Bone tumor radiological approach

1. RADIOLOGIAL
APPROACH TO
BONE TUMORS
DR. C. K.VASU, M.D

2. THERAPEUTIC GOALS
DO NOT OVERTREAT A BENIGN
TUMOR
DO NOT UNDERTREAT A
MALIGNANT TUMOR
DO NOT MISDIRECT BIOPSY

3. RADIOLOGIST CAN SEE THE THREE
DIMENSIONAL GROSS PATHOLOGY
IF RADIOLOGIC FINDINGS ARE NOT
CORRELATING WITH THE PATHOLOGY
FINDINGS:SPECIAL STAINS, ADDITIONAL
IMAGES WILL HELP
TUMOR MAY HAVE VARYING HISTOLOGY
AND REPRESENTATIVE SAMPLE FROM
EPICENTRE OF THE LESION HAS TO BE
TAKEN

4. ROLE OF PLAIN
RADIOGRAPH
INITIAL EXAMINATION–STARTS THE
DIAGNOSTIC ALGORITHM
SCREENING,DETECTION,DIAGNOSIS,
FOLLOWUP
IN THIS COST-CONSCIOUS ERA

5. SYSTEMATIC APPROACH
AGE
SITE
ZONE OF TRANSITION
MATRIX
CORTEX
PERIOSTEAL REACTION
SOFT TISSUE COMPONENT
SINGLE -MULTIPLE

6. AGE AT PRESENTATION
DIFFERENTIAL DIAGNOSIS CAN BE NARROWED
1 ST DECADE:
NEUROBLASTOMA,LEUKEMIA
2 ND DECADE:
OSTEOSARCOMA, EWINGS SARCOMA
3
RD
DECADE:
GIANT CELL TUMOR
ELDERLY :
METASTASIS, CHONDROSARCOMA
CLUE TO AGE :
FROM EPIPHYSEAL FUSION

7. OSTEOSARCOMA@

8. CHONDRO
BLASTOMA

9. GCT
@

10. LOCATION
EPIPHYSEAL :
CHONDROBLASTOMA,
GIANT CELL TUMOUR
METAPHYSEAL :
OSTEOSARCOMA,
ANEURYSMAL BONE CYST
DIAPHYSEAL:
EWINGS SARCOMA

11. CHONDRO
BLASTOMA@

12. GCT /
ABC

13. E
W
I
N
G
S
S
A
R
C
O

14. EWINGS
SARCOMA

15. ZONE OF TRANSITION
IT IS AN ASSESSMENT OF THE
BIOLOGICAL ACTIVITY
GEOGRAPHIC OR TYPE 1(LODWIG)
1A----WITH SCLEROSIS: BONE DEPOSITION
TO REDIRECT TRANSMITTED FORCES
IN TYPE 1A LESIONS IDEAL POSTOP
RADIOGRAPH SHOULD SHOW COMPLETE
REMOVAL OF NOT ONLY SCLEROTIC RIM
BUT ALSO SEVERAL MMS ―NORMAL
BONE‖

16. IF SCLEROTIC RIM REMAINS HIGHER
RECURRENCE CHANCE
EX: CHONDROBLASTOMA, BONE CYST
TYPE 1B:
BIOLOGIC ACTIVITY IS SLIGHTLY MORE:
NO SCLEROTIC RIM
EX: GIANT CELL TUMOR

17. TYPE 1CLESION
LYTIC LESION WITH ILL DEFINED
MARGIN: THEY ARE MALIGNANT
UNLESS PROVED OTHERWISE:
EX: CHONDROSARCOMA,
FIBROSARCOMA

18. MULTIPLE CLUSTERED SMALL
HOLES(<5MM)
(TYPE 3)
PERMEATIVE PATTERN
LUCENT LINEAR STREAKS
DD IS SIMILAR: OSTEOSARCOMA,
EWINGS SARCOMA
(TYPE 2)
MOTH EATEN

19. LYTI
C
LESI
ON
WIT
H
SCLE
ROTI
C
RING

20. GCT

21. CHONDRO
SARCOMA
RADIUS

22. OSTEO
GENIC
SARCO
MA

23. PERME
ATIVE
PATTE
RN

24. CORTICAL BREAK
MALIGNANT LESIONS
:OSTEOSARCOMA,EWINGS
SARCOMA
BENIGN LESIONS: NO
CORTICAL BREAK USUALLY:
EX: GCT,ABC

25. GIANT CELL
TUMOUR
PATELLA

26. DESMOPLAS-
TIC FIBROMA

27. OSTEOCHON
DROMA@

28. OSTEO
CHONDROMA

29. PERIOSTEAL REACTION
OUTER FIBROUS LAYER AND INNER
CELLULAR LAYER.
10-21DAYS : SEEN EARLIER IN
YOUNGER PATIENTS
INDICATION OF BIOLOGICAL
ACTIVITY

30. TYPES OF PERIOSTEAL
REACTION
CONTINUOUS: LAMELLATED (ONION
–PEEL)
DISCONTINUOUS : CODMAN ANGLES
COMPLEX: LAMELLATED + CODMAN
MORE EXTENSIVE AND COMPLEX
THE PERIOSTEAL REACTION
GREATER BIOLOGICAL ACTIVITY

31. EWINGS
SARCO
MA@

32. LAM
ELLA
R
APPE
AREN
CE

33. SU
N
R
A
Y

34. OST
EOS
ARC
OMA

35. PAROSTEAL
OSTEOSAR
COMA

36. EWINS SARCOMA

37. MATRIX
OSSEUS MATRIX: OSTEOMA,OSTEOID
OSTEOMA---CLOUD LIKE RELATIVELY
HOMOGENOUS AREA OF BLASTIC
CHANGE
CARTILAGE MATRIX:
STIPLLED, CURVILINEAR
CALCIFICATION(RINGS AND ARCS) ---
ENCHONDROMA,CHONDROSARCOMA
NON-MINERALIZED MATRIX: GIANT CELL
TUMOR, OSTEOLYTIC OSTEOSARCOMA

38. OSTEOID
OSTEOMA
D/D:GARRE’S
OSTEOMYELITIS

39. OST
EOS
ARC
OM
A@

40. CHONDRO
SARCOMA
@

41. MED
ULLA
RY
NECR
OSIS

42. NO
MATRIX-
-
FIBROSA
RCOMA

43. SOFT TISSUE
COMPONENT
DETECTED ON PLAIN XRAY -
DISPLACED FAT PLANE
ROLE OF CT AND MRI

44. FIBROSAR
COMA@

45. E
WI
N
GS
SA
RC
O

46. LESION MULTIPLICITY
KEY DIAGNOSTIC SIGN
PRIMARY BONE TUMORS
USUALLY SINGLE
PRIMARY : SECONDARY --1: 500

47. MULTIPLE
EXOSTOSIS

48. OLLIERS
DISEASE

49. ME
TAS
TAS
IS-
from
bron
chus
@

50. QUIZ

51. OSTE
O
CHO
NDR
OMA

52. OSTEOCHONDROMA
METAPHYSEAL
GROWS AWAY FROM THE JOINT
ANY AGE
NO CORTICAL BREAK
NORMAL CORTEX WITH WHICH IT IS
CONTINUOUS

53. CHOND
RO
BLAST
OMA@

54. CHONDROBLASTOMA
CARTILAGINOUS
MATRIX
BEFORE EPIPHYSEAL
FUSION
NARROW ZONE OF
TRANSITION
EPIPHYSEAL

55. GCT

56. GIANT CELL TUMOUR
EPIPHYSEAL
20-45 YEARS
MATRIX NOT
MINERALIZED
NARROW ZONE OF
TRANSITION

57. OSTE
OSAR
COMA

58. OSTEOSARCOMA
15-25 YEARS
2 ND PEAK AT 40+
METAPHYSEAL
OSTEOID MATRIX
CODMAN,SUNBURST
ZONE OF TRANSITION

59. CHONDRO
SARCOMA

60. CHONDROSARCOMA
40 + AGE GROUP
MATRIX CALCIFIED
DISPROPORTIONATE SOFT
TISSUE
ENDOSTEAL SCALLOPING

62. EWINGS SARCOMA
AGE GROUP—5-30 YEARS
ONION PEEL PERIOSTEAL
REACTION
DD OSTEOMYELITIS
WIDE ZONE OF TRANSITION
DIAPHYSEAL

63. NO
MATRIX-
-
FIBROSA
RCOMA

64. FIBROSARCOMA
NO MINERALIZED MATRIX
LARGE SOFT TISSUE
DIAPHYSEAL
CORTICAL BREAK

65. OS
TE
OI
D
OS
TE
O

66. OSTEOID OSTEOMA
SCLEROTIC
NIDUS
WELL DEFINED
NO CORTICAL BREAK

68. HEMANGIOMA
SPINE

70. EWING’S
SARCOMA

72. HEMANGIOMA

74. IVORY
VERTEBRA

75. OSTEOCHONDROMA

76. OSTEOCHONDROMA