Chondrosarcoma - xraysChondrosarcoma - xraysAppearence similar to
enchondroma, it is a lesion arising in medullary cavity with irregular matrix calcification. Pattern is described as “punctate,” “popcorn,” or “comma-shaped”. Compared with enchondroma, chondrosarcoma has more aggressive appearence with bone destruction and cortical erosions, periosteal reaction, and rarely soft-tissue mass.
Destructive lesion in the diaphyses of longbone with and “onion skin” periosteal reaction.
Ewing sarcoma - MRIEwing sarcoma - MRI To evaluate full
extent of lesion
Ewing sarcoma - Ewing sarcoma - investigations investigations CXR CT chest Bone scan Bone marrow aspirate
Ewing sarcoma – Ewing sarcoma – treatmenttreatment Radiosensitive Large central unresectable mass –
radiotherapy. Smaller more accessible lesions surgery. Neo adjuvant and adjuvant chemotherapy
ChordomaChordoma Rare malignant neoplasm arises from notochord
remnants. Second most common in spine, most common in
sacrum. 50% of chordomas arise in sacrococcygeal region,
30% arise in base of the skull. Age sacrococcygeal 50 – 70 yrs spenooccipital 40 –
60 yrs Clinically: spenooccipital: headaches, symptoms of
cranial nerve compression, retropharyngeal abscess. Sacrococcygeal: lower back pain, sciatic pain, bowel and bladder problems. Palpable mass on PR. Spinal: presents with nerve root or cord compression.
Malignant fibrous Malignant fibrous histocytoma and histocytoma and fibrosarcomafibrosarcoma 3 – 5 % primary bone
malignancies All ages except 1st decade Both sexes affected equally Tendency to occur in distal
femur and proximal tibia. 25% considered secondary
from paget’s disease, irradiation, giant cell tumor and bone infarction.
Clinically presents with pain and pathological fracture(20%)
Radiologically aggressive appearance and are typically purely lytic with indistinct borders.
Giant Cell TumorGiant Cell Tumor5% of bone neoplasmsAge: 20 to 40 yrsFemale>MaleLocation: distal femur> proximal tibia >
distal radiusBenign but pulmonary metastasis can occurClinically: progressive pain, pathological
fractures(10 – 30 %)Radiologically lesions are eccentrically
located in the epiphysis of long bones and usually abut subchondral bone. Lesions are purely lytic.
MRI useful for determining extent of disease.
Giant cell tumor – x raysGiant cell tumor – x rays
Giant cell tumor – MRI Giant cell tumor – MRI Dark in T1 weighted image and Bright in T2 weighted images
Giant cell tumor – Giant cell tumor – treatment treatment Aggressive extended curettage and use of
adjuvants like argon beam coagulator. And fill the bone cavity with cement or bone graft
Inoperable lesions in pelvis use radiation or embolisation.
Follow up is very imp as lesions can reccur.
ChondroblastomaChondroblastoma Age: 10 – 25 yrs M:F is 2:1 Commonly distal femur, proximal humerus, and
proximal tibia. Older patients flat bones Clinically: progressive pain Radiologically: well circumscribed lesion centered in
epiphyses of long bone, or an apophysis like greater trochanter or greater tuberosity. Often it has surrounding rim of reactive bone.
In children well circumscribed epiphyseal lesion that crosses open growth plate is diagnostic. In Adults DD is giant cell tumor and clear cell chondrosarcoma.
Treatment is extended curettage and adequate follow-up
Chondroblastoma - adultsChondroblastoma - adults
Chondroblastoma - kidsChondroblastoma - kids
Chondromixoid FibromaChondromixoid Fibroma 10 – 30 yrs Commonly proximal tibia Clinically pain or swelling Xrays – well circumscribed lesion with rim of
sclerosis in metaphyses of long bone. Intra lesional calcium is absent.
Treatment – resection or extended curettage with bone grafting
Chondromixoid FibromaChondromixoid Fibroma
OsteoblastomaOsteoblastoma Bone forming neoplasm 10 – 30 yrs old M:F is 3:1 Any bone but commonly in spine Clinically: Pain worse at night relived by NSAID, in
spine scoliosis or root or cord compression. Xrays: Spine it shows bone forming neoplasm in
posterior elements(DD aneurismal bone cyst and Osteoid osteoma). Out side spine calcified central nidus with surrounding radiolucent halo and reactive sclerosis. (DD Osteoid osteoma)
Treatment extended curettage or resection. In spine may require instrumented fusion.
Langerhans Cell Langerhans Cell HistiocytosisHistiocytosis Also known as Histocytosis X Isolated bony lesions called as eosinophilic granuloma 5 – 20 yrs Clinically progressive pain, fever, local signs of
inflammation Commonly affects vertebral bodies, flat bones and
diaphyses of long bones. X-rays – in spine vertebra plana. In flat bones lesions
are well circumscribed and “punched out” purely lytic lesions. In diaphyses of long bones aggressive permeative appearance with periosteal reactive bone formation.
Biopsy is required for diagnosis Treatment conservative (steroid therapy, radiation,
Multiple hereditary exostoses AD Two types: Pedunculated or Sessile Surgery(enbloc resection) is indicated when
unsightly, symptomatic or any suggestion of malignancy.
Non Ossifying fibromaNon Ossifying fibroma Developmental abnormalities Metaphyseal region of long bones (40% distal
femur, 40% tibia, 10% fibula) 2 – 20 yrs Plain radiographs well lobulated lesion located
eccentrically in metaphysis. Asymptomatic
Non Ossifying fibromaNon Ossifying fibroma
Cortical DesmoidCortical Desmoid Is a irregularity in posteromedial aspect of
distal femoral metaphysis and usually is seen in boys 10 to 15 yr old.
Benign fibrous Benign fibrous HistiocytomaHistiocytoma Diaphysis or epiphysis 30 – 40 yrs Radiographically it is well defined lytic,
expanding lesion with little periosteal reaction Extended curettage or wide resection
Fibrous dysplasiaFibrous dysplasia Developmental anomaly Replacement of normal bone and marrow by
fibrous tissue and small, woven spicules of bone.
Radiographic appearance is lucent area with lucent area having a granular, ground-glass appearance
Surgical treatment is indicated when there is severe deformity, pathological fracture occurs or when significant pain exists.
Bisphosphonates treatment is probably beneficial.
Fibrous dysplasiaFibrous dysplasia
Osteofibrous DysplasiaOsteofibrous Dysplasia Ossifying fibroma of long bones Tibia and Fibula (middle third of Tibia) Diaphyseal Tibia is enlarged and often bowed anteriorly No pain unless pathological fracture Radiographs show eccentric intracortical
osteolysis with expansion of cortex
Osteofibrous DysplasiaOsteofibrous Dysplasia
Desmoplastic fibromaDesmoplastic fibroma Locally aggressive 2nd and 3rd decades Pain is complaint Radiographs show well circumscribed lytic
lesion with a narrow zone of transition and frequently a reactive bone.
Treatment wide resection
Desomplastic fibromaDesomplastic fibroma
Unicameral bone cystUnicameral bone cyst First 2 decades M:F is 2:1 Common in proximal humerus and femur, in
adults common in pelvis and calcaneum. Asymptomatic unless pathological fracture Radiographs centrally located , purely lytic
lesion with well marginated outline. Fallen fragment sign
Small, asymptomatic lesions treated with observation and serial radiographs
Large, symptomatic, and lesions in lower extremity are treated with curettage or aspiration and injection.
Unicameral bone cystUnicameral bone cyst
Aneurysmal bone cystAneurysmal bone cyst Locally destructive blood filled reactive lesions
of bone Proximal humerus, distal femur, proximal tibia
and spine < 20 yrs Mild to moderate pain, neurological symptoms
in spinal patient. Radiographically expansile lytic lesion that
elevates periosteum, but remains contained by a thin shell of cortical bone.
Treatment with extended curettage and grafting
Aneurysmal bone cystAneurysmal bone cyst
Intraosseous Ganglion Intraosseous Ganglion CystCyst Distal tibia, around knee and shoulder Intra osseous extensions of ganglia of local
Epidermoid cystEpidermoid cyst Skull Radiographically they appear as rarefied
defects surrounded by sclerotic bone
HemangiomaHemangioma Vertebral bodies and
skull Radiographically in
spine it is characteristic with thickened, vertically oriented trabecuale giving the classic “jailhouse” appearance