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How to Approach Bone Tumors

How to Approach Bone Tumors. Frank O’Dea December 20, 2002. Introduction. If you try to look at hole/abnormality in bone without a system then you will get lost!

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How to Approach Bone Tumors

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  1. How to Approach Bone Tumors Frank O’Dea December 20, 2002

  2. Introduction • If you try to look at hole/abnormality in bone without a system then you will get lost! • Once you have a system that works and apply it every time then the diagnosis becomes self apparent or at the very least a rational plan of attack develops.

  3. Don’t think like a shot gun!!!! • Think of the age of the patient. • Think of where the abnormality is …. or isn’t. • Think of the tissue categories of tumors. • Think in terms of benign, benign aggressive or malignant.

  4. Tumor Tissue types • Metastatic 90% • Hematologic (Myeloma, Lymphoma, Leukemia 5%) • Primary Mesenchymal Tumors 5%

  5. Primary Bone Tumors • Osteogenic • Fibrous • Chondroid • Lipomatous • Other • *****These are the broad categories******

  6. Osteogenic • Benign: Osteoma, Osteoid Osteoma, Bone Islands • Benign Aggressive: Osteoblastoma • Malignant: Osteogenic Sarcoma

  7. Fibrous Tumours • Benign: Fibrous Cortical Defect, Non-Ossifying Fibroma, Fibroma of Bone. • Benign Aggressive: Fibromatosis(desmoid), Ossifying Fibroma of bone, Fibrous Dysplasia. • Malignant: Malignant Fibrous Histiocytoma of bone, Fibrosarcoma.

  8. Chondroid • Benign: Enchondroma, Peri-osteal Chondroma, Osteochondroma. • Benign Aggressive: Chondromyxoid Fibroma, Chondroblastoma. • Malignant: Chondrosarcoma.

  9. Other Bone Tumors • Benign: Bone Cyst, Ganglion, Hemangioma. • Benign Aggressive: Giant Cell Tumor, Aneurysmal Bone Cyst, EOG. • Malignant: Adamantinoma, Chordoma, Ewings.

  10. Radiographic Features of the Various Tumors • Benign: well circumscribed, narrow transition, no reaction, sclerotic border, ‘does one thing’. • Benign Aggressive: neocorticalization, expansion, thinning of cortex, usually lytic, +/-reaction, +/- narrow zone of transition. • Malignant: ++++reaction, large, permeative, moth eaten, ‘does more than one thing’. • Conditions/Mets: more than one bone, symmetry.

  11. Benign Features

  12. Benign Aggressive Features

  13. Malignant Features

  14. Radiographic Tissue Identifiers • Bone, Sclerosis, Calcification….. Osteoid. • Popcorn, Arc Ring Calcification, Bright on T2, Low on T1….chondroid. • Lytic, Low on T2, Low on T1….Fibrous. • Lytic, well circumsribed, Bright T2, Dark T1……Cystic fluid. • Fluid Fluid Levels….ABC

  15. Sites of Tumors • Diaphyseal: Ewings, Osteoid Osteoma, Mets, Adamantinoma, Fibrous Dysplasia • Epiphyseal: Chondroblastoma, Clear Cell Chondrosarcoma, GCT, Ganglion of Bone. • Metaphyseal: Everything!!!!!!

  16. Age of Tumors • 20>…..Osteogenic Sarcoma, Ewings. • 40……GCT, Chondrosarcoma, MFH, Lymphoma, Mets. • 60……Mets, Myeloma, Chondrosarcoma, late Osteogenic, MFH, Fibrosarcoma.

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