BONE TUMORS

By

Dr. Ahmed Hosny

 Clues by Appearance of Lesion
Clues by Location of Lesion
Clues by Density of Lesion
Other Clues
Clues by Appearance of
Lesion
Patterns of Bone Destruction
Periosteal Reactions
Tumor Matrix
Expansile Lesions of Bone
Clues by Appearance of
Lesion
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative
 Geographic Bone
Destruction
Destructive lesion with sharply
defined border
Implies a less-aggressive, more slow-
growing, benign process
Narrow transition zone
Patterns of Bone Destruction

Geographic
Moth-eaten
Permeative

Non-ossifying fibroma
 Geographic Bone
Destruction
Examples:
Non-ossifying fibroma
Chondromyxoid fibroma
Eosinophilic granuloma
Moth-eaten Bone Destruction

Areas of destruction with ragged

borders
Implies more rapid growth
Probably a malignancy
Patterns of Bone Destruction

Geographic
Moth-eaten
Permeative

Multiple Myeloma
Moth-eaten Bone Destruction

Examples:
Myeloma
Metastases
Lymphoma
Ewings sarcoma
 Permeative Bone Destruction

Ill-defined lesion with multiple

worm-holes
Spreads through marrow space
Wide transition zone
Implies an aggressive malignancy
Round-cell lesions
Patterns of Bone Destruction

Geographic
Moth-eaten
Permeative

Leukemia
Permeative Bone Destruction

Examples:
Lymphoma, leukemia
Ewings Sarcoma
Myeloma
Osteomyelitis
Neuroblastoma
 Patterns of Bone Destruction

Geographic Moth-eaten Permeative

Less malignant More malignant

 Periosteal Reactions
Benign
None
Solid
More aggressive or malignant
Lamellated or onion peel
Sunburst
Codmans triangle
 Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle

Non-ossifying fibroma
 Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle

Chronic osteomyelitis
 Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle

Ewing sarcoma
 Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle

Osteo-sarcoma
 Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle

Osteo-sarcoma
Periosteal Reactions

Solid Sunburst onion-peel Codmans

triangle

Less malignant More malignant

 Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like
densities
Osteosarcoma
Cartilaginous
Comma-shaped, punctate, annular, popcorn-like
Enchondroma, chondrosarcoma, chondromyxoid fibroma
 Tumor Matrix

Osteoblastic
Cartilaginous
 Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities
as Osteosarcoma

Cartilaginous
Comma-shaped, punctate, annular,
popcorn-like
as Enchondroma, chondrosarcoma,
chondromyxoid fibroma
 Tumor Matrix

Osteoblastic
Cartilaginous

Chondrosarcoma
Expansile Lesions of Bone

Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia

Renal cell carcinoma

 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
 Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
 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
In the Transverse Plane

.
In the longitudinal Plane
Epiphyseal
GCT, chondroblastoma

Metaphyseal
Osteomyelitis, osteo-and chondrosarcoma

Diaphyseal
Round cell lesions, ABC, enchondroma
 Characteristic Locations
Simple bone
cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
 Characteristic Locations
Simple bone cyst
Proximal humerus

Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
 Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses

Giant Cell tumor

Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
 Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses

Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
 Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia

Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
 Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus

Osteoblastoma
Spine, posterior
 Clues by Density of
Lesion
Sclerotic Cortical Lesions
Lytic Lesions in Children
Lytic Lesions in Adults
Blastic Lesions in Children
Blastic Lesions in Adults
 Sclerotic Cortical Lesions

Osteoid
osteoma
Brodies abscess
 Sclerotic Cortical Lesions

Osteoid osteoma

Brodies
abscess
 Lytic Lesions in Children
Eosinophilic
granuloma
Leukemia
 Lytic Lesions in Children
Eosinophilic granuloma

Leukemia
 Lytic Lesions in Adults

Metastatic lesions
Lung
Renal
Thyroid
Multiple myeloma
Primary bone tumor

Metastatic thyroid carcinoma

 Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid

Multiple myeloma
Primary bone tumor
 Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid
Multiple myeloma

Primary bone
tumor

Chondrosarcoma
Blastic Lesions in Children

Lymphoma
 Blastic Lesions in Adults
Metastatic
disease
Breast
female
Prostate
male
Lymphoma
Pagets disease
Fluorosis

Prostatic Ca.
 Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male

Lymphoma
Pagets disease
Fluorosis
 Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma

Pagets disease
Fluorosis
 Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma
Pagets disease

Fluorosis
 Other Clues

Soft Tissue Extension

Benign vs. Malignant
 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
Soft Tissue Extension

lymphoma
Benign vs. Malignant
Thank You