Bone Tumors. Clues and Cues. Bone Tumors. Clues and Cues. William Herring,
M.D. © 2002. In Slide Show mode, advance the slides by pressing the spacebar.
William Herring, M.D. © 2002
Bone Tumors Clues and Cues In Slide Show mode, advance the slides by pressing the spacebar All Photos Retain the Copyright of their Authors
Clues by Appearance of Lesion
Patterns of Bone Destruction
O
Geographic
O
Moth-eaten
O
Permeative
Geographic Bone Destruction
O
O
O
Destructive lesion with sharply defined border Implies a less-aggressive, more slow-growing, benign process Narrow transition zone
Patterns of Bone Destruction
O
Geographic
O
Moth-eaten
O
Permeative
© R3, 2000
Non-ossifying fibroma
Geographic Lesions Examples
O
Non-ossifying fibroma
O
Chondromyxoid fibroma
O
Eosinophilic granuloma
Moth-eaten Appearance
O
O
Areas of destruction with ragged borders Implies more rapid growth Q
Probably a malignancy
Patterns of Bone Destruction
O
Geographic
O
Moth-eaten
O
Permeative
© R3, 2000
Multiple Myeloma
Moth-eaten Appearance Examples
O
Myeloma
O
Metastases
O
Lymphoma
O
Ewing’s sarcoma
Permeative Pattern
O
Ill-defined lesion with multiple “wormholes”
O
Spreads through marrow space
O
Wide transition zone
O
Implies an aggressive malignancy Q
Round-cell lesions
Patterns of Bone Destruction
O
Geographic
O
Moth-eaten
O
Permeative
Leukemia
Permeative Pattern Round cell lesions
O Lymphoma, leukemia O Ewing’s Sarcoma O Myeloma O Osteomyelitis O Neuroblastoma
Patterns of Destruction
Geographic Less malignant
Moth-eaten
Permeative More malignant
Periosteal Reactions O
O
Benign Q
None
Q
Solid
More aggressive or malignant Q
Lamellated or onion-skinning
Q
Sunburst
Q
Codman’s triangle
Periosteal Reactions O
O
Benign Q
None
Q
Solid
Aggressive/malignant Q
Onion-skinning
Q
Sunburst
Q
Codman’s triangle © R3, 2000
Non-ossifying fibroma
Periosteal Reactions O
O
Benign Q
None
Q
Solid
Aggressive/malignant Q
Onion-skinning
Q
Sunburst
Q
Codman’s triangle © R3, 2000
Chronic osteomyelitis
Periosteal Reactions O
O
Benign Q
None
Q
Solid
Aggressive/malignant Q
Onion-skinning
Q
Sunburst
Q
Codman’s triangle © Greenspan, 2000
Ewing’s sarcoma
Periosteal Reactions O
O
Benign Q
None
Q
Solid
Aggressive/malignant Q
Onion-skinning
Q
Sunburst
Q
Codman’s triangle © Greenspan, 2000
Osteosarcoma
Periosteal Reactions O
O
Benign Q
None
Q
Solid
Aggressive/malignant Q
Onion-skinning
Q
Sunburst
Q
Codman’s triangle © R3, 2000
Ewing’s-Codman’s triangle
Periosteal Reactions
Solid Less malignant
Lamellated
Sunburst
Codman’s More malignant
Tumor Matrix O
Osteoblastic Q
Fluffy, cotton-like or cloud-like densities V Osteosarcoma
O
Cartilaginous Q
Comma-shaped, punctate, annular, popcornlike V
Enchondroma, chondrosarcoma, chondromyxoid fibroma
Tumor matrix
O
Osteoblastic
O
Cartilaginous
© R3, 2000
Osteosarcoma
Tumor matrix
O
Osteoblastic
O
Cartilaginous
© R3, 2000
Chondrosarcoma
Expansile Lesions of Bone
O
Multiple myeloma
O
Brown tumor
O
Mets
O
Enchondroma
O
Aneurysmal bone cyst
O
Lymphoma
O
Fibrous dysplasia
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma Multiple Myeloma
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma Renal Cell Carcinoma
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma Aneurysmal Bone Cyst
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma Fibrous Dysplasia
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma
© R3, 2000
Brown Tumor
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
Lymphoma © R3, 2000
Enchondroma
Expansile lesions O
Multiple myeloma
O
Mets
O
Aneurysmal bone cyst
O
Fibrous dysplasia
O
Brown tumor
O
Enchondroma
O
© R3, 2000
Lymphoma Lymphoma
Clues by Location of Lesion
In the Transverse Plane O
Central Q
O
Eccentric Q
O
GCT, osteosarcoma, chondromyxoid fibroma
Cortical Q
O
Enchondroma
Non-ossifying fibroma, osteoid osteoma
Parosteal Q
Parosteal osteosarcoma, osteochondroma
Osteosarcoma
Parosteal sarcoma Osteochondroma © Greenspan, Lippincott, 2000
In The Transverse Plane
In the Longitudinal Plane
O
Epiphyseal Q
O
Metaphyseal Q
O
GCT, chondroblastoma
Osteomyelitis, osteo- and chondrosarcoma
Diaphyseal Q
Round cell lesions, ABC, enchondroma
Tumor Types Characteristic Locations
O
Simple bone cyst Q
O
Chondroblastoma Q
O
Proximal humerus
Epiphyses
Giant Cell tumor Q
Epiphyses
Characteristic locations O
Simple bone cyst Q
O
Chondroblastoma Q
O
Proximal humerus
Epiphyses
Giant Cell tumor Q
Epiphyses © R3, 2000
Characteristic locations O
Simple bone cyst Q
O
Chondroblastoma Q
O
Proximal humerus
Epiphyses
Giant Cell tumor Q
Epiphyses © R3, 2000
Chondroblastoma
Characteristic locations O
Simple bone cyst Q
O
Chondroblastoma Q
O
Proximal humerus
Epiphyses
Giant Cell tumor Q
Epiphyses © R3, 2000
Giant Cell Tumor
Tumor Types Characteristic Locations
O
Adamantinoma Q
O
Chordoma Q
O
Tibia
Sacrum, clivus
Osteoblastoma Q
Spine, posterior
Characteristic locations O
Adamantinoma Q
O
Chordoma Q
O
Tibia
Sacrum, clivus
Osteoblastoma Q
Spine, posterior © R3, 2000
Adamantinoma
Characteristic locations O
Adamantinoma Q
O
Chordoma Q
O
Tibia
Sacrum, clivus
Osteoblastoma Q
Spine, posterior © R3, 2000
Chordoma
Characteristic locations O
Adamantinoma Q
O
Chordoma Q
O
Tibia
Sacrum, clivus
Osteoblastoma Q
Spine, posterior © R3, 2000
Osteoblastoma
Tumor Types Characteristic Locations
O
Parosteal sarcoma Q
O
Distal femur
Periosteal sarcoma Q
Tibia
Characteristic locations
O
Parosteal sarcoma Q
O
Distal femur
Periosteal sarcoma Q
Tibia
Parosteal sarcoma
Characteristic locations
O
Parosteal sarcoma Q
O
Distal femur
Periosteal sarcoma Q
Tibia
© R3, 2000
Characteristic Tumors By Body Site
Pelvic Lesions
O
Chondrosarcoma
O
Solitary plasmacytoma
O
Chordoma
Pelvic lesions
O O
O
Chondrosarcoma Solitary plasmacytoma Chordoma
Pelvic lesions
O O
O
Chondrosarcoma Solitary plasmacytoma Chordoma
Plasmacytoma
Pelvic lesions
O O
O
Chondrosarcoma Solitary plasmacytoma Chordoma
© R3, 2000
Chordoma
Expansile Rib Lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
Thyroid Carcinoma
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
© R3, 2000
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
O O
Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia
© R3, 2000
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
© R3, 2000
Expansile rib lesions O
Plasmacytoma
O
Metastases
O
Chondrosarcoma
O
Eosinophilic granuloma
O
Neurofibromatosis
O
Fibrous dysplasia
© R3, 2000
Lesions of the Spine
O
Osteoblastoma Q
Expansile, with punctate densities within
O
Chordoma
O
ABC
O
Metastatic disease
Spine lesions
O
Osteoblastoma
O
Chordoma
O
ABC
O
Metastatic disease © R3, 2000
Osteoblastoma
Spine lesions
O
Osteoblastoma
O
Chordoma
O
ABC
O
Metastatic disease © R3, 2000
Chordoma
Spine lesions
O
Osteoblastoma
O
Chordoma
O
ABC
O
Metastatic disease Aneurysmal bone cyst
Spine lesions
O
Osteoblastoma
O
Chordoma
O
ABC
O
Metastatic disease
© R3, 2000
Metastatic Breast Carcinoma
Clues by Density Of Lesion
Sclerotic Cortical Lesions
O
Osteoid osteoma
O
Brodie’s abscess
O
Stress fracture
Sclerotic cortical lesions
O
Osteoid osteoma
O
Brodie’s abscess
O
Stress fracture
Osteoid Osteoma
Sclerotic cortical lesions
O
Osteoid osteoma
O
Brodie’s abscess
O
Stress fracture
© R3, 2000
Brodie’s abscess
Sclerotic cortical lesions
O
Osteoid osteoma
O
Brodie’s abscess
O
Stress fracture
Healing Stress Fracture
Sclerotic Cortical Lesions
Osteoid Osteoma
Brodie’s abscess
Healing Stress Fracture
Lytic Lesions in Children
O
Eosinophilic granuloma
O
Neuroblastoma
O
Leukemia
Lytic Lesions in Children
O
Eosinophilic granuloma
O
Neuroblastoma
O
Leukemia
© R3, 2000
Eosinophilic granuloma
Lytic Lesions in Children
O
Eosinophilic granuloma
O
Neuroblastoma
O
Leukemia
© R3, 2000
Neuroblastoma
Lytic Lesions in Children
O
Eosinophilic granuloma
O
Neuroblastoma
O
Leukemia
© R3, 2000
Leukemia
Lytic Lesions in Adults O
Metastatic lesions Q
Lung
Q
Renal
Q
Thyroid
O
Multiple myeloma
O
Primary bone tumor
Lytic Lesions in Adults
O
Mets
O
Myeloma
O
Primary bone tumor
Met from Thyroid Carcinoma
Lytic Lesions in Adults
O
Mets
O
Myeloma
O
Primary bone tumor
Multiple myeloma
Lytic Lesions in Adults
O
Mets
O
Myeloma
O
Primary bone tumor
Chondrosarcoma
Blastic Lesions in Children
O
Medulloblastoma
O
Lymphoma
Blastic Lesions in Children
O
Medulloblastoma
O
Lymphoma
© R3, 2000
Medulloblastoma
Blastic Lesions in Children
O
Medulloblastoma
O
Lymphoma
Lymphoma
Blastic Lesions in Adults O
Metastatic disease Q
Breast – female
Q
Prostate – male
O
Lymphoma
O
Paget’s disease
O
Etcetera-mastocytosis, fluorosis
Blastic Lesions in Adults
O
Mets
O
Lymphoma
O
Paget’s
Prostate Mets
Blastic Lesions in Adults
O
Mets
O
Lymphoma
O
Paget’s
Breast Mets
Blastic Lesions in Adults
O
Mets
O
Lymphoma
O
Paget’s
Lymphoma
Blastic Lesions in Adults
O
Mets
O
Lymphoma
O
Paget’s
Paget’s of Spine
Other Clues
Benign Lesions Without Sclerotic Boarders
O
Giant Cell tumor
O
Brown tumor
O
Osteolytic phase of Paget’s Disease
Benign Lesions without Sclerotic Borders
O
Giant cell tumor
O
Brown tumor
O
Osteolytic Paget’s
© R3, 2000
Giant Cell Tumor
Benign Lesions without Sclerotic Borders
O
Giant cell tumor
O
Brown tumor
O
Osteolytic Paget’s
© R3, 2000
Brown Tumor
Benign Lesions without Sclerotic Borders
O
Giant cell tumor
O
Brown tumor
O
Osteolytic Paget’s
© R3, 2000
Osteolytic Paget’s
Soft Tissue Extension O
Usually implies malignancy Q
O
More likely to form discrete soft tissue mass
Benign conditions with soft tissue extension Q
Osteomyelitis V
Usually infiltration of fat
© R3, 2000
Osteosarcoma
Multiple Lesions O
More often benign
O
Malignancies with multiple lesions Q
Metastatic disease
Q
Multiple myeloma
Q
Lymphoma
Q
Ewing’s sarcoma (rarely)
Q
Osteosarcoma (rarely)
Multiple lesions
O
Metastatic
O
Multiple myeloma
O
Lymphoma
© R3, 2000
Mets from Ca of Prostate
Multiple lesions
O
Metastatic
O
Multiple myeloma
O
Lymphoma
© R3, 2000
Multiple Myeloma
Multiple lesions
O
Metastatic
O
Multiple myeloma
O
Lymphoma
© R3, 2000
Lymphoma
Multiple lesions
O
Metastatic
O
Multiple myeloma
O
Lymphoma
O
Osteosarcomatosis
© R3, 2000
Osteosarcomatosis
Benign vs. Malignant
© Greenspan, Lippincott, 2000
The End
