By

Dr.Muhammad Ben Zulfiqar(PGR-1)

Clues by Appearance of Lesion Clues by Location of LesionClues by Density of LesionOther Clues

Clues by Appearance of LesionPatterns of Bone Destruction Periosteal ReactionsTumor Matrix Expansile Lesions of Bone

Clues by Appearance of Lesion Patterns of Bone Destruction

GeographicMoth-eatenPermeative

Geographic Bone Destruction Destructive lesion with sharply defined

borderImplies a less-aggressive, more slow-growing,

benign processNarrow transition zone

Patterns of Bone Destruction

GeographicMoth-eatenPermeative

Non-ossifying fibroma

Examples:• Non-ossifying fibroma• Chondromyxoid fibroma• Eosinophilic granuloma

Moth-eaten Bone Destruction

Areas of destruction with ragged bordersImplies more rapid growth

Probably a malignancy

Patterns of Bone DestructionGeographicMoth-eatenPermeative

Multiple Myeloma

Moth-eaten Bone Destruction

Examples:MyelomaMetastasesLymphomaEwing’s sarcoma

Permeative Bone Destruction

Ill-defined lesion with multiple “worm-holes”Spreads through marrow spaceWide transition zoneImplies an aggressive malignancy

Round-cell lesions

Patterns of Bone Destruction

GeographicMoth-eatenPermeative

Leukemia

Permeative Bone Destruction

Examples:Lymphoma, leukemia Ewing’s SarcomaMyelomaOsteomyelitisNeuroblastoma

Patterns of Bone Destruction

Geographic Moth-eaten Permeative

Less malignant More malignant

Periosteal ReactionsBenign

NoneSolid

More aggressive or malignantLamellated or onion peelSunburstCodman’s triangle

Periosteal Reactions

• Benign– None– Solid

• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle

Non-ossifying fibroma

Periosteal Reactions

• Benign– None– Solid

• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle

Chronic osteomyelitis

Periosteal Reactions

• Benign– None– Solid

• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle

Ewing sarcoma

Periosteal Reactions

• Benign– None– Solid

• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle

Osteo-sarcoma

Periosteal Reactions

• Benign– None– Solid

• Aggressive/malignant– onion-peel– Sunburst– Codman’s triangle

Periosteal Reactions

Solid onion-peelSunburst Codman’s

triangle

Less malignant More malignant

Tumor MatrixOsteoblastic

Fluffy, cotton-like or cloud-like densitiesOsteosarcoma

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

CartilaginousComma-shaped, punctate, annular,

popcorn-likeas Enchondroma, chondrosarcoma,

chondromyxoid fibroma

Tumor Matrix

OsteoblasticCartilaginous

Chondrosarcoma

Expansile Lesions of Bone

• Multiple myeloma • Mets• Brown tumor• Enchondroma• Aneurysmal bone cyst• Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma

MetsBrown tumorEnchondromaAneurysmal bone cystFibrous dysplasia

Multiple myeloma

MetsBrown tumorEnchondromaAneurysmal bone

cystFibrous dysplasia

Expansile Lesions of Bone

Renal cell carcinoma

Multiple myeloma Mets

Brown tumorEnchondromaAneurysmal bone

cystFibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma MetsBrown tumor

EnchondromaAneurysmal bone

cystFibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma MetsBrown tumorEnchondroma

Aneurysmal bone cyst

Fibrous dysplasia

Expansile Lesions of Bone

Multiple myeloma MetsBrown tumorEnchondromaAneurysmal 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 PlaneEpiphyseal

GCT, chondroblastoma

MetaphysealOsteomyelitis, osteo-and chondrosarcoma

DiaphysealRound cell lesions, ABC, enchondroma

Characteristic LocationsSimple bone cyst

Proximal humerus Chondroblastoma

Epiphyses Giant Cell tumor

Epiphyses Adamantinoma

Tibia Chordoma

Sacrum, clivus Osteoblastoma

Spine, posterior

Characteristic Locations

Simple bone cystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior

Simple bone cystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior

Characteristic Locations

Simple bone cystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior

Characteristic Locations

Simple bone cystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior

Characteristic Locations

Simple bone cystProximal humerus

ChondroblastomaEpiphyses

Giant Cell tumorEpiphyses

AdamantinomaTibia

ChordomaSacrum, clivus

OsteoblastomaSpine, posterior

Characteristic Locations

Clues by Density of LesionSclerotic Cortical LesionsLytic Lesions in ChildrenLytic Lesions in AdultsBlastic Lesions in Children Blastic Lesions in Adults

Sclerotic Cortical Lesions

Osteoid osteoma

Brodie’s abscess

Sclerotic Cortical Lesions

Osteoid osteoma

Brodie’s abscess

Lytic Lesions in ChildrenEosinophilic

granulomaLeukemia

Lytic Lesions in ChildrenEosinophilic granuloma

Leukemia

Lytic Lesions in Adults

Metastatic lesions

LungRenalThyroid

Multiple myelomaPrimary bone tumor

Metastatic thyroid carcinoma

Lytic Lesions in AdultsMetastatic lesions

LungRenalThyroid

Multiple myelomaPrimary bone tumor

Lytic Lesions in AdultsMetastatic lesions

LungRenalThyroid

Multiple myeloma

Primary bone tumor

Chondrosarcoma

Blastic Lesions in Children

Lymphoma

Blastic Lesions in AdultsMetastatic disease

Breast –female

Prostate –male

LymphomaPaget’s diseaseFluorosis

Prostatic Ca.

Blastic Lesions in AdultsMetastatic disease

Breast –female Prostate –male

LymphomaPaget’s diseaseFluorosis

Blastic Lesions in AdultsMetastatic disease

Breast –female Prostate –male

Lymphoma

Paget’s diseaseFluorosis

Blastic Lesions in AdultsMetastatic disease

Breast –female Prostate –male

LymphomaPaget’s disease

Fluorosis

Other CluesSoft Tissue ExtensionBenign 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 Osteosarcoma

Soft Tissue Extension

Benign vs. Malignant

Thank You