08 musculoskeletal tumor.ppt

8/21/2019 08 Musculoskeletal Tumor.ppt

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Imaging of

Musculoskeletal Tumors

57 kg

Neurofibroma-

tosis involvingthe whole R

lower

extremity



The objectives of radiologic

evaluation

• detection of suspected lesion: +/-,

soft tissue or bone tumor

• establishment of a diagnosis or

formulation of an appropriate

differential diagnosis, and• radiologic staging of the lesion*

*not discussed



Challenges in Diagnosis

• Rare (< 1% from all malignant neoplasm)

• Treatment choice can be drastic (amputation)

• Radiograph interpretation have its limitation indifferentiating between malignant and benignlesion: ABC can looked malignant, intraosseoussarcoma can be seen as benign.

Kilpatrick S, Renner JB, Diagnostic Musculoskeletal Surgical Pathology, 1-4, 2004, Saunders



Tripple diagnosis Multidisciplinary

approach

FNA

Clinical Info Imaging



MRI

CT Scan

Ultrasound

Plain

Radiograph

Scintigraphy



Radiograph remains the most

reliable predictor of thehistologic nature of a given

lesion

Despite all of the imaging advances: CT,

MRI, Scintigraphy …….

Sundaram M, McDonald DJ (1989) The Solitary tumor or tumor like lesion of bone. Topics Magn Reson

Imaging 1(4):17-29



Growth Rate/ Activity

+

Periosteal reaction Age

LocationMatrix calcification



1. Pattern of destruction

2. Lesion Margin

3. Cortex Penetration

4. Presence of a sclerotic rim

5. Presence and extent of expandedcortical shell

Growth Rate/ Activity:

Lodwick et al. Radiology 134:577-583,1980

Geographic, moth-eaten, permeative



Permeative Geographic



Pola Destruksi tulang



Dari Jenis

BATAS lesi

3 JenisDestruksi

tulang



Destruksi:



What do you see?



Destruksi: geografik (+ sklerotik)



Moth eaten



Moth Eaten: Small areas of destruction

Multiple Myeloma



AggressiveNon-aggressive



Periosteal reaction

Uninterupted Interupted Interupted



Prof. Enneking:

“Tell me the age – I’ll tell you the pathology”



Location

• What bone?

• Epi/Met/Dia?

• Cortex/Med/par-ost/para-ost?

• Multiple/single?



Brown tumor - Hyperparathyroidism



Calcification

• Chondroblastic vs.

Osteoblastic



Role of CT scan

• Examine the presentor absence of nidus

• Demonstrating lesionin flat bones

• Confirming anycortical break inlesion with thin cortex

• Help characterizedtype of matrixcalcification

• Guide to Biopsy



MRI: 44 yrs M, malignant

degeneration of osteochondroma?



Examples:

MRI of

Bone tumor



Soft tissue sarcoma with blood vessel encasement &extra-compartmental infiltrationstaging



Soft Tissue Tumors

And Tumor-like Lesions



RELATION OF AGE TO INCIDENCE OF SARCOMA

SOFT TISSUE MALIGNANT TUMORS



Soft tissue

tumors

Plain Film

MRI

Lipoma Probable

hemangioma/

IM lipoma Doppler US

Other

Arteriography/ MR

angio

Biopsy



Plain Radiography

• To exclude a palpablelesion caused by an

underlying skeletaldeformity:

* Exuberant callus

* Bony exostosis

* Bone tumor withsoft tissue mass.



Plain Radiography

• Soft tissue calsification

characteristic of a specific

diagnosis:* Phleboliths

* Synovial

osteochondromatosis.

* Myositis ossificans.



Routine chest-xray screening for

metastasis



CT scan has been replaced

by MRI



Soft tissue mass on the chest wall



“Spesific” Diagnosis

in MRI

• Lipomatous lesions

• Angiomatous lesions• Tumorlike lesions

• Peripheral nerve lesions

• Fibrous lesions

• Synovial lesions



Lipoma



Hemangioma



Sign of Malignant lesion

• Larger

• Deeper

• More heterogenous

• Bone & neurovascular

involvement

I filt ti t dj t



Infiltration to adjacent

compartment



Neurofibroma



Variable signal intensity



Ultrasound + Doppler

• Doppler and high resolution

ultrasonography challenges the role

of MRI.• It has a few advantages compare to

MRI; low cost, real time scanning

and more available examination.



Spesific Diagnosis(Soft tissue masses

with pathognomonic ultrasound appearance)

• Angiomatous lesions

• Lipomatous lesions• Neurogenic tumors

• “cystic” masses



Phleboliths of hemangioma

Hemangioma



Lipoma

•

Hypoechoic

• Homogenous

• Well defined margin

• Oval

• Long axis parallel to skin

• Compressible

Neurogenic tumors



Neurogenic tumors



Big Bursitis



Huge

Baker’s Cyst



A case study:

“Triple



ClinicalFindings

Radiology Pathology

TripleDiagnosis”



Thank You



DIAGNOSIS FINAL, harus melalui

serangkaian analisis yang melibatkan:

Agresifitas

+

Umur

Lokasi

Jenis kalsifikasi



• AGRESIF GANAS

• NON AGRESIF JINAK

Benign – non aggresive vs.



g gg

Ganas - aggresive

1.Batas Lesi

2.Jenis reaksiperiosteal

3.Besarnya

massa jaringan

lunak



Batas Lesi

3 Jenis “margin”

3 Jenis Destruksi

Benign/

Malignant



Periosteal

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