Bone Tumors
Bone tumors are either primary or metastatic. Primary bone tumors can be either benign or malignant. Radioisotope scans (99-Tc MDP) can estimate the local intramedullary extent of the tumor and screen for other skeletal areas of involvement. For potentially active and aggressive lesions, an MRI is useful. Definitive diagnosis requires a biopsy.
In general, less aggressive lesions have a narrow zone of transition, a geographic pattern of destruction, and no periostitis of adjacent soft tissue involvement. Sclerosis of the surrounding normal bone also indicates a slow growing lesion.
TYPES OF PERIOSTEAL RESPONSE
Buttressing (Thick Periostitis)
Slow growing tumor presses against the periosteum and thickens the cortex.
Codman Triangle
|
A triangle elevation of the periosteum seen in osteogenic sarcoma and other condition including hemorrhage and acute osteomyelitis
Sunburst
|
Delicate rays of periosteum bone formation separated by spaces containing blood vessels
Seen with Ewing sarcoma, osteogenic sarcoma, chondrosarcoma, fibrosarcoma, leukemia, and acute osteomyelitis
Onion Skin
|
Multiple layers of new periosteal bone
Seen in Ewing sarcoma, eosinophilic granuloma, lymphoma of bone, osteogenic sarcoma, and acute osteomyelitis
Hair on End
|
Similar to sunburst pattern, but rays are all parallel
Rays of periosteal bone project in a perpendicular direction to the underlying bone.
Seen in Ewing sarcoma
PATTERNS OF BONE DESTRUCTION
Geographic
|
Well-defined margins with a narrow zone of transition from normal to abnormal bone
Indicative of a slow growing, less aggressive lesion
Moth-Eaten
|
Less well-defined lesion margins and a wider zone of transition between normal and abnormal bone
More aggressive pattern than geographic and indicates a faster growing lesion
Seen in aggressive tumors and in osteomyelitis
Permeative
|
Poorly defined lesion margins with a wide zone of transition; the lesion boundaries are not easily discerned from normal bone.
Aggressive, rapidly growing lesion seen in malignant bone tumors
THE MOST COMMON SOURCES OF METASTATIC BONE TUMORS
Breast, lung, prostate, kidney, and thyroid
MOST COMMON BENIGN PRIMARY BONE TUMOR
Osteochondroma
MOST COMMON MALIGNANT PRIMARY BONE TUMOR
Osteogenic sarcoma
NOTE: Multiple myeloma is more common than osteogenic sarcoma but is often considered a marrow cell tumor vs. a bone tumor.
MALIGNANT VS. BENIGN TUMORS
MALIGNANT
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Ewing sarcoma
Multiple myeloma
Osteoid osteoma
Osteoblastoma
Nonossifying fibroma
Intraosseous lipoma
Giant cell tumor (locally malignant)
Unicameral bone cyst
Enostosis
Nonossifying fibroma
Aneurysmal bone cyst
Chondroblastoma
BENIGN
Osteoma
Osteochondroma
Enchondroma
Chondroblastoma
Chondromyxoid fibroma
MALIGNANT VS. BENIGN AND AGE DISTRIBUTION
|
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
