Bone Tumor (radiografic finding)

Bone Tumors
Bone tumors can be primary or secondary.
Secondary (metastasis) tumors are the most common
malignancy of bone.
Primary bone tumors are divided into benign and malignant.
Benign primary bone tumors are much more common than
malignant primary bone tumors.
 Imaging
Primary bone tumors, both benign and malignant
often have specific radiographic appearances on
plain film.
MRI is used for local staging and to assess the
position of the tumor in the medullary canal,
degree of extracortical involvement, and proximity
to surrounding structures.
Plain Radiographs
Assess for:
Precise location
Underlying bony abnormality
Well-defined margin
Cortical expansion or destruction
Periosteal reaction
Soft tissue mass
CORTICAL INTEGRITY
A key factor in assessing the growth
rate.
Appearances:
Cortical Erosion
Cortical Penetration
Cortical Expansion
CORTICAL INTEGRITY
Cortical Erosion
Slow growing medullary tumors may
erode the inner cortex producing a
lobulated or scalloped appearance.
Endosteal scalloping is frequent feature of
cartilaginous and fibrous tumors.
CORTICAL INTEGRITY

Cortical Expansion:
The result of progressive endosteal erosion together with
periosteal bone formation
Rate of bone expansion is variable
Generally a sign of a benign, medullary tumor, however
may be the result of a slow-growing malignancy
CORTICAL INTEGRITY
Cortical Penetration:
Strong indicator of aggressive bone disease.
Cortical destruction is easier to identify than
destruction within the medullary cavity.
Periosteal response and or soft tissue mass may
be identified.
Cortical Destruction
Notice in this benign
Aneurysmal Bone Cyst
how the thinned cortex
could be mistaken for
cortical destruction
BONE DESTRUCTION

Three Patterns of Bone Destruction

Geographic Pattern
Moth-Eaten Pattern
Permeative Pattern

Result from the degree of aggressiveness of the

lesion
BONE DESTRUCTION

Geographic Pattern:
Least aggressive pattern
Circumscribed and uniformly lytic
Tend to be sharply marginated
May be trabeculated
M/C indicative of a slow-growing lesion
BONE DESTRUCTION

Moth-Eaten Pattern:
Multiple small or moderate sized lucenies
2 to 5 mm in size
Margins are frequently ill-defined
Longer zone of transition
Indicative of aggressive lesions
BONE DESTRUCTION

Permeative Pattern:
Multiple holes < 1mm in size
Poorly demarcated, not easily separated from normal
bone
Areas of destruction may coalesce
Indicative of a very aggressive lesion
Zone of Transition
Narrow Zone of
Transition seen in a benign
nonossifying fibroma. The
margins of this lesion can
be drawn with a fine-point
pen.
Zone of Transition
Permeative lesions seen in
this primary lymphoma
have a Wide Zone of
Transition and are therefore
aggressive. Notice also the
pathologic fracture seen in
the proximal humeral
diaphysis
Benign Lesions
Radiographic findings: Examples:

-Geographic pattern of bone -Enchondroma

destruction (well defined area -Aneurysmal bone cyst
of lysis) with a sclerotic rim. -Simple bone cyst
-Sclerotic rim (indicates that the -Nonossifying fibroma
bone has had time to react).
-Chondroblastoma
-Solid periosteal reaction
displaying focal cortical
thickening.
Malignant Lesions
Radiographic findings: Examples:

-Permeative pattern of bone -Osteogenic sarcoma

destruction displays tiny -Ewings sarcoma
radiolucencies between residual
bone trabeculae (characteristic of -Chondrosarcoma
rapidly growing, poorly defined
lesions).
-Poorly defined bone pattern
-Periosteum shows separation from
the cortex and formation of new
bone.
-codmans triangle
-onion-skinning
Enchondroma
Metaphysis of tubular
bones, ie small bones of the
hands and feet.
Lytic geographic lesion.
Well-circumscribed oval
lucencies. surrounded by a
thin rim of radiodense
bone.
 Simple Bone Cyst
- Proximal humerus and proximal
femur
- central, well marginated &
symmetric
- metaphysis is not broader than
with width of epiphyseal plate
- thin rim of non-reactive bone
borders the bone cyst
Nonossifying Fibroma
Metaphyseal or diaphyseal
regions of distal femur or
tibia.
Eccentrically located,
lobulated, surrounded by
sclerotic margin.
 Osteogenic Sarcoma
Metaphyseal region of distal
femur and proximal tibia.
Destroy surrounding cortices
and produce soft tissue
masses.
Codmans triangle
Osteosarcoma
Elevated periosteum
described as Codmans
triangle
Ewings Sarcoma
Diaphysis of femur
Destructive, lytic lesion
with permeative margins
Onion-skinning