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Premium member Presentation Transcript : BONE TUMOURSCLASSIFICATION: CLASSIFICATION Primary Secondary (metastases) Primary tumors: Benign MalignantGENERAL PRINCIPLES OF RADIOLOGICAL DIAGNOSIS: GENERAL PRINCIPLES OF RADIOLOGICAL DIAGNOSIS AGE SOLITARY OR MULTIPLE SITE OF INVOLVEMENT LOCATION WITHIN THE BONE MARGINS SOFT TISSUE EXTENSIONBENIGN VS MALIGNANT: BENIGN VS MALIGNANT Narrow zone of transition Sclerotic margin Periosteal reaction Tumor matrix Pattern of bone destruction Geographic or moth eaten or permeativeBENIGN TUMOURS: BENIGN TUMOURSENOSTOSIS: ENOSTOSIS Single/ multiple Uniformly dense Always medullary in location Narrow zone of transition DD- osteoblastic metastasesOSTEOMA: OSTEOMA Slow growing Arises from skull,paranasal sinuses and mandible Broad base with well defined margins. Gardners syndromeOSTEOID 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-ChondrosarcomaPowerPoint Presentation: DIAPHYSEAL ACLASIAENCHONDROMA: 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 diseasePowerPoint Presentation: MAFFUCI’S SYNDROME Multiple enchondromas + haemangiomasCHONDROBLASTOMA: CHONDROBLASTOMA 10-20 Years Epiphysis Well defined, radiolucent,oval lesion,with thin rim of sclerosis and cortical expansion. Stippled calcification may presentGIANT 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 ChondroblastomaHEAMANGIOMA: HEAMANGIOMA Solitary Thoracic or Lumbar vertebrae Increased translucency with fine vertical striations. CT: Polka dot appearanceNON 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 tumoursINTRAOSSEOUS LIPOMA: INTRAOSSEOUS LIPOMA Arises in the medulla Well defined lytic lesion with sharp margins. Central ossified noduleMALIGNANT BONE TUMOURS: MALIGNANT BONE TUMOURSOSTEOSARCOMA: 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 triangleCHONDROSARCOMA: 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 involvementCHORDOMA: 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 spaceEWINGS 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 massMULTIPLE MYELOMA: MULTIPLE MYELOMA Most common primary neoplasm of bone Disease of the elderly, >50yrs Well defined punched out lytic lesions all over skeleton DD- MetastasesPLASMOCYTOMA: PLASMOCYTOMA Solitary myeloma Thoracolumbar Can also occur in pelvis,femur and humerus Well defined,sharply demarcated and characteristically without sclerotic reactionLYMPHOMA: 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: METASTASESGENERAL 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 rareOSTEOLYTIC METASTASES: OSTEOLYTIC METASTASESOSTEOBLASTIC METASTASES: OSTEOBLASTIC METASTASESDIFFERENCE BETWEEN MULTIPLE MYELOMA & METASTASES: DIFFERENCE BETWEEN MULTIPLE MYELOMA & METASTASES Destruction of IV discs Destruction of pedicles Soft tissue mass Mandible Serum alkaline phosphataseMETHODS OF INVESTIGATIONS: METHODS OF INVESTIGATIONSSCINTIGRAPHY: SCINTIGRAPHY Bone seeking pharmaceuticals 99mTc-MDP HOT SPOT More accurate Can detect metastases as early as 18 months before their detection on radiographOTHER INVESTIGATIONS: OTHER INVESTIGATIONS COMPUTED TOMOGRAPHY MRI ANGIOGRAPHYTEST YOURSELF: TEST YOURSELFSPOTTER 1: SPOTTER 1SPOTTER 2: SPOTTER 2SPOTTER 3: SPOTTER 3SPOTTER 4: SPOTTER 4SPOTTER 5: SPOTTER 5PowerPoint Presentation: WISH YOU A HAPPY DIWALI You do not have the permission to view this presentation. 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