Bone Tumors Clues and Cues
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1 William Herring, M.D Bone Tumors Clues and Cues In Slide Show mode, advance the slides by pressing the spacebar All Photos Retain the Copyright of their Authors
2 Clues by Appearance of Lesion
3 Patterns of Bone Destruction Geographic Moth-eaten Permeative
4 Geographic Bone Destruction Destructive lesion with sharply defined border Implies a less-aggressive, more slow-growing, benign process Narrow transition zone
5 Patterns of Bone Destruction Geographic Moth-eaten Permeative Non-ossifying fibroma R 3, 2000
6 Geographic Lesions Examples Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma
7 Moth-eaten Appearance Areas of destruction with ragged borders Implies more rapid growth Probably a malignancy
8 Patterns of Bone Destruction Geographic Moth-eaten Permeative R 3, 2000 Multiple Myeloma
9 Moth-eaten Appearance Examples Myeloma Metastases Lymphoma Ewing s sarcoma
10 Permeative Pattern Ill-defined lesion with multiple wormholes Spreads through marrow space Wide transition zone Implies an aggressive malignancy Round-cell lesions
11 Patterns of Bone Destruction Geographic Moth-eaten Permeative Leukemia
12 Permeative Pattern Round cell lesions Lymphoma, leukemia Ewing s Sarcoma Myeloma Osteomyelitis Neuroblastoma
13 Patterns of Destruction Geographic Moth-eaten Permeative Less malignant More malignant
14 Periosteal Reactions Benign None Solid More aggressive or malignant Lamellated or onion-skinning Sunburst Codman s triangle
15 Periosteal Reactions Benign None Solid Aggressive/malignant Onion-skinning Sunburst Codman s triangle Non-ossifying fibroma R 3, 2000
16 Periosteal Reactions Benign None Solid Aggressive/malignant Onion-skinning Sunburst Codman s triangle R 3, 2000 Chronic osteomyelitis
17 Periosteal Reactions Benign None Solid Aggressive/malignant Onion-skinning Sunburst Codman s triangle Greenspan, 2000 Ewing s sarcoma
18 Periosteal Reactions Benign None Solid Aggressive/malignant Onion-skinning Sunburst Codman s triangle Greenspan, 2000 Osteosarcoma
19 Periosteal Reactions Benign None Solid Aggressive/malignant Onion-skinning Sunburst Codman s triangle R 3, 2000 Ewing s-codman s triangle
20 Periosteal Reactions Solid Lamellated Sunburst Codman s Less malignant More malignant
21 Tumor Matrix Osteoblastic Fluffy, cotton-like or cloud-like densities Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcornlike Enchondroma, chondrosarcoma, chondromyxoid fibroma
22 Tumor matrix Osteoblastic Cartilaginous R 3, 2000 Osteosarcoma
23 Tumor matrix Osteoblastic Cartilaginous Chondrosarcoma R 3, 2000
24 Expansile Lesions of Bone Multiple myeloma Mets Aneurysmal bone cyst Brown tumor Enchondroma Lymphoma Fibrous dysplasia
25 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma Multiple Myeloma
26 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma Renal Cell Carcinoma
27 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma Aneurysmal Bone Cyst
28 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma Fibrous Dysplasia
29 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma R 3, 2000 Brown Tumor
30 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma R 3, 2000 Enchondroma
31 Expansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma Lymphoma R 3, 2000
32 Clues by Location of Lesion
33 In the Transverse Plane Central Enchondroma Eccentric GCT, osteosarcoma, chondromyxoid fibroma Cortical Non-ossifying fibroma, osteoid osteoma Parosteal Parosteal osteosarcoma, osteochondroma
34 Osteosarcoma Parosteal sarcoma Osteochondroma Greenspan, Lippincott, 2000 In The Transverse Plane
35 In the Longitudinal Plane Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo- and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma
36 Tumor Types Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses
37 Characteristic locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses R 3, 2000
38 Characteristic locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses Chondroblastoma R 3, 2000
39 Characteristic locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses R 3, 2000 Giant Cell Tumor
40 Tumor Types Characteristic Locations Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
41 Characteristic locations Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior R 3, 2000 Adamantinoma
42 Characteristic locations Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Chordoma R 3, 2000
43 Characteristic locations Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior Osteoblastoma R 3, 2000
44 Tumor Types Characteristic Locations Parosteal sarcoma Distal femur Periosteal sarcoma Tibia
45 Characteristic locations Parosteal sarcoma Distal femur Periosteal sarcoma Tibia Parosteal sarcoma
46 Characteristic locations Parosteal sarcoma Distal femur Periosteal sarcoma Tibia R 3, 2000
47 Characteristic Tumors By Body Site
48 Pelvic Lesions Chondrosarcoma Solitary plasmacytoma Chordoma
49 Pelvic lesions Chondrosarcoma Solitary plasmacytoma Chordoma
50 Pelvic lesions Chondrosarcoma Solitary plasmacytoma Chordoma Plasmacytoma
51 Pelvic lesions Chondrosarcoma Solitary plasmacytoma Chordoma R 3, 2000 Chordoma
52 Expansile Rib Lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia
53 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia
54 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia Thyroid Carcinoma
55 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia R 3, 2000
56 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia R 3, 2000
57 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia R 3, 2000
58 Expansile rib lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia R 3, 2000
59 Lesions of the Spine Osteoblastoma Expansile, with punctate densities within Chordoma ABC Metastatic disease
60 Spine lesions Osteoblastoma Chordoma ABC Metastatic disease Osteoblastoma R 3, 2000
61 Spine lesions Osteoblastoma Chordoma ABC Metastatic disease Chordoma R 3, 2000
62 Spine lesions Osteoblastoma Chordoma ABC Metastatic disease Aneurysmal bone cyst
63 Spine lesions Osteoblastoma Chordoma ABC Metastatic disease Metastatic Breast Carcinoma R 3, 2000
64 Clues by Density Of Lesion
65 Sclerotic Cortical Lesions Osteoid osteoma Brodie s abscess Stress fracture
66 Sclerotic cortical lesions Osteoid osteoma Brodie s abscess Stress fracture Osteoid Osteoma
67 Sclerotic cortical lesions Osteoid osteoma Brodie s abscess Stress fracture Brodie s abscess R 3, 2000
68 Sclerotic cortical lesions Osteoid osteoma Brodie s abscess Stress fracture Healing Stress Fracture
69 Sclerotic Cortical Lesions Osteoid Osteoma Brodie s abscess Healing Stress Fracture
70 Lytic Lesions in Children Eosinophilic granuloma Neuroblastoma Leukemia
71 Lytic Lesions in Children Eosinophilic granuloma Neuroblastoma Leukemia Eosinophilic granuloma R 3, 2000
72 Lytic Lesions in Children Eosinophilic granuloma Neuroblastoma Leukemia R 3, 2000 Neuroblastoma
73 Lytic Lesions in Children Eosinophilic granuloma Neuroblastoma Leukemia Leukemia R 3, 2000
74 Lytic Lesions in Adults Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor
75 Lytic Lesions in Adults Mets Myeloma Primary bone tumor Met from Thyroid Carcinoma
76 Lytic Lesions in Adults Mets Myeloma Primary bone tumor Multiple myeloma
77 Lytic Lesions in Adults Mets Myeloma Primary bone tumor Chondrosarcoma
78 Blastic Lesions in Children Medulloblastoma Lymphoma
79 Blastic Lesions in Children Medulloblastoma Lymphoma Medulloblastoma R 3, 2000
80 Blastic Lesions in Children Medulloblastoma Lymphoma Lymphoma
81 Blastic Lesions in Adults Metastatic disease Breast female Prostate male Lymphoma Paget s disease Etcetera-mastocytosis, fluorosis
82 Blastic Lesions in Adults Mets Lymphoma Paget s Prostate Mets
83 Blastic Lesions in Adults Mets Lymphoma Paget s Breast Mets
84 Blastic Lesions in Adults Mets Lymphoma Paget s Lymphoma
85 Blastic Lesions in Adults Mets Lymphoma Paget s Paget s of Spine
86 Other Clues
87 Benign Lesions Without Sclerotic Boarders Giant Cell tumor Brown tumor Osteolytic phase of Paget s Disease
88 Benign Lesions without Sclerotic Borders Giant cell tumor Brown tumor Osteolytic Paget s R 3, 2000 Giant Cell Tumor
89 Benign Lesions without Sclerotic Borders Giant cell tumor Brown tumor Osteolytic Paget s R 3, 2000 Brown Tumor
90 Benign Lesions without Sclerotic Borders Giant cell tumor Brown tumor Osteolytic Paget s R 3, 2000 Osteolytic Paget s
91 Soft Tissue Extension Usually implies malignancy More likely to form discrete soft tissue mass Benign conditions with soft tissue extension Osteomyelitis Usually infiltration of fat
92 Osteosarcoma R 3, 2000
93 Multiple Lesions More often benign Malignancies with multiple lesions Metastatic disease Multiple myeloma Lymphoma Ewing s sarcoma (rarely) Osteosarcoma (rarely)
94 Multiple lesions Metastatic Multiple myeloma Lymphoma Mets from Ca of Prostate R 3, 2000
95 Multiple lesions Metastatic Multiple myeloma Lymphoma R 3, 2000 Multiple Myeloma
96 Multiple lesions Metastatic Multiple myeloma Lymphoma Lymphoma R 3, 2000
97 Multiple lesions Metastatic Multiple myeloma Lymphoma Osteosarcomatosis R 3, 2000 Osteosarcomatosis
98 Benign vs. Malignant Greenspan, Lippincott, 2000
99 The End
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