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Distal femur
Bone
- Longitudinal: diaphysis/metaphysis/epiphysis
- Eccentricity: central
- Transverse: medullary
Location
Monostotic
Mono/polyostotic
>1 cm
Size
- Mixed
- Long zone of transition
Behavior
Cortical destruction
Cortex
Osseous
Matrix
Spiculated
Periosteal reaction
- Soft tissue swelling
- Soft tissue extension
- Soft tissue calcification
Soft tissue involvement
None
Joint involvement
Aggressive
Aggressive or non-aggressive?
- Osteosarcoma*
- Ewing's Sarcoma
What are 2 differential diagnoses?
Refer to pediatric oncologist
Next step?
- Left leg is very swelled up
• Spiculated periosteal reaction
• Soft tissue extension
• Destruction
Can you locate the findings that you described previously?
To look for cannonball metastasis
Why did they do a chest CT?
- Location: metaphyseal of distal femur
- Matrix: flocculent cartilaginous
- Non-aggressive
- Dx: Enchondroma
- What is the exact location?
- What type of matrix is demonstrated?
- At this point, is this aggressive or non-aggressive?
- Diagnosis at this point?
Refer to orthopedist (non-aggressive)
Next step at this point?
- Cortical thinning
- Tumor more sclerotic - grew in size
- More lucency around tumor
- Aggressive
These x-rays were taken 3.5 years later:
- List at least 3 new findings
- At this point, is this aggressive or non-aggressive?
Chondrosarcoma
Diagnosis?
- Refer to oncologist
- Would not adjust patient's knee
- Next step?
- Would you adjust this patient's knee?
Humerus
Bone
- Longitudinal: metaphysis
- Eccentricity: eccentric
- Transverse: medullary
Location
Monostotic
Mono/polyostotic
>1 cm
Size
- Lytic
- Permeative/motheaten
- Long zone of transition
Behavior
- Cortical thinning
- Cortical destruction
Cortex
Nothing visible
Matrix
Laminated
Periosteal reaction
Soft tissue swelling
Soft tissue involvement
None
Joint involvement
Aggressive
Aggressive or non-aggressive?
- Osteosarcoma
- Ewing's Sarcoma*
What is your differential diagnosis?
Soft tissue swelling
Is there soft tissue extension/involvement?
To check for metastasis to another bone
Why do you think they did a bone scan?
- Left proximal femur
- Left ilium
Bone
- Longitudinal: metaphysis
- Eccentricity: central, some eccentric lesions
- Transverse: medullary
Location
Polyostotic
Mono/polyostotic
Non-uniform
Uniform or non-uniform?
>1 cm
Size
- Lytic
- Permeative/motheaten
- Long zone of transition
Behavior
Cortical thinning
Cortex
Nothing visible
Matrix
None
Periosteal reaction
None
Soft tissue involvement
None
Joint involvement
Aggressive
Aggressive or non-aggressive?
Non-Hodgkin's Lymphoma
What is your differential diagnosis?
- Both femurs
- Both ilia
- Everywhere
What bone(s) is/are involved?
Refer to oncologist
Next step?
- Sacral destruction (arcuate line, foramina)
- S3-S5 involved
Findings?
Chordoma
Most likely diagnosis?
Distal sacrum (sacrococcygeal)
What is the exact lesion of the lesion?
- Spheno-occipital
- Vertebral
Where else do these occur?
Right distal femur
Bone
- Longitudinal: metaphysis
- Eccentricity: central
- Transverse: medullary
Location
Monostotic
Mono/polyostotic
>1 cm
Size
- Blastic
- Long zone of transition
Behavior
- Cortical thinning
- Cortical destruction
Cortex
Osseous
Matrix
Spiculated
Periosteal reaction
- Soft tissue swelling
- Soft tissue extension
- Soft tissue calcification
Soft tissue involvement
Patellofemoral joint
Joint involvement
- Osteosarcoma*
- Ewing's Sarcoma
What is your differential diagnosis?
Pediatric oncology referral
Next step?
Calcification
What do you see?
Arc and ring cartilaginous
Matrix
Chondrosarcoma
Most likely diagnosis?
Humerus
Bone
- Longitudinal: diaphysis
- Eccentricity: central
- Transverse: medullary
Location
Monostotic
Mono/polyostotic
>1 cm
Size
- Blastic
- Long zone of transition
Behavior
Cortical thinning
Cortex
Osseous
Matrix
- Laminated
- Spiculated
Periosteal reaction
- Soft tissue swelling
- Soft tissue extension
Soft tissue involvement
None
Joint involvement
- Osteosarcoma
- Ewing's Sarcoma*
What is your differential diagnosis?
Refer to pediatric oncologist
Next step?