“BONE TUMORS”

Patterns of Bone Destruction

- Geographic
- Moth-eaten
- Permeative

Geographic Bone Destruction

- Destructive lesion with sharply defined border

- Implies a less-aggressive, more slow-growing,
benign process.
- Narrow transition zone

Moth-eaten Appearance

- Myeloma
- Metastases
- Lymphoma
- Ewing’s Sarcoma

Permeative Pattern

- Ill defined lesion with multiple “worm-holes”

- Spreads through marrow space
Geographic Lesions
- Wide transition zone (it means you cannot
- Non-ossifying fibroma distinguish very the transition from normal to the
- Chondromyxoid fibroma abnormal bone and it implies the aggressive
- Eosinophilic Granuloma malignancy
- Implies an aggressive malignancy
o Round-cell lesions

Moth-eaten Appearance

- Areas of destruction with ragged borders on the

areas of destruction and this implies a rapid
growth and more or less malignant in nature see
that you do not see the well defined borders they
appear as moth eaten, you already have this
pathologic fracture because of the moth eaten or
destructive leasions this becomes weak and
therefore it becomes prone to fracture
- Implies more rapid growth
o Probably a malignany

- This type is the permeative pattern you do not see

the borders found in leukemia. But sometimes
your permeative pattern maybe inflammatory
process this should be differentiated from
malignant process because osteomyelitis may have
a permeative pattern
- So in patterns of destruction benign lesions you - In this type your non-ossifying fibroma you do not
have geographic destruction distribution or have any periosteal reaction so this is benign
geographic pattern where in you have well defined
borders there is narrow transition from the
normal to the abnormal while in Moth appearance
it is more of the malignant type.

Permeative Pattern (Round cell Lesions)

- Lymphoma, Leukemia
- Ewing’s Sarcoma
- Myeloma
- Osteomyelitis
- Neuroblastoma

Patterns of Destruction - This one in osteomyelitis you have a solid type of

periosteal reactions it is not very well seen but you
can see this periosteal reaction here this is a solid
periosteum in the proximal portion this is likewise
beningn

Periosteal Reactions

- Benign
o None or
o Solid
- More aggressive or malignant - This one the sunburst appearance of the
o Lamellated or onion-skinning periostium appears like rays of the sun usually
o Sunburst appearance found in osteosarcoma.
o Codman’s triangle
- Your codman’s triangle usually is seen in weak - So this one shows you the different location of the
sarcoma you have elevation of the periostium in tumors. The central portion, the enchondromas,
this aspect and appears like a triangle eccentric, the giant cell the firbrous cortical
aneurismal bone cyst and osteoma
Periosteal Reactions

In the Longitudinal Plane

- Epiphyseal
o GCT, chondroblastoma
- Metaphyseal
o Osteomyelitis, Osteo- and
chondrosarcoma
- Diaphyseal
o Round cell lesions, ABC, Enchondroma

- SO with the different periosteal reactions if you do

not have any periosteal reaction or if it is solid it is
benign if you have lamellated like sunburst
appearance, codman’s triangle or onion skinning
it is more or less of the malignant type of
periosteal reaction

In the Transverse Plane

- Central
o Enchondroma (usually in the long bones)
- Eccentric
o GCT, osteosarcoma, chondromyxoid
fibroma
- Cortical
o Non-ossifying fibroma, osteiod osteoma Benign Bone Tumors
- Parosteal
o Parosteal osteosarcoma, osteochondroma - Benign Cartilaginous tumors
o Enchondroma
o Osteochondroma
o Chondroblastoma
- Benign Osseous tumors
o Bone islands
o Osteoid osteoma
o Osteoblastoma

- Benign Fibrous Tumors

o Non-ossifying fibromas
o Unicameral bone cyst (simple Cyst)
o Giant cell tumor
o Aneurysmal bone cyst
o Hemangioma
 Benign Cartilaginous Tumors - Radiographic features:
o Arises from the cortex, growing outward
- Enchondroma pointing away from the nearest joint.
- Osteochondroma o Pedunculated and cauliflower shaped, the
- Chondroblastoma pedicle merging smoothly with the
normal cortex of the bone
o Has malignant degeneration
Enchondroma (chondrosarcoma)

- Arise from cartilage cell, most common in the

hands but may occur in the pelvis, ribs and
occasionally in long bones
- Radiographic features-
o Central lesion originating from the
medullary cavity
o Radiolucent mass, expands and thins the
cortex.
o Geographic lesion, clearly defiend and
marginated by sclerotic bone.

Benign Osseous Tumors

- Bone islands
- Osteoid Osteoma
- Osteoblastoma

Bone Islands

- Enostosis
- Asymptomatic radiodense nodules of little clinical
Chondroblastoma significance other than they must be distitguished
from other pathologic processes.
- Common between the ages of 10-20 years old - Most commonly found In the pelvis, prox femur
- Usually located in the epiphyses (proximal and ribs
humerus, distal femur, proximal tibia) - Radiographic features:
- Radiographic features: o Ovoid, round or oblong sclerotic areas of
o Well defined geographic area of bone variable size but often less than 1.5cm
destruction with stippled calcification o Radiating bony spicules extend from the
o May extend into the metaphysic and periphery of the lesion.
articular surface but not into the joint.

Osteoid Osteoma
Osteochondroma (Exostosis)
- Resembles a low grade chronic bone abscess
- Is composed of cartilage, calcified cartilage and - If the lesion is less than 1.5 cm it is osteoid
bone. Occur frequently in the distal ends of long osteoma; if greater than 1.5 cm it is an
tubular bones, part. End of the femur. osteoblastoma.
 - Radiographic features: - Localized defect in bone growth; not true
o Small lucent area surrounded by dense neoplasm
compact sclerosis; central lucent area - Found in children and adolescents
may contain a nidus of calcification - Difference in non-ossifying fibroma and beningn
o May be located in the posterior elements fibrous cortical defect is the size. IF lesion is more
of the spine than 1.5-2.0 cm, it is non ossifying fibroma.
- Radiographic features:
o Found or directly beneath the cortex
o Aria of rare faction sharply marginted by
a thin rim of sclerosis
o Eccentric in location

Simple Bone Cyst (Unicameral)

- True fluid cyst with a wall of fibrous tissue

- Not a true neoplasm but may resemble one
- Asymptomatic and often discovered incidentally.
- Common in the proximal humerus and proximal
femur
- Radiographic Features:
o Expansile radiolucent centrally located
lesion with well defined thin sclerotic
margin
o Cortex is thinned
Benign Fibrous Tumors o Does not cross the growth plate

- Non ossifying fibromas

- Unicameral Bone cyst (simple cyst)
- Giant cell tumor
- Aneurysmal bone cyst
- Hemangioma

Non-ossifying fibromas and benign fibrous cortical defect

 - Eccentric lucent lesion originating in the
epiphyseal scar extending into both metaphysis
and epiphysis and to the immediate subarticular
cortex but does not involve the joint
- As it expands toward the shaft it produces the
characteristic appearance of multiple large
bubbles prepared by thin strips of bone.

Aneurysmal Bone Cyst

- Consists of numerous blood filled arteriorvenous

communication thought to be caused by trauma
- Affects the metaphysic of long bones
- Radiographic Appearance:
o Expansile, eccentric, cystlike lesion
causing ballooning of the thinned cortex
originating in the metaphysic; well
defined margin with or without sclerotic Malignant Bone Tumors
rim.
o CT scan- well lobulated lesion
o MRI- Better shows the internal
Osteogenic Sarcoma
loculations and fluid level that produce
low signal on T2 weighted images - Generally occurs at the end of longs bones in the
metaphysic
- Age- between 10-25 years old, more common in
males
- Local pain and swelling
- Feven and weight loss
- Great tendency to metastasize to the lungs
- Three forms recognized radiographically
o Ostolytic- begins in the metaphysic
o Sclerogenic/ Osteoblastic- Arises within
the medullary canal, Amorphous hazed of
sclerosis indicative of osteoid formation
o Mixed-most common mixture of bone
detrcution and osteoid production
- Radiographic Findings
o Mixed destruction and sclerotic lesion
associated with soft tissue mass
Giant Cell Tumor (osteoclastoma) o Irregular periosteal reaction and reactive
new bone formatin
- Typically arises at the end of the distal femur or
o Sunburst patter- horizontal bony spicules
proximal tibia of young adult after epiphyseal
extend in radiating fashion into the soft
closure
tissue mass
- Have malignant counterpart o CT scan – demonstrates periosteal change
in flat bone
 Chondrosarcoma Ewing’s Sarcoma

- Commonly occurs in longs bones often originating - Malignant tumor arising in the bone marrow of
in the rib, scapula or vertabera. longs bones
- Develops at a late age- peak in 35-60 years old. - Tumor of children and young adults
- Grows more slowly and metastasize later - Peak incidence in midteens and rare over 30 years
- May be primary (w/o pre-existing lesion) or old
secondary (develops in pre-existing enchondroma - Occur Frequently in the metaphysic and disphysis
or osteochondroma). of longs bones
- Radiographic Findings: - Ill defined permeative area of bone destruction
o May be central or peripheral depending involving a large portion of the shaft of a long
on its location in the bone of origin bone. Fusiform layers periosteal reaction (“onion-
o Puncrate or amorphous calicification in skin appearance”) – parallel to the saft
cartilaginous matrix - Codman’s triangle.
o CT scan- endosteal scalloping and cortical
destruction
o MRI- T2W1 produce high signal intensity
with low signal intensity of septations.

Multiple Myeloma

- Disseminatied or widespread malignancy of the

plasma cells associated with bone destruction,
marrow failure, renal failure, hypercalcemia and
recurret infection
- Affects persons between 40-70 years old
- Attacks the intramedullary canal of the diaphysis
- Presence of Bence Jones protein in the urine
- Radiographic findings:
o Multiple punched out osteolytic lesions
scattered throughout the skeletal system-
more discrete and uniform in size.
o Affects primarily the flat bones with red
marrow
o Vertebrae- decreased bone density with
destructive changes sparing the pedicles-
results in compression fractures.