Bone tumors

Aneurysmal bone cyst

Is a solitary, expansile and erosive lesion of bone

An ABC is like a Soft, fibrous walls separate spaces filled
with friable blood clot

Aneurysmal bone cyst

Causes:

Trauma and vascular

disturbance

Clinical

pain or swelling and

tenderness
Rapid progression

Aneurysmal bone cyst

Benign tumor.

Male = female.

80% occur before the age of 20.

Common sites :- Spine , long bones, pelvis .

Aneurysmal bone cyst

Radiological picture :

Expandile osteolytic lesion 2-20 cm ( soap bubble

appearance ).
Well defined margin.
Metaphysis of long bone (Eccentric location ).
Thin maintained cortex

Role of CT in ABC

CT scan can help delineate lesions in the pelvis or spine

where plain film imaging may be inadequate.

CT scan can narrow the differential dignosis of ABC by

demonstrating multiple fluid-fluid levels within the cystic
spaces

Role of MRI in ABC

MRI can confirm the multiple fluid-fluid levels and the nonhomogeneity of the lesion.

Aneurysmal bone cyst

An expansile lytic lesion involving the metaphysis of the distal ulna.
The margins are well-defined and there are multiple internal
septations.

Aneurysmal bone cyst

Large expansile lytic lesion involving the posterior elements of the L3

vertebra. A large expansile component extends into the left paraspinal
muscles.
Fine septations are seen within the expansile portion of the mass. The
borders are lobulated.

Aneurysmal bone cyst

Giant cell tumor

Benign tumor
Equal sex incidence
20 to 40 years (after epiphyseal closure )
Malignant changes in 20%
Site :- Around the knee, at the ankle , at the wrist

Giant cell tumor

Clinical picture :

The first symptom is pain in the area of the tumor.

Pain generally increases with activity and decreases
with rest.
Pain is usually mild at first, but it progressively
increases.
Swelling at the affected area

Giant cell tumor

Radiographic appearance: Lytic Subarticular lesion ( metaphysis )
Expanding destructive lesion
No sclerotic margin
May erode into the joint
Pathological fracture in 30%

Giant cell tumor

Giant cell tumor

Giant cell tumor

Giant cell tumor

Giant cell tumor

Giant cell tumor

Osteosarcoma (osteogenic
sarcoma)

Malignant tumor.
More common in males
50 % around the knee joint, humerus and pelvis.
5-20 years old age.
May occur in eldery as a complication of pagets disease.

Osteosarcoma
(osteogenic sarcoma)
Clinical picture: Pain , swelling
Soft tissue extension

Osteosarcoma (osteogenic
sarcoma)
Radiographic picture:

Destructive lesion.
Arises in the medulla of the metaphysis of long bones
The disease usually extends from the metaphysis to the
epiphysis

Malignant radiographic features are:-

Codmans triangle .
Sun ray appearance.

Osteosarcoma
(osteogenic sarcoma)
Role of MRI
Determine the distribution of tumor within the bone and
extend of any associated soft tissue mass.
Note :- CT is less sensetive than MRI to detect the tumor but
used to detect chest metastasis

Osteosarcoma

Osteosarcoma

Osteosarcoma

Metastasis
The commonest malignant bone tumor

Radiological appearance of
metastasis

Sclerotic :- Prostatic and Breast carcinoma.

Lytic
:- Neuroblastoma, leukaemia in the
children ,Prostatic and Breast carcinoma.
Mixed lytic and sclerotic :- may be seen in
carcinoma of the breast.

Metastasis
Sites of affection:Spine, skull, ribs , pelvis, humerus and femor.
In the long bones , arise in the medulla and as they grow
, elnarge and destroy the cortex.

Metastasis

Metastasis

Metastasis

Periosteal reaction is uncommon with metastasis

except with neuroblastoma.

Radionuclide bone scan is better in cases of

metastasis than plain films as : It is much more sensetive for detecting
metastasis.
Easier examination for the patient to do skeletal
survey.
30% of metastasis seen on a bone scan will not be
visible on plain films.

Metastasis

Metastasis

Metastasis

Metastasis

Multiple myeloma

Primary malignant tumor of bone marrow, the

marrow spaces has been replaced by a diffuse
gelatenous red brown tissue

Location :

Skull, spine, pelvis, ribs , scapula .

The disease may occur in the disseminated form
or as a localized solitary enlarging mass
(plasmacytoma)

Multiple myeloma
Clinical presentation:

Male predominance
Over 40 years old
Weight loss
Malaise
Bone pain
Backache
Fracture

Multiple myeloma
Radiological features :

Generalised osteoprosis.
Pathological fracture.
Scattered punched out lytic lesions with well
defined margins .
Bone expansion with extension through the
cortex producing soft tissue masses.
No sclerotic margin

Multiple myeloma
Numerous lytic lesions, which are typical for the
appearance of widespread myeloma.

How can you differentiate between

multiple myeloma and
metastasis ???

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Intervertebral disc
Vertebral pedicles
Mandible
Soft tissue mass