Diagnostic Imaging 2- Exam 3- Benign Tumors- part 2

A benign tumor arising in membranous bone that is commonly found in adulthood

Osteoma

Osteoma is associated with what disease

Gardner`s syndrome (multiple osteoma colonic polyposis and soft tissue fibroma)

Most common location for osteoma

Para nasal sinuses (front and ethmoid) (MAINLY THIS)

Also inner/outer table of calvarium (skull)

Osteoma in the frontal sinus

Another osteoma in frontal sinus

A benign cartilaginous growth in the medullary cavity of bones preformed in cartilage

It arises as residual islands of cartilage left behind

Enchondroma

Age of occurrence for Enchondroma

10-30 years

What is the most common benign tumor of the hand

Enchondroma

Enchondroma radiographic features

Round/oval lucency with fine marginal line

Endosteal scalloping

Stippled or punctate calcifications

Slightly Expansile Enchondroma in the finger

Enchondroma with punctate calcifications

Enchondroma with pathological fracture

Age of occurrence for Enchondroma

10-30 years

What is the rule with an Enchondroma and the closer it forms to the axial skeleton

Greater chance for malignant degeneration

-echondroma becomes a malignant Chondrosarcoma

Treatment and prognosis for Enchondroma

Usually no treatment

-if symptomatic in long bones they they require surgical curettage and bone chips

What is multiple echondromas

Enchondromatosis (aka Ollier`s Disease)

Enchondromatosis (ollier`s disease) occurs at what age

Early childhood

What is it called when the young patient has Enchondromatosis with multiple soft tissue hemangiomas

Maffuccii syndrome

Another name for Enchondromatosis

Ollier`s disease

Example of Enchondromatosis

Calcified venous thrombi in the pelvis are called

Phelobliths

Another example of Enchondromatosis

Are phleboliths bad to have in the pelvis

No as long as they are blow the ischial spine and parallel to the pelvic brim

Multiple Enchondromas and multiple soft tissue hemangiomas (phleboliths) is called

Maffucci`s syndrome

Solitary vascular neoplasm which is slow growing and composed of newly formed capillary, CAVERNOUS or venous blood vessel

Hemangioma

Hemangioma age

4-5th decades

What is the most common benign tumor of the spine

Hemangioma

Most hemangiomas are

Asymptomatic

What causes symptoms of hemangioma

Expansion causing spinal stenosis and cord compression... need MRI if symptomatic

Locations of hemangioma

Vertebral body and lower Thoracics/upper lumbars

Calvarium with predilection for frontal bone

What do you see on X ray with with an hemangioma in the spine

Exaggerated vertical trabeculations

Example of hamangioma

What do you see on CT form a vertical view of a hemangioma in the spine

Polka-dot appearance

Another example of hemangioma of the spine

Radiographic skull features of hemangioma

Small round lytic lesion'

Sunburst or spoked wheel when viewed straight on

Occur in diploids space producing a palpable lump secondary to widening of the space

Hemangioma in the skull

Hemangioma of the frontal bone

Hemangioma on CT on a T1 weighted MRI

Treatment for hemangioma

No treatment

If symptomatic may undergo decompression surgery and need MRI

Symptomatic with skull then en bloc excision

What is a rare benign bone tumor that occurs between the ages of 5-25 and before the cessation of enchondral bone growth

Chondroblastoma

Clinical features and symptoms of Chondroblastoma

Often symptomatic for months to years

Mild joint pain, tenderness, joint swelling, and limitation of motion

Location of Chondroblastoma on the bone

Apophysis or epiphysis in a sub articular location

Difference between apophysis and epiphysis

Apophysis= growth center for bump on bone

Epiphysis= growth center for length of bone`

Most Chondroblastoma are on what bones

Proximal femur and distal femur

Radiographic features of Chondroblastoma

Round or oval eccentric lytic lesion of epiphysis or apophysis

Well defined sclerotic margin]

Lobulated

Treatment and prognosis of Chondroblastoma

Surgical curettage and packing with bone chips

Resection in expendable area

12 year old boy with Chondroblastoma

Example of Chondroblastoma in 17 yr old male

One more example of Chondroblastoma and explain why it isn't a giant cell tumor

Patient is too young and the giant cell likes metaphasis and epiphysis

Chondroblastoma in the proximal humerus

16 yr old with a Chondroblastoma in the proximal tibia, explain why its not a giant cell tumor

Giant cell tumors like age 20-40 so this patient is too young

Fibrous cortical defect (FCD) is most common in what ages

2-8 yrs with peak around 7-8 yrs

What is the term that encompasses FCD and NOF

Fibrous xanthoma

What is the only difference between an fibrous cortical defect and a NOF

Age

FCD is 2-8 and less than 2 cm

NOF is 8-20 and greater than 2 cm

Location of fibrous cortical defect

Posterior media surface of distal femur, tibia, fibula and proximal femur

Metaphyseal cortex of long bones of lower extremity

Round. Lyitc lesion that is less than 2 cm, well defined sclerotic margin

Eccentric and metaphyseal

Oval and extending parallel to the long axis which could produce cortical thinning

Lytic or bubbly with sclerotic border

Fibrous cortical defects

Treatment for fibrous cortical defect

No treatment needed, spontaneously regressed over a 2-5 year period

Fibrous cortical defect

Also could be a non ossifying fibroma

Fibrous cortical defect or non ossifying fibroma in distal femur

Should a non ossifying fibroma have pain

NO

Non ossifying fibroma and why is it not a fibrous cortical defect

It's too big to be a FCD

Fibrous cortical defect or a fibrous xanthoma

Fibrous cortical defect in the distal tibia

Age of occurrence for a nonossifying fibroma

8-20 with most occurring in 2nd demand

Do nonossifying fibroma (NOF) have symptoms

No they're asymptomatic

Favorite location of nonossifying fibroma

DISTAL TIBIA

Or distal femur, proximal tibia, fibula

Location of nonossifying fibroma on the bone

Eccentric and metadiaphyseal

Eccentric multi ocular ovoid lesion along the long axis of a bone which is about 2 cm with a dense sclerotic border

Endosteal scalloping with thinning and bulging of cortex and migrates towards the diaphysis

Nonossifying fibroma

Treatment and prognosis for nonossifying fibroma

No treatment, they should spontaneously regress with age

Large ones greater than 8 cm may require surgery

Nonossifying fibroma and why is it not an FCD

It's too big to be a fibrous cortical defect

Nonossifying fibroma in the distal tibia compared to an fibrous cortical defect in the distal tibia

One more non ossifying fibroma

What is a tumor like process that occurs in people typically older than 40 and effects extra in the northern latitude

Paget's disease

What is characterized by bone lysis followed by extensive repair attempts

Paget's disease

What are known as the great imitators of bone disease

Pagets and fibrous dysplasia

Age for Paget's disease

Most are older than 55

Etiology of Paget's

Mostly unknown but thought to have som genetic component as well

What is it when the bone undergoes increased resorption followed by increased bone formation, this new brown is disorganized and leads to bone softening

Paget's disease

What type of bone pathology is Paget's

Bone softening

Most Paget's disease cases are

Asymptomatic

What is given to treat Paget's disease

Bisphophonates or calcitonin

If there is sympomts with Paget's what is the most common symptom

Bone pain

What can occur if Paget's occurs around a joint

Secondary osteoarthritis

What type of bone deformity can occur with Paget's

Bowing of an extremity

What is something that you can feel with Paget's

Excessive warmth from hypervascularity

When it comes to Paget's disease ossous locations it is usually _________ and _______

Polyostotic (multiple locations) and asymmetric

What should you do if you see Paget's in one location

Bone scan to see if it has gone somewhere else

Common lcoations for Paget's

Pelvis

Lumbar spine

Thoracic spine

Proximal femur

Lab findings with Paget's

Increased hydroxyproline and alkaline phosphatase

Different stages of Paget's disease

1. Osteolytic/destructive

2. Mixed/combined

3. Sclerotic/ivory

4. Malignant degeneration (very rare)

Radiological feature of Paget's

Coarsened irregular trabecular pattern

Thickens cortex

Bone expansion

Osseous deformity

What is it when Paget's is in the skull

Osteoporosis circumscripta

-described as map like (geographic lysis) of the frontal and occipital regions

What does Paget's disease in the skull (osteoporosis curcumscripta) look like

Cotton wool appearance (fuzzy poorly defined)- blastic phase

What can happen when there is Paget's disease in the skull

Basilar invagination with foraminal encroachment

What two lines are used to help determine basilar invagination

McGreggors line and Chamberlins

Osteoporosis circumscripta

Another example of osteoporosis circumscripta

Enlarged cotton wool fluffy like densities in the skull from Paget's disease

Example of chamberlins line and McGregor`s line

Example of blastic phase of Paget's in the skull

Cotton wool appearance