Bone Tumors
Department of Radiology, Affiliated Hospital of Xuzhou Medical College
Bone and Soft Tissue Tumor and
Tumor-like Disease
Radiological examination is essential before any
attempt at diagnosis of a bone tumor is made.
The diagnosis of a bone tumor requires the
cooperation of the clinician, radiologist and
pathologist.
Radiology provides the earliest useful diagnostic
evidence of the nature of a bony lesion.
Bone and Soft Tissue Tumor and
Tumor-like Disease
• Radiological assessment of bone tumors
location, rate of growth, number，matrix
mineralization, periosteal reaction, regularity
of the margin, soft tissue mass
age of presentation，incidence rate，
symptom and physical sign，the result of
laboratory examination
Patterns of Bone Destruction
l
Geographic
l
Moth-eaten
l
Permeative
Geographic Bone Destruction
l
l
l
Destructive lesion with sharply
defined border
Implies a less-aggressive, more
slow-growing, benign process
Narrow transition zone
Patterns of Bone Destruction
l
Geographic
l
Moth-eaten
l
Permeative
Non-ossifying fibroma
Geographic Lesions
Examples
l
Non-ossifying fibroma
l
Chondromyxoid fibroma
l
Eosinophilic granuloma
Moth-eaten Appearance
l
l
Areas of destruction with ragged
borders
Implies more rapid growth
n
Probably a malignancy
Patterns of Bone Destruction
l
Geographic
l
Moth-eaten
l
Permeative
Multiple Myeloma
Moth-eaten Appearance
Examples
l
Myeloma
l
Metastases
l
Lymphoma
l
Ewing’s sarcoma
Permeative Pattern
l
Ill-defined lesion with multiple “wormholes”
l
Spreads through marrow space
l
Wide transition zone
l
Implies an aggressive malignancy
n
Round-cell lesions
Patterns of Bone Destruction
l
Geographic
l
Moth-eaten
l
Permeative
Leukemia
Permeative Pattern
Round cell lesions
l Lymphoma, leukemia
l Ewing’s Sarcoma
l Myeloma
l Osteomyelitis
l Neuroblastoma
Patterns of Destruction
Geographic
Less malignant
Moth-eaten
Permeative
More malignant
Periosteal Reactions
l
l
Benign
n
None
n
Solid
More aggressive or malignant
n
Lamellated or onion-skinning
n
Sunburst
n
Codman’s triangle
Periosteal Reactions
l
l
Benign
n
None
n
Solid
Aggressive/malignant
n
Onion-skinning
n
Sunburst
n
Codman’s triangle
Non-ossifying fibroma
Periosteal Reactions
l
l
Benign
n
None
n
Solid
Aggressive/malignant
n
Onion-skinning
n
Sunburst
n
Codman’s triangle
Chronic osteomyelitis
Periosteal Reactions
l
l
Benign
n
None
n
Solid
Aggressive/malignant
n
Onion-skinning
n
Sunburst
n
Codman’s triangle
Ewing’s sarcoma
Periosteal Reactions
l
l
Benign
n
None
n
Solid
Aggressive/malignant
n
Onion-skinning
n
Sunburst
n
Codman’s triangle
Osteosarcoma
Periosteal Reactions
l
l
Benign
n
None
n
Solid
Aggressive/malignant
n
Onion-skinning
n
Sunburst
n
Codman’s triangle
Ewing’s-Codman’s
triangle
Periosteal Reactions
Solid
Less malignant
Lamellated
Sunburst
Codman’s
More malignant
Tumor Matrix
l
Osteoblastic
n
Fluffy, cotton-like or cloud-like densities
s
l
Osteosarcoma
Cartilaginous
n
Comma-shaped, punctate, annular, popcorn-like
s
Enchondroma, chondrosarcoma, chondromyxoid
fibroma
Tumor matrix
l
Osteoblastic
l
Cartilaginous
l
Osteosarcoma
Tumor matrix
l
Osteoblastic
l
Cartilaginous
l
Chondrosarcoma
Expansile Lesions of Bone
l
Multiple myeloma
l
Brown tumor
l
Mets
l
Enchondroma
l
Aneurysmal bone cyst
l
Lymphoma
l
Fibrous dysplasia
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Multiple Myeloma
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Renal Cell Carcinoma
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Aneurysmal Bone Cyst
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Fibrous Dysplasia
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Brown Tumor
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Enchondroma
Expansile lesions
l
Multiple myeloma
l
Mets
l
Aneurysmal bone cyst
l
Fibrous dysplasia
l
Brown tumor
l
Enchondroma
l
Lymphoma
•
Lymphoma
Clues by Location
of Lesion
In the Transverse Plane
l
Central
n
l
Eccentric
n
l
GCT, osteosarcoma, chondromyxoid fibroma
Cortical
n
l
Enchondroma
Non-ossifying fibroma, osteoid osteoma
Parosteal
n
Parosteal osteosarcoma, osteochondroma
Osteosarcoma
Parosteal sarcoma
Osteochondroma
In The Transverse Plane
In the Longitudinal Plane
l
Epiphyseal
n
l
Metaphyseal
n
l
GCT, chondroblastoma
Osteomyelitis, osteo- and chondrosarcoma
Diaphyseal
n
Round cell lesions, ABC, enchondroma
Tumor Types
Characteristic Locations
l
Simple bone cyst
n
l
Chondroblastoma
n
l
Proximal humerus
Epiphyses
Giant Cell tumor
n
Epiphyses
Characteristic locations
l
Simple bone cyst
n
l
Chondroblastoma
n
l
Proximal humerus
Epiphyses
Giant Cell tumor
n
Epiphyses
Characteristic locations
l
Simple bone cyst
n
l
Chondroblastoma
n
l
Proximal humerus
Epiphyses
Giant Cell tumor
n
Epiphyses
Chondroblastoma
Characteristic locations
l
Simple bone cyst
n
l
Chondroblastoma
n
l
Proximal humerus
Epiphyses
Giant Cell tumor
n
Epiphyses
Giant Cell Tumor
Tumor Types
Characteristic Locations
l
Adamantinoma
n
l
Chordoma
n
l
Tibia
Sacrum, clivus
Osteoblastoma
n
Spine, posterior
Characteristic locations
l
Adamantinoma
n
l
Chordoma
n
l
Tibia
Sacrum, clivus
Osteoblastoma
n
Spine, posterior
Adamantinoma
Characteristic locations
l
Adamantinoma
n
l
Chordoma
n
l
Tibia
Sacrum, clivus
Osteoblastoma
n
Spine, posterior
Chordoma
Characteristic locations
l
Adamantinoma
n
l
Chordoma
n
l
Tibia
Sacrum, clivus
Osteoblastoma
n
Spine, posterior
Osteoblastoma
Tumor Types
Characteristic Locations
l
Parosteal sarcoma
n
l
Distal femur
Periosteal sarcoma
n
Tibia
Characteristic locations
l
Parosteal sarcoma
n
l
Distal femur
Periosteal sarcoma
n
Tibia
Parosteal sarcoma
Characteristic locations
l
Parosteal sarcoma
n
l
Distal femur
Periosteal sarcoma
n
Tibia
Clues by Density
Of Lesion
Sclerotic Cortical Lesions
l
Osteoid osteoma
l
Brodie’s abscess
l
Stress fracture
Sclerotic cortical lesions
l
Osteoid osteoma
l
Brodie’s abscess
l
Stress fracture
Osteoid Osteoma
Sclerotic cortical lesions
l
Osteoid osteoma
l
Brodie’s abscess
l
Stress fracture
Brodie’s abscess
Sclerotic cortical lesions
l
Osteoid osteoma
l
Brodie’s abscess
l
Stress fracture
Healing Stress Fracture
Sclerotic Cortical Lesions
Osteoid Osteoma
Brodie’s abscess
Healing Stress
Fracture
Benign vs. Malignant