemyeloma Primary bone tumor



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Metastatic lesions

Lung

Renal

Thyroid

Multiple myeloma

Primarybonetumor

Chondrosarcoma



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Lymphoma

Blastic Lesions in Children


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Metastaticdisease

Breast

female Prostate male

Lymphoma

Pagets disease Fluorosis

Prostatic Ca.



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Metastatic disease

Breast female

Prostate male

Lymphoma Pagets disease

Fluorosis



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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 tissueextension

Osteomyelitis

Usually infiltration of fat


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lymphoma

Soft Tissue Extension


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Benign vs. Malignant


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Thank You

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Bone Tumors Ger

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