Tumor and Tumor-like Lesion of Bone by BKKESqq0


									Tumor and Tumor-like
   Lesion of Bone

• Osteoma is a benign mass protruding from
 osseous tissue

• Most common tumor of the paranasal
  sinuses, most frequently seen in the
  frontal sinus and ethmoids
• Two varieties are described: the dense
  'ivory' type and 'cancellous' osteoma
(a)                                                   (b)
       Osteoma       Lateral radiograph of the skull (a) and axial CT
      scan (b) demonstrate an ossific nodule (arrow) arising from
      the outer table of the calvarium
          Giant cell tumor

• Giant cell tumor is a locally aggressive
• The sites affected most frequently are the
  long tubular bones
          Giant cell tumor

• Clinical manifestation
• Earliest manifestations include pain, local
 swelling, limitation of motion and
 pathologic fractures
           Imaging feature

• On radiographs, the long and short
 tubular bones reveal eccentric osteolytic
• With MR imaging, intraosseous fluid
 levels may be seen
 Giant cell tumor a, b. AP (a) and lateral (b)
radiographs of the knee demonstrate an eccentric
osteolytic lesion in the proximal tibia. The lesion has a
non-sclerotic border and abuts the articular surface of the
c. Sagittal T1-weighted MR image of the knee
demonstrates the low signal intensity mass in the proximal
 d. Fat-suppressed T1-weighted MR image after gadolinium
adminstration demonstrates enhancement of the mass in
the proximal tibia.
Giant cell tumor
osteolytic lesion in the distal
soap bubble
Soft tissue swelling
               Bone cyst

• Bone cyst is a usually cavitary lesion of
• Bone cysts may occur after trauma and in
• These cysts occur most frequently in long
 tubular bones, especially the metaphysis,
 and in the bony pelvis
           Imaging feature

• Radiographically, these lesions appear
  radiolucent and are located centrally, with
  cortical thinning and mild expansion of the
• CT scanning and MR imaging with contrast
  enhancement reveal presence of fluid
  within the lesion
• Complications of simple bone cysts include
 complete and incomplete fractures,
 and (rarely) malignant transformation
Bone cyst
Simple bone cyst.
AP radiograph of
the shoulder
demonstrates a
fracture through
the simple bone
cyst in the

Note the "fallen
fragment" within
the bone cyst.

• Osteosarcoma is a malignant neoplasm of
 bone composed of proliferating tumor cells
 that in most instances produce osteoid or
 immature bone
           Clinical feature

• 75% of cases occurring between the ages
  of 10 and 25 years
• 86% occur in the long bones with the
  distal femoral metaphyseal region
• The next commonest sites are the upper
  tibia and humerus
            Clinical feature

• The commonest presentation is pain in the
  affected area or, occasionally, a
  pathological fracture
• This tumor metastasises early, particularly
  to the lungs and other bones
           Imaging feature

• On the radiograph, the tumor may be
 purely lytic or sclerotic , or a mixture of the
            Imaging feature

• Pure lytic lesions vary from areas of
  diminished bone density to completely lytic
  areas with very little reaction from the
• They may have a very thin periosteal
  reaction overlying the lesion with very little
  evidence of new bone formation
           Imaging feature

• The sclerotic osteogenic sarcomas may
  produce a region of dense sclerosis with
  loss of the inner cortical margins
• The periosteal reaction may be laminated
  or spiculated with so-called 'sunburst'
             Imaging feature

• More often the tumors are both lytic and
 sclerotic with destruction of the bone and
 cortex, and extension into the soft tissues
• There may be a variable amount of
 calcification in the soft tissues
•   a prominent periosteal reaction with a
    Codman's triangle
• MRI:
• The lytic areas of the tumor show a low
 signal on T1 and high signal on T2
• The extension in the medullary cavity is
 very accurately determined by MRI, as is
 the soft tissue extent
Osteosarcoma AP
(a) and lateral (b)
radiographs of the
femur demonstrate
a large soft tissue
mass      with   an
periosteal reaction
creating        the
osteosclerosis   and
osteolysis in     the
distal femur
Osteolytic sarcoma
of the fibular head.
There is a small
amount               of
calcification    within
the tumor.
Osteogenic sarcoma
Osteoblastic sarcoma
in the upper
metaphyseal region of
the tibia.
There is sclerosis,
breach of the cortex
and sclerotic extension
of the tumor into the
tissues. The cortical
margin is lost
Osteogenic        sarcoma
Radiograph of a distal
femoral         osteogenic
On the radiograph
there is a mixed sclerotic
and lytic lesion with a
layered periosteal reaction
anteriorly and showing
Osteogenic sarcoma
The large soft tissue
component is well seen
on the MR.
There is high signal
within the lesion and in
the medullary cavity

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