bone tumors - clues and cues
TRANSCRIPT
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Bone Tumors Clues and Cues
William Herring, M.D. © 2002
In Slide Show mode, advance the slides by pressing the spacebar All Photos Retain the Copyright of their Authors
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Clues by Appearance
of Lesion
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Geographic Bone Destruction
Destructive lesion with sharply defined border
Implies a less-aggressive, more slow-growing, benign process
Narrow transitional zone
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Non-ossifying fibroma
Geographic
Moth-eaten
Permeative
Patterns of Bone DestructionPatterns of Bone Destruction
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Geographic LesionsExamples
Non-ossifying fibroma = NOF
Eosinophilic granuloma = EG
Chondromyxoid fibroma = CMF
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Moth-eaten Appearance
Areas of destruction with ragged borders
Implies more rapid growth Probably a malignancy
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Multiple Myeloma
Patterns of Bone DestructionPatterns of Bone Destruction
Geographic
Moth-eaten
Permeative
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Moth-eaten AppearanceExamples
Lymphoma
Ewing’s sarcoma
Myeloma
Metastases
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Permeative Pattern
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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Leukemia
Patterns of Bone DestructionPatterns of Bone Destruction
Geographic
Moth-eaten
Permeative
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Permeative PatternRound cell lesions (MOLEN)
Myeloma
Osteomyelitis
Lymphoma, leukemia
Ewing’s Sarcoma
Neuroblastoma
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Patterns of Destruction
Geographic Moth-eaten Permeative
Less malignant More malignant
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Periosteal Reactions
Benign None Solid
More aggressive or malignant Lamellated or onion-skinning Sunburst Codman’s triangle
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Non-ossifying fibroma
Benign None Solid
Aggressive/malignant Onion-skinning Sunburst Codman’s triangle
Periosteal Reactions
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Chronic osteomyelitis
Benign None Solid
Aggressive/malignant Onion-skinning Sunburst Codman’s triangle
Periosteal Reactions
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Benign None Solid
Aggressive/malignant Onion-skinning Sunburst Codman’s triangle
Periosteal Reactions
Ewing’s sarcoma© Greenspan, 2000
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Osteosarcoma
Benign None Solid
Aggressive/malignant Onion-skinning Sunburst Codman’s triangle
Periosteal Reactions
© Greenspan, 2000
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Ewing’s-Codman’striangle
Benign None Solid
Aggressive/malignant Onion-skinning Sunburst Codman’s triangle
Periosteal Reactions
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Periosteal Reactions
Solid Lamellated Codman’sSunburst
Less malignant More malignant
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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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Osteoblastic
Cartilaginous
Tumor matrix
Osteosarcoma
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Osteoblastic
Cartilaginous
Tumor matrix
Chondrosarcoma
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Expansile Lesions of Bone
Multiple myeloma Brown tumor
Mets Enchondroma
Aneurysmal bone cyst Lymphoma
Fibrous dysplasia
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Multiple Myeloma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
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Renal Cell Carcinoma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
•
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Aneurysmal Bone Cyst
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
•
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Fibrous Dysplasia
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
•
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Brown Tumor
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
•
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Enchondroma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
• © R3, 2000
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Lymphoma
Expansile lesions
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma
•
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Clues by Location
of Lesion
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In the Transverse Plane
Central Enchondroma
Eccentric GCT, osteosarcoma, chondromyxoid fibroma
Cortical Non-ossifying fibroma, osteoid osteoma
Parosteal Parosteal osteosarcoma, osteochondroma
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Parosteal sarcoma
Osteochondroma
Osteosarcoma
In The Transverse Plane
© Greenspan, Lippincott, 2000
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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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Tumor TypesCharacteristic Locations
Simple bone cyst Proximal humerus
Chondroblastoma Epiphyses
Giant Cell tumor Epiphyses
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Simple bone cyst Proximal humerus
Chondroblastoma Epiphyses
Giant Cell tumor Epiphyses
Characteristic locations
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Chondroblastoma
Simple bone cyst Proximal humerus
Chondroblastoma Epiphyses
Giant Cell tumor Epiphyses
Characteristic locations
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Giant Cell Tumor
Simple bone cyst Proximal humerus
Chondroblastoma Epiphyses
Giant Cell tumor Epiphyses
Characteristic locations
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Tumor TypesCharacteristic Locations
Adamantinoma Tibia
Chordoma Sacrum, clivus
Osteoblastoma Spine, posterior
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Adamantinoma Tibia
Chordoma Sacrum, clivus
Osteoblastoma Spine, posterior
Characteristic locations
Adamantinoma© R3, 2000
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Adamantinoma Tibia
Chordoma Sacrum, clivus
Osteoblastoma Spine, posterior
Chordoma
Characteristic locations
© R3, 2000
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Osteoblastoma
Adamantinoma Tibia
Chordoma Sacrum, clivus
Osteoblastoma Spine, posterior
Characteristic locationsCharacteristic locations
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Tumor TypesCharacteristic Locations
Parosteal sarcoma Distal femur
Periosteal sarcoma Tibia
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Characteristic locations
Parosteal sarcoma Distal femur
Periosteal sarcoma Tibia
Parosteal sarcoma
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Characteristic locations
Parosteal sarcoma Distal femur
Periosteal sarcoma Tibia
© R3, 2000
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Characteristic Tumors
By Body Site
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Pelvic Lesions
Chondrosarcoma
Solitary plasmacytoma
Chordoma
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Chondrosarcoma
Solitary plasmacytoma
Chordoma
Pelvic lesions
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Plasmacytoma
Chondrosarcoma
Solitary plasmacytoma
Chordoma
Pelvic lesions
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Chordoma
Chondrosarcoma
Solitary plasmacytoma
Chordoma
Pelvic lesions
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Expansile Rib Lesions
Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
Thyroid Carcinoma
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
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Plasmacytoma
Metastases
Chondrosarcoma
Eosinophilic granuloma
Neurofibromatosis
Fibrous dysplasia
Expansile rib lesions
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Lesions of the Spine
Osteoblastoma Expansile, with punctate densities
within
Chordoma
ABC
Metastatic disease
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Osteoblastoma
Osteoblastoma
Chordoma
ABC
Metastatic disease
Spine lesions
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Chordoma
Osteoblastoma
Chordoma
ABC
Metastatic disease
Spine lesions
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Aneurysmal bone cyst
Osteoblastoma
Chordoma
ABC
Metastatic disease
Spine lesions
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Metastatic Breast Carcinoma
Osteoblastoma
Chordoma
ABC
Metastatic disease
Spine lesions
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Clues by Density
Of Lesion
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Sclerotic Cortical Lesions
Osteoid osteoma
Brodie’s abscess
Stress fracture
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Osteoid Osteoma
Osteoid osteoma
Brodie’s abscess
Stress fracture
Sclerotic cortical lesions
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Brodie’s abscess
Osteoid osteoma
Brodie’s abscess
Stress fracture
Sclerotic cortical lesions
© R3, 2000
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Healing Stress Fracture
Osteoid osteoma
Brodie’s abscess
Stress fracture
Sclerotic cortical lesionsSclerotic cortical lesions
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Sclerotic Cortical Lesions
Healing Stress Fracture
Osteoid Osteoma Brodie’s abscess
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Lytic Lesions in Children
Eosinophilic granuloma
Neuroblastoma
Leukemia
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Eosinophilic granuloma
Neuroblastoma
Leukemia
Lytic Lesions in Children
Eosinophilic granuloma
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Neuroblastoma
Eosinophilic granuloma
Neuroblastoma
Leukemia
Lytic Lesions in Children
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Leukemia
Eosinophilic granuloma
Neuroblastoma
Leukemia
Lytic Lesions in Children
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Lytic Lesions in Adults
Metastatic lesions Lung
Renal
Thyroid
Multiple myeloma
Primary bone tumor
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Met from Thyroid Carcinoma
Mets
Myeloma
Primary bone tumor
Lytic Lesions in Adults
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Multiple myeloma
Mets
Myeloma
Primary bone tumor
Lytic Lesions in Adults
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Chondrosarcoma
Mets
Myeloma
Primary bone tumor
Lytic Lesions in Adults
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Blastic Lesions in Children
Medulloblastoma
Lymphoma
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Medulloblastoma
Medulloblastoma
Lymphoma
Blastic Lesions in ChildrenBlastic Lesions in Children
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Lymphoma
Medulloblastoma
Lymphoma
Blastic Lesions in ChildrenBlastic Lesions in Children
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Blastic Lesions in Adults
Metastatic disease Breast – female
Prostate – male
Lymphoma
Paget’s disease
Etcetera-mastocytosis, fluorosis
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Prostate Mets
Mets
Lymphoma
Paget’s
Blastic Lesions in Adults
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Breast Mets
Mets
Lymphoma
Paget’s
Blastic Lesions in Adults
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Lymphoma
Mets
Lymphoma
Paget’s
Blastic Lesions in AdultsBlastic Lesions in Adults
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Other Clues
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Benign LesionsWithout Sclerotic Boarders
Giant Cell tumor
Brown tumor
Osteolytic phase of Paget’s Disease
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Benign LesionsWithout Sclerotic Boarders
Giant Cell tumor
Brown tumor
Osteolytic phase of Paget’s Disease
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Brown Tumor
Benign Lesions without Sclerotic Benign Lesions without Sclerotic BordersBorders
Giant cell tumor
Brown tumor
Osteolytic Paget’s
© R3, 2000
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Osteolytic Paget’s
Benign Lesions without Sclerotic Benign Lesions without Sclerotic BordersBorders
Giant cell tumor
Brown tumor
Osteolytic Paget’s
© R3, 2000
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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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Osteosarcoma
© R3, 2000
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Multiple Lesions
More often benign
Malignancies with multiple lesions Metastatic disease
Multiple myeloma
Lymphoma
Ewing’s sarcoma (rarely)
Osteosarcoma (rarely)
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Mets from Ca of Prostate
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
© R3, 2000
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Multiple Myeloma
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
© R3, 2000
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Lymphoma
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
© R3, 2000
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Osteosarcomatosis
Multiple lesionsMultiple lesions
Metastatic
Multiple myeloma
Lymphoma
Osteosarcomatosis
© R3, 2000
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Benign vs. Malignant
© Greenspan, Lippincott, 2000
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The End