bone tumors

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BONE TUMOURS

CLASSIFICATION:

CLASSIFICATION Primary Secondary (metastases) Primary tumors: Benign Malignant

GENERAL PRINCIPLES OF RADIOLOGICAL DIAGNOSIS:

GENERAL PRINCIPLES OF RADIOLOGICAL DIAGNOSIS AGE SOLITARY OR MULTIPLE SITE OF INVOLVEMENT LOCATION WITHIN THE BONE MARGINS SOFT TISSUE EXTENSION

BENIGN VS MALIGNANT:

BENIGN VS MALIGNANT Narrow zone of transition Sclerotic margin Periosteal reaction Tumor matrix Pattern of bone destruction Geographic or moth eaten or permeative

BENIGN TUMOURS:

BENIGN TUMOURS

ENOSTOSIS:

ENOSTOSIS Single/ multiple Uniformly dense Always medullary in location Narrow zone of transition DD- osteoblastic metastases

OSTEOMA:

OSTEOMA Slow growing Arises from skull,paranasal sinuses and mandible Broad base with well defined margins. Gardners syndrome

OSTEOID OSTEOMA:

OSTEOID OSTEOMA Male prepondarance 2 nd to 3 rd decade Diaphysis of long bones. Round or oval area of translucency with sclerotic margin and nidus. DD-Osteoblastoma Chronic sclerosing osteomyelitis.

OSTEOBLASTOMA:

OSTEOBLASTOMA Males, second decade Similar to osteoid osteoma but >2cms Spine & flat bones Well defined radiolucency in cortex or medulla with cortical expansion .

EXOSTOSES:

EXOSTOSES Osseous outgrowth arising from bone cortex Arises in tubular bones,near the metaphysis Cartilage cap +, thickness 1-6mms. Complication-Chondrosarcoma

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DIAPHYSEAL ACLASIA

ENCHONDROMA:

ENCHONDROMA Originates in the medullary cavity Commonly in the phalanges Sharply defined lytic lesion with endosteal scalloping Few specks of calcifications Multiple in Ollier’s disease

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MAFFUCI’S SYNDROME Multiple enchondromas + haemangiomas

CHONDROBLASTOMA:

CHONDROBLASTOMA 10-20 Years Epiphysis Well defined, radiolucent,oval lesion,with thin rim of sclerosis and cortical expansion. Stippled calcification may present

GIANT CELL TUMOUR:

GIANT CELL TUMOUR 20-40 YEARS Predilection for bones adjacent to the knee and distal end of radius. Eccentrically located zone of translucency,beneath the articular cortex Soap-Bubble Appearance DD-Aneurysmal bone cyst Chondroblastoma

HEAMANGIOMA:

HEAMANGIOMA Solitary Thoracic or Lumbar vertebrae Increased translucency with fine vertical striations. CT: Polka dot appearance

NON OSSIFYING FIBROMA:

NON OSSIFYING FIBROMA Eccentric in the medullary cavity 10-20 yrs Around knee Xray: well marginated eccentric geographic lesion in the metadiaphysis with thin rim of sclerosis DD-Fibrous dysplasia Solitary bone cyst

SOLITARY BONE CYST:

SOLITARY BONE CYST Childhood / adolescence Always unilocular Proximal humerus and femur Metadiaphysealphyseal in location X –ray :welldefined lytic lesion, sclerotic borders, thinning of cortex DD-Chondroma Path #

ANEURYSMAL BONE CYST:

ANEURYSMAL BONE CYST <20yrs Predilection for long bones & DL spine X ray : Area of bone resorption with thin,expanded cortex DD-Giant cell tumours

INTRAOSSEOUS LIPOMA:

INTRAOSSEOUS LIPOMA Arises in the medulla Well defined lytic lesion with sharp margins. Central ossified nodule

MALIGNANT BONE TUMOURS:

MALIGNANT BONE TUMOURS

OSTEOSARCOMA:

OSTEOSARCOMA Male prepondarance 10-25 years Metadiaphysis of distal end of femur and upper end of tibia Eccentrically in the medullary cavity with ill defined cortical destruction and soft tissue involvement. Codmans triangle

CHONDROSARCOMA:

CHONDROSARCOMA >40yrs, 2:1 Pelvis, ribs, prox femur and humerus Types: Central – intramedullary epicentre Peripheral – from surface of bone Expansile osteolytic ragged looking lesion with calcifications and soft tissue involvement

CHORDOMA:

CHORDOMA Predilection for sacral and cranial regions 40 – 70 yrs, 2:1 Sacrum: Lytic,oval or lobulated with relatively well defined margins and a large soft tissue mass, amorphous caln + Spheno-occipital region: dorsal aspect of sella and clivus destroyed with a soft tissue mass indenting on the nasopharyngeal air space

EWINGS SARCOMA:

EWINGS SARCOMA Central diaphyseal lytic lesion 5-30 years Diaphysis Medullary in location Permeative destruction Lamellated / onion peel periosteal reaction Codman’s triangle Large well defined soft tissue mass

MULTIPLE MYELOMA:

MULTIPLE MYELOMA Most common primary neoplasm of bone Disease of the elderly, >50yrs Well defined punched out lytic lesions all over skeleton DD- Metastases

PLASMOCYTOMA:

PLASMOCYTOMA Solitary myeloma Thoracolumbar Can also occur in pelvis,femur and humerus Well defined,sharply demarcated and characteristically without sclerotic reaction

LYMPHOMA:

LYMPHOMA Wide range of incidence Biphasic distribution Involves diaphysis of long bones and also pelvis Lytic,permeative destruction.

ADAMANTINOMA:

ADAMANTINOMA Eccentric location Diaphysis Well circumscribed, multiloculated Slightly expansile with cortical thinning.

METASTASES:

METASTASES

GENERAL PRINCIPLES OF METASTASES:

GENERAL PRINCIPLES OF METASTASES 70% of all malignant tumours 90% Multiple 10% Solitary Types: Osteolytic – common Osteoblastic- prostate, stomach , carcinoid Mixed FEMALES 70% from Ca Breast MALES 60% from Ca Prostate Children from Neuroblastoma Exception ( CNS & BCC of skin) Below knee & elbow are rare

OSTEOLYTIC METASTASES:

OSTEOLYTIC METASTASES

OSTEOBLASTIC METASTASES:

OSTEOBLASTIC METASTASES

DIFFERENCE BETWEEN MULTIPLE MYELOMA & METASTASES:

DIFFERENCE BETWEEN MULTIPLE MYELOMA & METASTASES Destruction of IV discs Destruction of pedicles Soft tissue mass Mandible Serum alkaline phosphatase

METHODS OF INVESTIGATIONS:

METHODS OF INVESTIGATIONS

SCINTIGRAPHY:

SCINTIGRAPHY Bone seeking pharmaceuticals 99mTc-MDP HOT SPOT More accurate Can detect metastases as early as 18 months before their detection on radiograph

OTHER INVESTIGATIONS:

OTHER INVESTIGATIONS COMPUTED TOMOGRAPHY MRI ANGIOGRAPHY

TEST YOURSELF:

TEST YOURSELF

SPOTTER 1:

SPOTTER 1

SPOTTER 2:

SPOTTER 2

SPOTTER 3:

SPOTTER 3

SPOTTER 4:

SPOTTER 4

SPOTTER 5:

SPOTTER 5

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WISH YOU A HAPPY DIWALI