Age may be a useful clue

Primary malignant tumours,

A) In young people
 Ewing’s tumour and
 osteosarcoma.
B) Older people (fourth or sixth decades)
 Chondrosarcoma and
 fibrosarcoma
The commonest of all primary malignant bone tumours is
myeloma, is seldom seen before the sixth decade.
Over 70 years of age, metastatic bone lesions are more
common than all primary tumours together.

Pain – tiny lesion may be very painful if it is encapsulated in

dense bone
e.g. an osteoid osteoma
TO ASK WHEN STUDYING AN
X-RAY

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‘Cystic’ lesions are

Not necessarily hollow cavities:
Any radiolucent material may look like a cyst.
 a fibroma or
 a chondroma
If the boundary is sharply defined – probably
benign;
If it is hazy and diffuse – suggests an invasive
tumour.
Stippled calcification inside a cystic area –
cartilage tumours.

Bone surfaces:
 periosteal newbone formation and Suggestive of
malignant
 extension of the tumour into the soft tissues
change.

Soft tissues: Are the muscle planes

  distorted by swelling?
 Is there calcification?

With some notable exceptions, in which the appearances are

pathognomonic
 osteochondroma,
 non-ossifying fibroma,
 osteoid osteoma

Metastatic bone tumors arise from

i. Thyroid
ii. Breast
iii. Lungs
iv. Liver
v. Kidneys
vi. Prostate
Of these all are lytic in nature except from the prostate which
is sclerotic.
 Location of bone tumor
Epiphyseal – GC (General candidate)
GCT
Chondroblastoma
Metaphyseal – SOFA – Chair
Simple bone cyst
Osteosarcoma
Fibrous dysplasia
ABC
Osteochondroma
Diaphyseal – MALE Officer A LEMON FEMALE
Multiple myeloma Adamantinoma Fibrous
dysplasia
Adamantinoma Lymphoma Eosinophilic
granuloma
Leukemia Ewing’s sarcoma Multiple myeloma
Ewing’s sarcoma Multiple myeloma
Adamantinoma
Osteoid osteoma Osteoid osteoma Leukemia,
Lymphoma
Neuroblastoma Ewing’s sarcoma

Round cell tumor of Bone – R -1, CE – 2, TUM – 3

ROME
Reticulum cell sarcoma (Non – Hodgkin’s lymphoma)
Osteosarcoma ????? ( no round)
Metastatic neuroblastoma
Ewing’s sarcoma
Primary malignat bone tumor
1. Multiple myeloma
2. Osteosarcoma
3. Chondrosarcoma
4. Ewing’s sarcoma
5. Fibrosarcoma of bone
6. Malignant fibrous histiocytoma
7. Non – Hodgkin’s lymphoma
8. Chordoma
9. Adamantinoma

Codman’s triangle
Is a triangular area of new subperiosteal bone that is created when
a lesion often a tumor, raises the periosteum away from the bone

Is type of periosteal reaction seen in aggressive lesions

Osteosarcoma
Ewing’s sarcoma
Osteomyelitis
Active ABC
GCT
Chondrosarcoma (especially juxtacortical)
Malignant fibrous histiocytoma
Metastasis