ewing’s sarcoma & simple bone cyst

1.EWING’S SARCOMA

2.SIMPLE BONE CYST

1.EWING’S SARCOMA

Age of Incidence

Age of incidence 5 to 30 years

Peak incidence b/w 5 to 17 years

Rarely occurs after 30 years

Presenting complaints

Localized pain and swelling

Fever anemia and weight loss

Sign and symptoms stimulate Hodgkin's

lymphoma and osteomylitis

LOCATIONS

Involves Metadiaphysis

Arise in medullary cavity

Long bones 60%

Axial skeleton 40%

Conventional Radiography Poorly marginated lytic lesion

Permeative or mottled type

Soft Tissue mass or infiltration with

or without cortical break

Soft tissue mass ( saucerization)

Periosteal Reaction

Periosteal reaction

Lamellar type( onion skinning)

Sun burst or spiculated

Codman triangle

Less common findings

Thickened cortex

Bone expansion

Pathologic fracture

Mottled, osteolytic lesion (blue circle) with poorly marginated edges in the diaphysisof the bone.Sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white arrows).

Mixed lytic sclerotic lesion in diaphysis with permeativedestructive pattern spiculated periosteal reaction soft tissue extension

X ray femur lateral view showing Well defined expansile lesion with mottled appearance is visualized in diaphysis of femur. No calcification seen. cortical break is seen anteriorly. no soft tissue extension seen

MRI

Method of choice for stagging

Assess intra and extra osseous

involvement

Helps in evaluation of chemotherapy

response

MRI

T1

Low intensity with heterogeneous

contrast enhancement

T2

High signal intensity

MR coronal image both thigh T1 Post contrast showing heterogeneously enhancing mass in diaphyseas in medulary cavity of RT femur with cortical break fracture. edema is also seen

X ray femur showing subtle cortical thickening in diaphyseas but T1 post contrast image shows homogenously enhancing soft tissue mass in medial aspect of femur in proximal diaphyseas

CT Scan

Evaluate

Bone destruction

Extra osseous involvement

Bone scan

Increased uptake in areas of

destruction

Whole body scan for detecting

metastatic disease

PET Scan

PET Scan with FDG

Recommended for early detection of

changes in tumor metabolism

Angiography

Not standard for Ewing's sarcoma

Differential diagnosis

Osteosarcoma

Osteomylitis

Eosinophilic granuloma

Osteosarcoma

Osteomyelitis

Shorter duration less aggressive

periosteal reaction

Predictors of Prognosis

Size of tumor

Resectibility of tumor

Treatment

Depends upon extension and stage

Chemotherapy

Radiation therapy

Surgical resection

2.SIMPLE BONE CYST

Common in 10 to 20 years age

Solitary benign bone lesion

Male to female ratio 3. 1

Location Intra medullary

Involves Metaphysis

Abut growth plate

Proximal ends of tibia fibula and

humerus

May involve iliac and calcaneus over

2o yrs

Clinical features

Asymptomatic

Pain and swelling of adjacent joint

May present with fracture

Conventional radiography

Well defined solitary lytic lesion

Narrow zone of transition

Thin sclerotic margins

Some times expansile

No periosteal reaction

Long axis parallel to bone

Fallen fragment sign

Single well defined lytic lesion in metadiphysis with sharp zone of transition and pathological fracture

X ray femur frontal projection showing well defined rounded lytic lesion with sclerotic margins in greater trochantor of femur

Well defined expansile lytic lesion with sclerosis and fracture seen in metadiaphyseas

MRI FINDINGS

Un complicated SBC

T1 Low signal intensity

T2 High signal intensity

Complicated SBC

Heterogeneous signal

intensity on T1 T2

Gadolilnium- Peripheral enhancement

CT SCAN

Air fluid or Fluid fluid Levels

Bone scan

Photopenic / cold spot

Diffrential diagnosis

Giant cell tumor

Aneurysmal bone cyst

Chondromyxoid tumor

Giant cell tumor

Aneurysmal bone cyst

Treatment

Curettage and bone grafting

Nailing

Inj of bone marrow

Cryotherapy

Methyl prednisolone inj to promote

healing

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