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    Bone Tumors

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    drqazi777
    This document provides guidance for systematically approaching bone tumors. It emphasizes starting as a junior trainee by focusing on basics like lesion type, location, margins and effect on surrounding bone. Key characteristics should be used to generate differential diagnoses and determine if the lesion is benign or malignant. Further imaging may be used to characterize the lesion and plan biopsy. Common differentials are provided for solitary and multiple lucent lesions. Important benign and malignant lesions are demonstrated with examples. The role of different imaging modalities is outlined. An interactive approach is encouraged to apply the guidance.

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    Bone Tumors

    Uploaded by

    drqazi777
    127 views58 pages
    This document provides guidance for systematically approaching bone tumors. It emphasizes starting as a junior trainee by focusing on basics like lesion type, location, margins and effect on surrounding bone. Key characteristics should be used to generate differential diagnoses and determine if the lesion is benign or malignant. Further imaging may be used to characterize the lesion and plan biopsy. Common differentials are provided for solitary and multiple lucent lesions. Important benign and malignant lesions are demonstrated with examples. The role of different imaging modalities is outlined. An interactive approach is encouraged to apply the guidance.

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    Approach to Bone Tumors.

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    This document provides guidance for systematically approaching bone tumors. It emphasizes starting as a junior trainee by focusing on basics like lesion type, location, margins and effect on surrounding bone. Key characteristics should be used to generate differential diagnoses and determine if the lesion is benign or malignant. Further imaging may be used to characterize the lesion and plan biopsy. Common differentials are provided for solitary and multiple lucent lesions. Important benign and malignant lesions are demonstrated with examples. The role of different imaging modalities is outlined. An interactive approach is encouraged to apply the guidance.

    Copyright:

    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    127 views58 pages

    Bone Tumors

    Uploaded by

    drqazi777
    This document provides guidance for systematically approaching bone tumors. It emphasizes starting as a junior trainee by focusing on basics like lesion type, location, margins and effect on surrounding bone. Key characteristics should be used to generate differential diagnoses and determine if the lesion is benign or malignant. Further imaging may be used to characterize the lesion and plan biopsy. Common differentials are provided for solitary and multiple lucent lesions. Important benign and malignant lesions are demonstrated with examples. The role of different imaging modalities is outlined. An interactive approach is encouraged to apply the guidance.

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    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    of 58

    Approach to Bone Tumors

    www.frcrtutorials.com

    Dr Sameer
    Shamshuddin

    MBBS, DMRD, FRCR

    West of Scotland
    Bone Tumours FRCR 2B
    Test of Observation and Systematic Approach
     Do not jump to a diagnosis

     Start as a Year 1 trainee and finish the case as a Consultant MSK Radiologist

     Basics First

     Build a case

     Come to a logical set of differentials

     Assert with confidence if it is Benign or Malignant

     Diagnosis and Further management


    What to focus on ?
    What to do ?
     Radiograph: AP and Lateral
    ( if not given say single view and would always interpret with a
    conjunctional orthogonal view)

     Age: Skeletally mature / Immature

     Abnormality: Focal / Diffuse

     Where is it: which bone, which part of a bone?

     Epiphysis / Metaphysis / Diaphysis


    Very Basics First
     Type of the lesion: Lucent, Sclerotic or Mixed

     Epicentre of the lesion: Medullary / Cortical / Parosteal / Soft tissue

     Margins: Geographic/Moth eaten/permeative

     Zone of transition: Narrow / wide

     Expansile/non-expansile

     Matrix (Osteoid, Cartillaginous, Fibrous or mixed)

     Effect on endosteum, cortex and periosteum

     Periosteal reaction: Aggressive or Non-aggressive (forget sunburst , onion peel etc……)

     Soft tissue extension

     Last but not the least: How many??? ( solitory or multiple)


    Next Level: definite pass
    Characteristic feature of a lesion

     SBC: Fallen fragment sign


     ABC: Septated
     Osteoid osteoma: calcific nidus
     Fibrous dysplasia: ground glass matrix
     Myeloma: punched out lesion

    Makeup your mind: Aggressive or Non-aggressive

    Primary Dx and a few reasonable differentials:

    Osteoid, Chondroid, Fibrous, Sarcomatous , Mets or a Weird one !


    What Next: Consultant Stuff
     This is a no touch lesion or

     This needs a bone tumor centre referral

    Further characterization :
    MRI: extent of marrow involvement
    soft tissue involvement
    relationship to neurovascular bundle
    planning biopsy

    Bone Scan: multiplicity of the lesion

    Biopsy

    CT chest for staging


    Some Teaching
    DDX: Solitory Lucent Lx
    FEGNOMASCHIC / FOGMACHINES
     Fibrous Dysplasia

     Eosinophilic Granuloma / Enchondroma

     Giant Cell Tumor

     Non-ossifying Fibroma

     Osteoblastoma

     Metastasis / Myeloma

     Aneurysmal Bone Cyst

     Solitary Bone Cyst

     Chondroblastoma / Chondromyxoid Fibroma

     Hyperparathyroidism (brown tumors) / Hemangioma


    Multiple Lucent Bone Lesions

     Metastasis / Myeloma
     Lymphoma
     LCH, Leukemia, Neuroblastoma mets – Kids

     Fibrous Dysplasia
     Hyperparathyroidism (brown tumors)
     Multiple enchondroma
     HME (diaphyseal aclasia)
     Infection
    Don’t touch lesions
     NOF

     Bone infarction

     Fibroxanthoma

     Periosteal desmoid

     Intraosseous ganglion
    Role of Modalities
     Characterization of a lesion: Radiograph best

     Anatomic localization: CT / MRI

     Characterization of the calcification: CT>>MRI

     Cystic from solid – US or MRI + contrast

     Demonstration of vascular supply: MRI

     Planning biopsy: MR

     Performing a Biopsy: CT

     Nuclear medicine: Number of lesions


    Let the fun begin now 

    Enchondroma
    SBC
    ABC
    ABC
    ABC
    OSTEOCHONDROMA
    Osteochondroma
    HME
    Bn vs Malg ?
    Bn vs Malg ?
    Ollier’s
    Ollier’s
    Maffuci: calcific phleboliths
    OSTEOID OSTEOMA
    NOF / FCD 2cm
    Ganglion
    EPIDERMOID
    INCLUSION CYST

    GLOMUS TUMOR
    FB GRANULOMA
    ENCHONDROMA
    SARCOIDOSIS
    Osteomyelitis: never forget
    OSTEOPOIKILOSIS
    OSTEOPOIKILOSIS
    OSTEOPOIKILOSIS
    osteosarcoma
    Role of MR

    Skip lesions

    Marrow

    Soft tissue involvement


    Paroteal OS
    Periosteal osteosarcoma: typical spiculated periosteal
    reaction arising from the femur.
    Telangiectatic OS
    Ewing’s Sarcoma
    Ewing’s Sarcoma
    GCT: after fusion of
    growth plate, sub-
    articular, multi-
    septated, geographical
    Chondrosarcoma: Cortical thickening/Lesion larger
    than 4 CM and marked endosteal scalloping with
    presence of pain: All features favour chondrosarcoma
    Aggressive tx
    Septation ,fluid levels and solid
    components – aggressive sarcoma
    Chordoma
    Mets: Breast
    Mets
    LCH
    LCH
    Fib Dysplasia
    Polyostotic FD
    FD: Look for complications: path #
    Paget’s with Sarcoma
    MMLLL
    Osteomyelitis: don’t forget in kids
    across the growth plate
    Thank You

    Dr Sameer Shamshuddin
    MBBS, DMRD, FRCR,
    STR5, Glasgow, UK

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