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Imaging of benign bone tumors
- 1. Musculoskeletal Bone Tumors Radiological Approach and Benign Lesions
- 3. Radiographic features of tumors and tumor-like lesions of bone
- 4. Benign Criteria of Bone Tumors Well defined margin Sclerotic rim Expanding lesion No periosteal reaction No extraosseous soft tissue component Narrow zone of transition
- 5. Malignant Criteria of Bone Tumors Ill defined margins Cortical destruction Periosteal reaction Extraosseous extension Intra-articular invasion Neurovascular bundle affection Wide zone of transition
- 6. Peak age incidence of benign and malignant tumors and tumor-like lesions.
- 10. Types of matrix Bone Forming Tumors Cartilage Forming Tumors Fibrous Lesions Mesenchymal Tumors Myxoid Tumors Other Bone Tumors
- 14. Bone Island (Enostosis) a) Incidence Common b) Location Predilection for pelvis , long bones , spine and ribs c) Associations Osteopoikilosis : multiple bone islands d) Radiographic Features Small round or oval foci of dense bone within the medullary space- The appearance of radiating spicules at the margins that blend with the surrounding trabeculae is pathognomonic
- 19. Osteoblastoma
- 26. PERIOSTEAL CHONDROMA Slowly growing Benign cartilaginous tumor of limited size develops within and beneath the periosteum on the surface of cortical bone. Metaphyseal lesion in a tubular bone that appears as an area of cortical indentation, resulting in a scalloped, or saucerized depression of the outercortex, with a well- defined inner margin.
- 35. Chondroblastoma
- 43. FIBROUS XANTHOMA OF BONE: NON-OSSIFYING FIBROMA
- 48. Periosteal Desmoid AKA avulsive cortical irregularity / distal metaphyseal femoral defect / cortical desmoid, or medial supracondylar defect of the femur Tumor-like fibrous proliferation of the periosteum predilection for the posteromedial cortex of the medial femoral condyle.associated with erosion of the underlying bone. Periosteal desmoid usually occurs between the ages of 12 and 20 years, mainly in boys, and most lesions disappear spontaneously by the end of the second decade. It Represents an asymptomatic normal variant that does not require biopsy or treatment.
- 49. Fibrous Dysplasia AKA fibrous osteodystrophy, osteodystrophia fibrosa, and osteitis fibrosa disseminata
- 56. Osteofibrous Dysplasia (Kempson-Campanacci Lesion) (formerly called ossifying fibroma) is a rare disorder witha decided preference for the tibia. Characterized by the presence of fibrous connective tissue and trabeculae of immature nonlamellar bone rimmed by osteoblasts
- 58. Vascular Lesions
- 68. Intraosseous, cortical, or parosteal nonaggressive lesions. Radiolucent lesion with sharply defined borders, associated with thinning and bulging of the cortex particularlyin thin bones such as the fibula or rib. The central calcifications and ossifications - a sign of fat necrosis that is seen in an infarct of the fatty marrow. Intraosseous Lipoma
- 72. Lipoma Arborescens Villous lipomatous proliferation of the synovial membranes Nonneoplastic lipomatous proliferation of the synovium Soft tissue density within the joint, commonly interpreted as “joint effusion.” CT - Very little or non enhancing synovial mass MRI - Villous proliferation.
- 73. References 1.Yochum and Rowe’s ESSENTIALS OF SKELETAL RADIOLOGY 2.Adam Greenspan’s differential Diagnosis in Orthopaedic Oncology
- 74. Quiz
- 80. Multiple healing nonossifying fibromas
- 84. Chondroblastoma
Editor's Notes
- Location Within Anatomic Regions : a) Epiphysis : 1-Chondroblastoma 2-Infection 3-Geode 4-GCT b) Metaphyseal : -Lesions of different causes : neoplastic , inflammatory and metabolicc) Epiphyseal / Metaphyseal : -GCT d) Diaphysis : -After the 4th decade of life , most solitary diaphyseal bone lesions involve the bone marrow
- stippled calcification
- The superior and inferioredges may be overhanging.
- Multiple osteocartilaginous exostoses: magnetic resonance imaging (MRI). Coronal (A) and axial (B) T1- weighted (SE, TR 600, TE 20) MR images show several sessile osteochondromas affecting the proximal femora. Observe abnormal tubulation of the bones. C: In another patient with multiple cartilaginous exostoses MRI was performed because one of the osteochondromas continued to enlarge. Sagittal T1-weighted (SE, TR 400, TE 12) image demonstrates intact cortex covering the lesion. D: Axial fast-spin echo (FSE, TR 4000, TE 102 Ef) MRI shows high-intensity thin cartilaginous cap of osteochondroma without malignant changes. E: Lack of malignant transformation was confirmed on axial inversion recovery (FMPIR/90; TR 4000, TE 51 Ef, TI 140) MRI, which shows no soft tissue extension of the lesion (arrows).
- Chondroblastoma: magnetic resonance imaging (MRI). A: Conventional radiograph shows a lesion (arrowheads) with a narrow zone of transition in the left humeral head of an 18-yearold man. Note benign-appearing layer of periosteal reaction along the lateral cortex (arrow). B: Coronal T1-weighted (SE, TR 600, TE 20) MRI shows significant amount of perilesional edema. C: Axial T2-weighted (SE, TR 2000, TE 80) MRI shows the lesion exhibiting a heterogeneous signal.
- CHONDROMYXOID FIBROMA. Proximal Tibia. Note the eccentric, metaphyseal, geographic lesion in the proximal third of the tibia. Endosteal scalloping (arrows), along with bone expansion, is noted (arrowhead). COMMENT: The most common location for chondromyxoid fibroma is the proximal third of the tibia, as seen in this case. About 50% of chondromyxoid fibromas occur in the tibia, with other common sites being the femur, humerus, fibula, ribs, and small bones of the hands and feet.
- possibilities include nonossifying fibroma and fibrous dysplasia. Nonossifying fibroma, unlike chondromyxoid fibroma, rarely displays cortical ballooning or cortical destruction, and a periosteal reaction is present only in lesions that have sustained a pathologic fracture. Fibrous dysplasia, in contrast to chondromyxoid fibroma, is centrally located rather than eccentric, rarely shows internal septations, and does not elicit a periosteal reaction
- Chondromyxoid fibroma: magnetic resonance imaging (MRI). A: Sagittal T1-weighted (SE, TR 600, TE 19) MRI in a 10-year-old girl shows a well-demarcated lesion in the plantar aspect of the calcaneus, displaying low signal intensity. B: Two axial T1-weighted (SE, TR 600, TE 17) images show significant amount of peritumoral edema. C: Sagittal T2-weighted (SE, TR 2000, TE 80) MRI shows the lesion displaying high signal intensity. A sclerotic border is imaged as a rim of low signal intensity.
- SYNOVIOCHONDROMETAPLASIA: HIP. A. AP Hip. Note the multiple punctate opacities throughout the hip joint (arrows). No extrinsic bone erosions are present. B. Bone Window Axial CT: Hip. Observe the calcified loose bodies around the hip (arrows). Also carefully observe, by comparing with the contralateral normal side, the increased fat separating muscle planes (arrowhead) and the diminished muscle mass of the gluteus maximus (G) owing to disuse atrophy from long-standing hip dysfunction.
- Nonossifying fibroma (NOF): magnetic resonance imaging (MRI). A: Anteroposterior radiograph shows a radiolucent lesion with sclerotic border abutting the posteromedial cortex of the right femur. B: Sagittal T1-weighted MRI shows predominantly low signal intensity of the lesion. C: Sagittal T2-weighted image shows heterogeneous but mostly high signal intensity of NOF. D: Sagittal T1-weighted fat-suppressed MRI after intravenous injection of gadolinium shows slight heterogeneous enhancement of the lesion.
- Healed nonossifying fibroma. A lesion that healed spontaneously may persist as a sclerotic patch. In this sclerosing phase, nonossifying fibroma should not be mistaken for osteoblastic tumor or bone island. Nonossifying fibroma resembling an aneurysmal bone cyst. A large lesion in the fibula exhibits an expansive character and thus resembles an aneurysmal bone cyst. Note, however, the absence of a periosteal reaction that is invariably present in the latter lesion.
- FIBROUS CORTICAL DEFECT: DISTAL FEMUR. A. AP Knee. B. Lateral Knee. Note the eccentric, radiolucent lesion within the distal medial metaphysis of the femur. Observe the sclerotic margin and sharp zone of transition around this lesion, suggesting a benign response. This fibrous cortical defect was asymptomatic and found coincidentally on radiographic examination to rule out a fracture.
- Benign fibrous histiocytoma. A: A 37-year-old man presented with occasional pain in the right knee. An oblique radiograph of the knee shows a lobulated radiolucent lesion with a well-defined sclerotic border, located eccentrically in the proximal tibia. B: A 16-year-old boy presented with a painful tibial lesion that on radiography looked like a nonossifying fibroma. Because of persistent symptoms the lesion was biopsied and proved to be consistent with a benign fibrous histiocytoma. From the radiologic standpoint, the main differential possibilities include NOF and giant cell tumor, particularly when benign fibrous histiocytoma is situated at the articular end of bone. The radiographic features of NOF may be indistinguishable from those of benign fibrous histiocytoma, although the more aggressive appearance of the latter (such as an expanding border) and the location, which is atypical for NOF, are the clues to the diagnosis. Giant cell tumor only rarely exhibits a rim of reactive sclerosis, whereas this is a common feature of benign fibrous histiocytoma
- Anteroposterior radiograph of the distal leg of a 17-year-old girl shows a monostotic focus of fibrous dysplasia in the diaphysis of the tibia. Observe the slight expansion and thinning of the cortex and the partial loss of trabecular pattern in the cancellous bone, which gives the lesion a “ground-glass” or “smoky” appearance. B: Anteroposterior radiograph of the right hip in a 25-year-old man shows the focus of fibrous dysplasia in the femoral neck that exhibits a more sclerotic appearance than that seen in A.
- FIBROUS DYSPLASIA: POSITIVE BONE SCAN. Note that this adult with polyostotic fibrous dysplasia shows intense uptake in multiple lesions throughout the entire skeleton. Active lesions in polyostotic fibrous dysplasia will show intense uptake on nuclear medicine scans. FIBROUS DYSPLASIA. A. PA Skull. Observe the sclerotic and lytic lesions of fibrous dysplasia affecting half of the skull table and facial bones. These changes have distorted the orbit, creating a dense appearance to its floor (arrows). B. Lateral Skull. Observe the well-delineated lesions of fibrous dysplasia throughout the frontal and parietal bones. Extensive facial bone involvement has produced bony expansion, with a well-defined cortical margin (arrows). C. Coronal CT Scan. Note the dense ground glass appearance to the matrix of the lesion extending along the petrous ridge of the temporal bone (arrow) into the ethmoid sinuses.
- Polyostotic fibrous dysplasia: magnetic resonance imaging (MRI). A: Anteroposterior radiograph of the proximal right leg of a 23-year-old woman shows a long lesion in the proximal tibia exhibiting a “ground-glass” appearance. The bone is mildly expanded and the cortex is thin. B: Coronal T1-weighted MRI shows the lesion to be multifocal with isointense signal similar to that of the skeletal muscles. C: Coronal T2-weighted MRI shows heterogeneous signal of the lesion ranging from intermediate to high intensity. D: Coronal T1-weighted fat-suppressed MRI after intravenous injection of gadolinium demonstrates slight enhancement of the lesion
- Figure 11-199 HEMANGIOMA: SUNBURST OR SPOKEDWHEEL APPEARANCE. A. PA Skull. B. Lateral Skull. Note the circular radiolucent defect present primarily within the temporal bone, with minimal extension into the frontal bone. There is an intense, radiating spiculation of bone from the central portion of the lytic defect, creating the sunburst or spoked-wheel appearance of an intraosseous hemangioma. C. Tangential Skull. Observe the fine spicula radiating from the centrum of the lytic hemangioma. D. CT Skull. Observe the large, radiating hemangioma present within the table of the skull. COMMENT: Hemangiomas affecting the calvaria often present with dense, fine spicula radiating from the centrum, creating a sunburst or spoked-wheel appearance. The intense nature of the radiating spicules of bone can mimic osteosarcoma, particularly in tangential or profile views.
- RADIOLUCENT slightly sclerotic border in the calcaneus Sagittal T1-weighted (SE, TR 850, TE 15) MRI demonstrates homogeneous intermediate signal intensity within the lesion, rimmed by low-signal-intensity sclerotic margin. C: Sagittal STIR MR image shows that the lesion now is of homogeneous high signal intensity.
- expansive radiolucent lesion in the metaphysis of the distal tibia, extending into the diaphysis. Note its eccentric location in the bone and the buttress of periosteal reaction at the proximal aspect of the lesion
- MRI scan of the lumbar spine sagittal T1 (a) and T2 (b) Weighted images and axial sections; (c and d) of T2 weighted images showing characteristic findings of aneurysmal bone cyst with multiple fluid-fluid levels
- COCKADE SIGN
- Lateral radiograph of the knee of a 22-year-old woman with several episodes of knee pain and swelling shows fullness in the suprapatellar bursa that was interpreted as joint effusion. Note also the increased density in the region of the popliteal fossa and subtle erosion of the posterior aspect of the distal femur. B: Sagittal T1-weighted (SE, TR 800, TE 20) MRI shows a lobulated mass in the suprapatellar bursa, extending into the knee joint and invading the infrapatellar fat. Note also the lobulated mass in the posterior aspect of the joint capsule, extending toward the posterior tibia. These masses exhibit an intermediate to low signal intensity. The erosion at the posterior aspect of the distal femur (supracondylar) is clearly demonstrated by an area of low signal intensity (arrow). C: Coronal T2-weighted (SE, TR 1800, TE 80) MRI demonstrates areas of high signal intensity that represent fluid and congested synovium, interspersed with areas of low signal intensity, characteristic of hemosiderin deposits.
- Femur: Osteochondromas in the pelvis. Sessile osteochondromas of the proximal right femoral neck
- with both Sessile and pedunculated osteochondroma of the distal femur. Tibia and fibula: Pedunculated osteochondroma of the proximal fibula with more sessile osteochondroma of the proximal tibial diaphysis. Solitary osteochondroma Multiple enchondromatosis Chondromsarcoma
- Eccentric lucent lesions with sclerotic rims are located in the metaphyses of the femur and tibia. There is no pathologic fracture. Nonossifying fibromas Fibrous cortical defects Aneurysmal bone cyst
- Multiple heterogeneously enhancing (predominantly peripheral but with some band-like central enhancement), cortically based bilateral T1- and T2-hypointense lesions are seen in the distal femur and proximal tibial metaphyses, occupying 75% to 90% of the distal femoral metaphysis without pathologic fracture. These are healing nonossifying fibromas given the low signal intensity. ortically based lesions in the metaphyses of long bones that initially are T2-hyperintense with a hypointense rim, but as they heal, they become hypointense on all sequences. neurofibromatosis 1, fibrous dysplasia, and Jaffe-Campanacci syndrome.
- Radiograph shows a well-circumscribed lucent lesion in the medial femoral condyle with a narrow zone of transition, measuring up to 3.2 cm and confined to the epiphysis without periosteal reaction. Chondroblastoma Chondrosarcoma (clear cell) Intraosseous ganglion Osteomyelitis (Brodie's abscess)
- a contrast-enhanced MRI scan of the knee was performed. Click images to enlarge. In order: coronal T1-weighted, coronal short tau inversion-recovery (STIR), and sagittal fat-suppressed T2-weighted images A T1-isointense, T2-mixed, is centered in the lateral aspect of the medial femoral condyle. It has a hypointense border, in keeping with surrounding sclerosis, with surrounding edema, extending into the soft tissues, including Hoffa's fat pad.
- Top row: axial T1-weighted and STIR images. Bottom row: axial fat-suppressed T1-weighted precontrast and fat-suppressed T1-weighted postcontrast images. Right image: coronal fat-suppressed T1-weighted postcontrast image. heterogeneously enhancing geographic epiphyseal lesion