Bone Tumors and Bone Tumors and Tumorlike ConditionsTumorlike Conditions

Andrea Evans Khosasih

406138139

Clues by Age PredilectionClues by Appearance of Lesion

Clues by Location of LesionClues by Density of LesionOther Clues

Clues by Age Clues by Age PredilectionPredilection

Important to remember Important to remember

Small zone of transitionNotice that in all three patients, the growth plates have not yet closed.

Wide zone of transition

Clues by Appearance of Clues by Appearance of LesionLesionPatterns of Bone Destruction Periosteal ReactionsTumor Matrix

Clues by Appearance of Clues by Appearance of LesionLesion Patterns of Bone Destruction

◦Geographic◦Moth-eaten◦Permeative

Patterns of Bone Patterns of Bone DestructionDestruction

◦Geographic

Non-ossifying fibroma

Geographic Bone Geographic Bone DestructionDestruction

Examples:• Non-ossifying fibroma• Chondromyxoid fibroma• Eosinophilic granuloma

Patterns of Bone Patterns of Bone DestructionDestruction

◦Moth-eaten

Multiple Myeloma

Moth-eaten Bone Moth-eaten Bone DestructionDestruction

Examples:MyelomaMetastasesLymphomaEwing’s sarcoma

Patterns of Bone Patterns of Bone DestructionDestruction

◦Permeative

Leukemia

PermeativePermeative Bone Bone DestructionDestruction

Examples:Lymphoma, leukemia Ewing’s SarcomaMyelomaOsteomyelitisNeuroblastoma

Patterns of Bone Patterns of Bone DestructionDestruction

Geographic Moth-eaten Permeative

Less malignant More malignant

Periosteal ReactionsPeriosteal ReactionsBenign

◦SolidMore aggressive or malignant

◦Lamellated or onion peel◦Sunburst◦Codman’s triangle

Periosteal Reactions• Benign

– Solid

Chronic osteomyelitis

Periosteal Reactions• Aggressive/malignant

– onion-peel

Ewing sarcoma

Periosteal Reactions• Aggressive/

malignant– Sunburst

Osteo-sarcoma

Periosteal Reactions• Aggressive/

malignant– Codman’s triangle

Osteo-sarcoma

Periosteal Reactions

Solid onion-peelSunburst Codman’s triangle

Less malignant More malignant

Important to rememberImportant to remember

Tumor MatrixTumor MatrixOsteoblastic

◦Fluffy, cotton-like or cloud-like densities

◦Osteosarcoma

Tumor MatrixTumor Matrix

Osteoblastic

Tumor MatrixTumor MatrixCartilaginous

◦Comma-shaped, punctate, annular, popcorn-like

as Enchondroma, chondrosarcoma, chondromyxoid fibroma

Tumor MatrixTumor Matrix

Cartilaginous

Chondrosarcoma

Clues by Location of Lesion

• In the Transverse Plane• In the Longitudinal Plane• Characteristic Locations by

tumors

In the Transverse Plane

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In the longitudinal In the longitudinal PlanePlaneEpiphyseal

GCT, chondroblastoma

MetaphysealOsteomyelitis, osteo-and chondrosarcoma

DiaphysealRound cell lesions, ABC, enchondroma

Characteristic Characteristic LocationsLocations

Simple bone cystProximal humerus

Characteristic LocationsChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

Characteristic Locations

AdamantinomaTibia

Characteristic Locations

ChordomaSacrum, clivus

Characteristic Locations

OsteoblastomaSpine, posterior

Characteristic Locations

Cortical DestructionCortical Destruction left: Chondromyxoid

fibroma A benign, well-defined, expansile lesion with regular destruction of cortical bone and a peripheral layer of new bone.

right: Giant cell tumor A locally aggressive lesion with cortical destruction, expansion and a thin, interrupted peripheral layer of new bone. Notice the wide zone of transition towards the marrow cavity.

Benign vs. MalignantBenign vs. Malignant

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