Benign
Generally not painful (benign or malignant)
Benign
Often incidental findings (benign or malignant)
Malignant
Can be painful (benign or malignant)
Malignant
Can have associated soft tissue masses (benign or malignant)
Malignant
Have have constitutional symptoms (benign or malignant)
X-ray
What imaging do you always start with for bone tumors
What is the lesion doing to the bone? How is the bone responding to the lesion?
2 important questions when dealing with bone tumors
Benign
Narrow zone of transition (benign or malignant)
Benign
Well-marginated (benign or malignant)
Benign
Sclerotic border (benign or malignant)
Malignant
Wide zone of transition (benign or malignant)
Malignant
Permeative (benign or malignant)
Malignant
Aggressive (benign or malignant)
Malignant
+/- soft tissue extension (benign or malignant)
Benign
Osteochondroma (benign or malignant)
Benign
Enchondroma (benign or malignant)
Benign
Non-ossifying fibroma (NOF) (benign or malignant)
Benign
Unicameral bone cyst (benign or malignant)
Benign
Aneurysmal bone cyst (benign or malignant)
Osteochondroma
Outgrowth of cartilage from peripheral physeal plate that then undergoes enchondral ossification
Distal femur
Most common location of osteochondroma
Cut off the bone bump
What is exostectomy
Observation, exostectomy
Treatment for osteochondroma
Enchondroma
Benign cartilage lesion, remnants of hyaline cartilage from growth plate that failed enchondral ossification
Hand, femur, humerus
Most common location of enchondroma
Inside the bone, medullary lesion
Radiologic feature of enchondroma
Observation
Treatment for enchondroma
Non-ossifying fibroma
Developmental error in remodeling
Distal femur, tibia
Common locations of non-ossifying fibroma
Inside the bone, eccentric, metaphyseal, expansile, well-marginated
Radiological features of non-ossifying fibroma
Observation, activity modification
Treatment of non-ossifying fibroma
Most in long bones, esp. proximal humerus, femur, tibia
Most common locations of unicameral bone cyst
Active
Type of unicameral bone cyst that abuts the physis
Latent
Type of unicameral bone cyst that is separated from physis
Fallen fragment, leaf sign
Radiological sign of unicameral bone cyst
No consensus
Treatment for unicameral bone cyst
Femur, tibia, vertebra
Common locations of aneurysmal bone cyst
Female
Most common gender that gets aneurysmal bone cyst
Pain/swelling, or pathologic fracture
Clinical presentation of aneurysmal bone cyst
Lytic, eccentric, expansile (soap bubble)
Radiographic appearance of aneurysmal bone cyst
Intra-lesional curettage + adjuvant + bone grafting
Treatment for aneurysmal bone cyst
Malignant
Osteosarcoma (benign or malignant)
Malignant
Ewings sarcoma (benign or malignant)
Malignant
More rare (benign or malignant)
Sarcoma
Cancer arising from cells of mesenchymal origin (bone, cartilage, fat, muscle, vascular, neural, hematopoietic tissue)
Carcinoma
Cancer arising from epithelial cells (breast, lung, colon)
Osteosarcoma
The most common malignant tumor of bone
Pain, swelling, decreased ROM, pathologic fracture
Clinical signs of osteosarcoma
Knee!, proximal humerus
Most common locations of osteosarcoma
Codman's triangle, wide zone of transition
Radiographic appearance of osteosarcoma
Pre-op chemotherapy, surgery, post-op chemotherapy
Treatment for osteosarcoma
Chemotherapy
Most important part of treatment for osteosarcoma that will give the best survival rate
Ewings sarcoma
Second most common primary malignant tumor or bone
Fever, malaise, weight-loss, anemia, elevated ESR, leukocytosis
What are some constitutional symptoms of ewings sarcoma
Diaphysis (tibia, fibula), spine
Most common locations of ewings sarcoma
Onion-skinning (layering of the periosteum), Codman's triangles
Radiographic findings of ewings sarcoma
Codman's triangles
What is the radiologic name for periosteal new bone
Pre-op chemotherapy, surgery, post-op chemotherapy
Treatment for ewings sarcoma
Lung, renal, prostate, breast, thyroid
5 most common sources of metastatic lesions to bone
Batson vertebral plexus
Network of valve-less connecting veins hypothesized to be source of osseous spread of metastases
Pain, limp, gait change, weight loss, pathologic fracture
Presentation of metastatic bone disease
Metastatic disease
If you see a lytic lesion in a patient over 40, what do you suspect until proven otherwise
Radiation or surgical stabilization with radiation
Treatment for metastatic bone disease
Bimodal distribution, 2nd decade then 4th-5th decade)
Most common age for osteosarcoma
Primarily before 25
Most common age for aneurysmal bone cyst
20 or younger
Most common age for unicameral bone cyst
2nd decade
Most common age for non-ossifying fibroma
2nd decade
Most common age for enchondroma
2nd decade
Most common age for osteochondroma