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Bone Tumors
Bone Tumors
Bone Tumors
Bone tumors
19 July 08
•Bone tumors can be divided into primary and - kidney, lungs, colon, melanoma
secondary
•purely blastic
•Secondary tumors can be further subdivided into:
- prostate and breast carcinoma
o Metastatic tumors
•mixed lytic and blastic
o Tumors resulting from contagious
spread of adjacent soft tissue - most common appearance
neoplasm
Primary bone tumors
o Tumors representing malignant
•predominant appearance in the 1st 3 decades of
transformation of the preexisting
life
benign lesion
•the most common sites include distal femur and
Metastatic disease
proximal tibia
•Most malignant tumor found in the bone
•benign tumors are more common than malignant
•Predominant in 2 age group: one
-adult over 40 yr. old and children In the 1st •the most common benign tumors are
decade of life osteochondroma, non-ossfying fibroma and
enchondroma
•Multifocality and predilection for hematopietic
marrow sites in axial skeleton( vertebrae, pelvis, •among the primary malignant tumors:
ribs, cranium) and the proximal long bone
- osteosarcoma and multiple myeloma
•Metastases to long bones distal to elbows and have highest incidence followed by
knees are unusual chondrosarcoma and Ewing’s
sarcoma
Most common malignancies producing
skeletal metastases: AGE 0-10
•melanoma
Mika maQ 1 of 15
Radiology – GI Radiology by Dra Bandong Page 2 of 15
•Osteoblastoma
•Chondroblastoma
•Chondromyxiod fibroma
•myeloma
•leukemic involvement
•chondrosarcoma
•osteosarcoma (Paget’s
associated)
•MFH
•Chordoma
- osteosarcoma is
usually centered in the
metaphysis
-chondrosarcoma and
fibrosarcoma often
present as
metaphyseal lesions
Osteosarcoma
Chondrosarcoma
- typical chondroid
matrix calcification
- Classic location on a
non-ossfying fibroma
(NOF)
Metaphyseal exostosis
- Osteochondroma
Fibrous dysplasia Multiple myeloma
Enchodroma
BEHAVIOUR OF LESION
- osteolytic
- geographic
- moth-eaten
- permeative
- osteoblastic
- Mixed
“BUTTRESS”
“ HAIR-ON-END”
- response to a rapidly
growing lesion include
“onion-skinning” and
speculated types.
PERMEATIVE PATTERN
- characterized by numerous
tiny radioluscencies in
between the residual bone
trabeculae.
Case 1.
Location
•Most common skeletal sites includes - in general, low grade osteosarcoma should be
diaphyses of femur, tibia, and humerus, and differentiated from benign bone-producing tumors
also pelvias and ribs (askin tumor of the chest) (osteoblastoma), whereas a highgrade
osteosarcoma must be differentiated from other
•Associated tissue mass is a common finding. sarcoma.
Case 2. Case 3.
An 11 year old male was seen in consultation for an •A 20 year old male presented with a painless, hard
increasingly painful distal femoral lesion associated subcutaneous mass in popliteal fossa
with soft tissue mass.
•He stated that the mass had been present for
several years and did not change in size.
- plain Xray
demonstrated a
pedunculated bony
outgrowth at the
proximal tibial
metaphysis. The lesion
had a uniform,
cartilaginous cap with
stippled calcifications.
The tibial cortex and
medulla were
continuous with those
OSTEOSARCOMA
of the lesion.
•Most common primary sarcoma of the bone.
•Most common skeletal sites includes •A common, benign intramedullary bone tumor
metadiaphyses of femur and tibia at the knee composed of mature hyaline cartilage.
(35%), proximal femur and humerus, pelvis and
scapula. •It shows wide age distribution with peak incidence
during 3rd and 4th decade of life.
•This tumor does not occur in bones with
membranous type of ossification. •Characteristically, it has limited growth potential
and therefore many lesions remain small and
•Solitary osteochondromas may be either primary asymptomatic.
due to developmental anomaly of the bone or
secondary following trauma. •Pain in enchondroma is a worrisome symptom,
which indicates either a pathologic fracture or
•Secondary lesions are often seen in the phalanges continued growth. It is one of the criteria used to
of hands and feet and have their peak incidence in distinguished they benign tumor from low grade
the 3rd and 4th decade of life. (grade 1) chondrosarcoma.
•Multiple osteochondromas represent an autosomal •Location in general, enchondroma are very rare in
dominant hereditary disorder and are associated the sites most commonly affected by
with bone deformities. chondrosarcoma.
•Mid-shaft involvement
is rare.
CHONDROMYXOID Fibroma
•A rare benign tumor with predominant occurrence Giant Cell Tumor of Bone (GCT)
in patients younger than 40 year old.
•Is relatively common, locally aggressive neoplasm
•The peak incidence is between 20 and 30 years accounting for apprx 4% of all primary tumors.
old.
•It affect skeletally mature individuals, F > M, 20 to
•It one of the the 2 neoplasms of incompletely 50 years of age.
differentiated cartilages.
•It is extremely rare in children and patient older
•The other is chondroblastoma. than 60 years.
•Location: the most frequent skeletal sites are the •Location: most GCTs affects long bones with the
knee area (30%), pelvis and the small bones of the highest incidence (65%) in the distal femur,
feet. In the long bone, the tumor characteristically proximal tibia and distal radius.
involves the metaphysis or metadiaphysis and is
often seen in eccentric position. •In the long bones, the tumor is invariably centered
in the epiphysis.
Differential Diagnosis
•It can also be found in any other longbone, pelvis,
•Chondroblastoma- epiphyseal location and sacrum and spine (3%).
“chicken wire” calcifications.
•GCTs of the hands and feet are very rare.
•Chondrosarcoma- hyaline cartilage matrix, tumor
permeation of the sorroundinf bone and mitotic •Common secondary changes in the GCT are
activity. hemorrhage and necrosis, fibrohistiocytic
(Xanthomatous change) and aneurysmal bone cyst
Case 6. formation.
Radiology – GI Radiology by Dra Bandong Page 11 of 15
Plain radiograph
showed an irregular,
but circumscribed, lytic
epiphyseal lesion A complex appearance with lytic areas, multiple foci
surrounded by reactive “ground glass “ density and radiopaque areas.
bone sclerosis. There
was no evidence of Fibrous Dysplasia
bone expansion, and
•A common benign fibro-osseous lesion
the cortex was intact.
The growth plates were •Which occurs sporadically during the period of
open. skeletal growth (age 10-25)
•Usually between the age of 5 and 20 years old. b. Hand-Schuller-Christian disease ( Extensive
multifocal, symptomatic disease with
•Small lesions are usually incidental radiologic predominantly skeletal involvement).
findings.
c. Letterrer-siwe disease ( aggressive systemic
•The larger lesions occupying more than half form of the disease that involves multiple
organs and systems and leads to functional
•Of the bone diameter may present with a impairment of the affected sites).
pathologic fracture.
•EG commonly occurs in individuals younger than
•Location. Metaphysis or metadiaphysis of the long 30 years old and has the highest incidence in the
bone at the knee ( distal femur, proximal tibia or first decade of life.
fibula) distal tibia and proximal humerus.
•Location: skeletal sites include cranio-facial
•A syndrome of multiple non-ossifying fibroma and bones, ribs, vertebra, pelvis, and major long
cutaneous café au lait spots known as Jaffi- bones such as femur and humerus. Small bones of
Campanacci syndrome. the hands and feet are not affected. Extraskeletal
lesions most commonly arise in the lungs and
•GCT may enter your differential diagnosis. lymph node.
Remember, however, that it is characterized by the
epiphyseal location and occurrence in adults. •Differential diagnoses includes osteomyelitis,
granulomatous inflammation, hodgkin’s and non-
Case 10 hodgkin’s lymphoma. Identification of
morphologic features of langerhans cells and the
A 14 year old female presented with a 3 months
use of appropriate markers and/or EM help to
history of increasing pain in her elbow.
resolve diagnostic problems.
•Case 11
•Solitary bone cyst is relatively common, non- •Although ABC can occur at any age, the majority of
neoplastic lesion, which typically occurs in the the patients are younger than 25 year old.
skeletal immature patients, in the first and second
decade of life (80%). Case 13
•It is usually unicameral cyst, which does not have A 45 year old female presented with an increasing
pain and swelling around the knee. She mentioned
an epithelial lining (hence not a true cyst) and is
that the symptoms had progressed over the 4
filled with serous fluid.
months period.
•Location: about 80% of the case is diagnosed in 2
•Plain film
locations: humerus and proximal femur. In the long
demonstrates a large
bone, SBC characteristically involves the
lobulated, ill-defined
metaphysis and diaphysis.
lesion centered in the
•Other skeletal sites are the ilium, talus and distal femoral
calacaneus. metaphysis.
•Chondrosarcoma is the 2nd most common primary •Radiologic appearance is very typical. In about
malignant tumor after osteosarcoma. 70% of the cases the tumor involves the midshaft of
the shaft.
•Location. Unlike benign cartilaginous lesions,
chondrosarcoma has a predilection for trunk bones •In the remaining cases, it is found at the end of the
including the pelvis (particularly ilium), the ribs and tibia, and in fibula
scapula. It is also common In the long bone such as
femur and humerus. •Early lesions are characteristically centered in
anterolateral cortex.
Case 14
•Advance tumors may involved the medullary cavity
A 27 year old male presented with chronic, dull pain and soft tissue.
and some soft tissue swelling along the antero-
lateral surface of the left lower leg.
Case 15
•The femoral neck is one of the most common •They are slowly and progressively growing
anatomic sites. neoplasm.
•Other skeletal location includes humerus, the small •Although any bone maybe involve, osteoblastoma
bones of hands and feet, and the spine. tend to arise in the axial skeleton, involving the
spine and the sacrum in about 40 % of the cases.
•In a long bone, the tumor is usually found in the
metaphyses or diaphyses. •The 2nde most frequent site is mandible, fallowed
by cranio-facial bone.
Case 16
•Unlike osteoid sarcoma, osteoblastoma do not
A 21 year old male with a 6 month history of dull produce prostaglandin/ prostocyclin mediated tissue
pain in the knee that was not relieved by aspirin. reaction.
A plain x-ray
•Peak incidence in the 2nd and 3rd decade of life.
showed a well,
circumscribed,
low metaphyseal,
adioluscent lesion
containing matrix
type
radiodensities.
Note the absence
of sclerotic rim.
Osteoblastoma