BONE TUMOR

Dr. Karuniawan P SpOT

RSU UKI
JAKARTA




Introduction & Incidence:
Rare - 0.5% of cancer deaths.
40% Malignant.
Primary & Secondary/metastatic.
Primary in Young. (Osteosarcoma)
Secondary in the old. (Breast, Kidney,
thyroid, lung, prostate)
Marrow neoplasms (hemopoietic)
myeloma, leukemia, lymphoma etc.



PRIMARY TUMORS OF BONE
Bone-producing tumors
Osteoma, osteoid osteoma, osteoblastoma
Osteosarcoma*
Cartilage-producing tumors
Osteochondroma, chondroma (enchondroma)
chondromyxoid fibroma
chondroblastoma
Chondrosarcoma*
Miscellaneous tumors
Ewings sarcoma*
Giant cell tumor of bone
Tumour-like conditions of bone
Bone cysts
Simple bone cyst
Aneurysmal bone cyst
Fibrous-osseous lesions
Fibrous dysplasia
Eosinophilic granuloma (Langerhans
histiocytosis)
Osteochondroma - ?hamartoma
Approach
Clinical
X ray
Bone scanning
Patology : aspiration biopsy , open biopsy
Radiology / x-ray
Clues by Appearance of Lesion
Clues by Location of Lesion
Clues by Density of Lesion
Other Clues
Bone scanning

Clues by Appearance of
Lesion
Patterns of Bone Destruction
Periosteal Reactions
Tumor Matrix
Expansile Lesions of Bone
Clues by Appearance of
Lesion
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
Geographic Bone Destruction
Examples:
Non-ossifying fibroma
Chondromyxoid fibroma
Eosinophilic granuloma
Moth-eaten Bone Destruction
Areas of destruction with
ragged borders
Implies more rapid growth
Probably a malignancy

Examples:
Myeloma
Metastases
Lymphoma
Ewings sarcoma


Permeative Bone Destruction
Ill-defined lesion with multiple worm-holes
Spreads through marrow space
Wide transition zone
Implies an aggressive malignancy
Round-cell lesions
Patterns of Bone Destruction
Permeative

Examples:
Lymphoma,
leukemia
Ewings Sarcoma
Myeloma
Osteomyelitis
Neuroblastoma

Leukemia
Patterns of Bone Destruction
Geographic Moth-eaten Permeative
Less malignant More malignant
Periosteal Reactions
Benign
None
Solid
More aggressive or malignant
Lamellated or onion peel
Sunburst
Codmans triangle
Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle
Non-ossifying fibroma
Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle
Chronic osteomyelitis
Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle
Ewing sarcoma
Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle
Osteo-sarcoma
Periosteal Reactions
Benign
None
Solid
Aggressive/malignant
onion-peel
Sunburst
Codmans triangle
Osteo-sarcoma
Periosteal Reactions
Solid onion-peel Sunburst Codmans
triangle
Less malignant More malignant
Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities
Osteosarcoma
Cartilaginous
Comma-shaped, punctate, annular, popcorn-like
Enchondroma, chondrosarcoma, chondromyxoid fibroma
Tumor Matrix
Osteoblastic
Cartilaginous


Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities
as Osteosarcoma
Cartilaginous
Comma-shaped, punctate, annular, popcorn-
like
as Enchondroma, chondrosarcoma,
chondromyxoid fibroma
Tumor Matrix
Osteoblastic
Cartilaginous
Chondrosarcoma
Osteochondroma:
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Metastasis
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Osteolytic Metastasis: Breast ca
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Renal cell carcinoma
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia
Expansile Lesions of Bone
Clues by Location of Lesion
In the Transverse Plane
In the Longitudinal Plane
Characteristic Locations by tumors
Characteristic Tumors by Body Site
Pelvic Lesions
Expansile Rib Lesions
Lesions of the Spine
In the Transverse Plane
.
.
.
In the longitudinal Plane
Epiphyseal
GCT, chondroblastoma

Metaphyseal
Osteomyelitis, osteo-and chondrosarcoma

Diaphyseal
Round cell lesions, ABC, enchondroma
Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Characteristic Locations
Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior
Characteristic Locations
Clues by Density of Lesion
Sclerotic Cortical Lesions
Lytic Lesions in Children
Lytic Lesions in Adults
Blastic Lesions in Children
Blastic Lesions in Adults
Sclerotic Cortical
Lesions
Osteoid osteoma
Brodies abscess
Sclerotic Cortical
Lesions
Osteoid osteoma
Brodies abscess
Lytic Lesions in Children
Eosinophilic
granuloma
Leukemia
Lytic Lesions in Children
Eosinophilic granuloma

Leukemia
Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid
Multiple myeloma
Primary bone tumor
Metastatic thyroid carcinoma
Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid
Multiple myeloma
Primary bone tumor
Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid
Multiple myeloma
Primary bone tumor
Chondrosarcoma
Blastic Lesions in
Children
Lymphoma
Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma
Pagets disease
Fluorosis
Prostatic Ca.
Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma
Pagets disease
Fluorosis
Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma
Pagets disease
Fluorosis
Blastic Lesions in Adults
Metastatic disease
Breast female
Prostate male
Lymphoma
Pagets disease
Fluorosis
Other Clues

Soft Tissue Extension
Benign vs. Malignant
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
lymphoma
Soft Tissue Extension
Benign vs. Malignant