Benign Tumors

What is the 3d most common site of spread of cancers

Skeleton

Majority of bone metastases are from what cancers

Breast lung and prostate

Neoplasm that originates from non bone forming supportive connective tissue of marrow

Giant cell tumor

Does a giant cell tumor have pain

YES

Age for giant cell tumor

20-40

Another name for giant cell tumor

Osteoclastoma

Location for giant cell tumor

Mostly long bones

Sacrum newar SIJ

Giant cell tumors that are distal to the radius mean

Higher chance of being malignant

Most common benign tumor of the sacrum

Giant cell tumor

Clinical presentation of giant cell tumor

Localized pain

Restricted ROM

Radiographic features of giant cell tumor

Geographic

Eccentric

Metaphyseal-epiphyseal

Subarticular (doesn't enter joint space)

Cortical thinning

Soap bubbly

Giant cell tumor

Another giant cell tumor

Giant cell tumor in the distal ulna

Giant cell tumor in the distal radius

Giant cell tumor in the sacrum

Treatment of giant cell tumors

Surgical cureetage- recurrence of 12-50%

Radiation of spinal lesions

5 yr survival for malignant about 10%

Large geographic tumor, eccentric location, distal part of the radius but the X ray has open growth plates... is it a giant cell tumor

NO- because it is a kid and doesn't go to the end of the bone

Pedunculated Osteochondroma

Bony exostosis on the external surface of a bone and usually lined by hyaline cartilage cap

Solitary Osteochondroma

What is the most common benign osseous tumor

Solitary Osteochondroma

Age of solitary osteochondroma

Below age 20 (before growth plates close)

Clinical features of solitary Osteochondroma

Asymptomatic

Painless hard mass around a joint

Pain from fractured stalks or cord compression

Obstructive uropathy from pelvic tumor

If there is pain with a solitary Osteochondroma then what does this mean

Pain and new growth may indicate malignant transformation

-it should stop growing once the growth plates close

-usually turns into a Chondrosarcoma or osteosarcoma

What are the 2 types of solitary osteochondroma

Sessile

Pedunculated

What type of solitary Osteochondroma has a broad base and no stalk, common in the humerus and scapula

Sessile

What type of solitary Osteochondroma has a long stalk with cartilage cap, common in knee, hip and ankle

Pedunculated

Ways to describe a Pedunculated solitary Osteochondroma

Coat hanger exostosis

Cauliflower cap

Osseous location of solitary Osteochondroma

Any bone formed by enchondral ossification

Relationship of solitary Osteochondroma and growth plates

When growth plate stops growing some does the growth of the solitary osteochondroma

Radiographic features of solitary Osteochondroma

Bony exostosis

Pedunculated and sessile

Pedunculated base with elongated bony stalk

Tip may have dense cortical rime

Sessile may cause metaphyseal widening

If there is a single solitary Osteochondroma on a single bone than it is

Solitary Osteochondroma

If there are 2 or 3 bones with a solitary Osteochondroma then and no family history then

It's just multiple Osteochondromas

Widespread solitary osteochondromas with a family history then what is it called

Hereditary multiple exostosis (HME)

Pedunculated solitary osteochondroma

Sessile osteochondroma

Inherited automal dominant condion characterized by multiple Osteochondroma often causing metaphyseal overgrowth

Hereditary multiple exostosis (HM)

Age of occurrence for hereditary multiple exostosis

2-10 yrs

Difference between Pedunculated Osteochondroma and a supracondylar process slide

If it points away then Pedunculated Osteochondroma, if ti points towards the joint space then is a supracondylar process

What is it when there are multiple osteochondroma`s around multiple joints

Hereditary multiple exostosis

Does hereditary multiple exostosis hurt

No, its multiple painless hard masses

Radiographic features of hereditary multiple exostosis

Shortening of 4th and 5th metacarpals

Supernumerary fingers and toes

Madelung or bayonet deformity of forearm

Disproportionate shortening of extremity

Non-neoplastic fluid filled cystic cavity lined with fibrous tissue

Simple/solitary/unicarmeral bone cyst

-not really a tumor

Age for simple/solitary bone cyst

3-14 yrs

Hereditary multiple exostosis

Example of madelungs deformity and hereditary multiple exostosis

Clinical symptoms of solitary bone cyst

Asymptomatic unless fractured

Where do most solitary bone cysts occur

Proximal humerus (MAINLY THIS)

Femur, fibula, calcaneal neck, talus

Where on the bone does a solitary bone cysts occur

Metaphyseal adjacent to growth palte

Central, long axis parallel to host bone

What does solitary bone cysts look like

Loculatd with Endosteal scalloping

Truncated cone appearance (wider at metaphysics and narrower near diaphysis)

Fallen fragment sign if fractured

Most effective treatment for solitary bone cyst

Injection of steroids

Non-neoplastic Expansile lesion containing thin-walled blood-filled cystic cavities

Aneurysmal bone cyst

What do you look for to see if a solitary bone cysts fractured

Fallen fragment sign

Solitary bone cyst up the proximal humerus

Solitary/simple bone cyst

Solitary bone cyst in the calcaneus

Age for aneurysmal bone cyst and mainly occurs in who

10-30 yrs in females

Most aneurysmal bone cysts are primary or secondary? If they're secondary what are they from

Mainly primary

Secondary dare from another lesion (Giant cell tumor, osteosarcoma, simple bone cyst)

Clinical features of aneurysmal bone cyst

ACUTE ONSET OF PAIN WIT RAPID INCREASE IN SEVERITY

Often people with an aneurysmal bone cyst also have

History of trauma

Most aneurysmal bone cyst occur when

Spine, especially the posterior elements of the spine

Radiographic features of aneurysmal bone cyst

Purely lytic and eccentric, metaphysis

Soap bubble appearance

Aneurysmal bone cyst is hard to see on what imaging

CT

-cause how thin the cortex is

What do you see on CT with an aneurysmal bone cyst

FLUID FLUID LEVELS

-due to blood layering

What do you see on bone scan with aneurysmal bone cyst

Increased uptake

What do you see on MRI with aneurysmal bone cyst

Multiple different signal intensities representing different stages of blood by-products

-also can see fluid fluid levels

What part of the spine does an aneurysmal bone cyst like

Neural arch part in the spine

Treatment for aneurysmal bone cyst

Surgical curettage

Radiation therapy especially for when its in the spine

Aneurysmal bone cyst and why would it not be a giant cell tumor

Giant cell tumors are age 20-40 and the patient here is a 13 yr old kid, ant the tumor is not subarticular

Fluid fluid levels on an MRI from an aneurysmal bone cyst

Aneurysmal bone cyst

Difference between aneurysmal bone cyst and giant cell tumor in the distal radius slide

A rare benign tumor with unlimited growth potential

Osteoblastoma

Aneurysmal bone cyst causing a missing pedicle

Another aneurysmal bone cyst in the spine

Age for osteoblastoma

10-20 years

What resembles an Osteoid osteoma but is large

Osteoblastoma

Symptoms of osteoblastoma

Dull pain of insidious onset, worse at night and NOT RELIEVED BY ASPRIN

Swelling and tenderness

Locations of osteoblastoma

Spine (especially the posterior elements)

Long bones

Radiographic features of an osteoblastoma

Spinal lesions radiolucent and Expansile

Long bones show progressive Expansile lesion that may rapidly increase in metaphyseal to diaphyseal direction

Treatment for osteoblastoma

Small legions are by excision or curettage

Spinal lesion respond well to radiation

Osteoblastoma in the spine

(Also read slide here)

Osteoblastoma of the spine in lumbars and on CT

Another sample of an osteoblastoma in the cervical spine

Giant osteoid osteoma

Benign skeletal neoplasm composed of osteoid and woven bone that is less than 1.5 cm in diameter

Osteoid osteoma

Age for Osteoid osteoma

10-25 yrs of age

Clinical features of Osteoid osteoma

Local pain weeks to years in duration, decreased by activity

PAIN RELIEVERS HELP WITHIN 20-30 minutes

What occurs in the spine with an osteoid osteoma

Painful scoliosis (concave)

-effects the posterior elements of lower thoracic and upper lumbars

Other than the spine where else does Osteoid osteoma like

Metaphysis and into the diaphysis of long bones show progressive

Radiographic features of osteoid osteoma

Lesion is the radiolucent nidus (central part of radiolucent where the tumor lives) with REACTIVE SCLEROSIS

CORTICAL: NIDUS IN CORTEX

Example of that ovoid radiolucency (the nidus) with surrounding reactive sclerosis that comes along with osteoid osteoama

Osteoid osteoma in the femur

What may occur with an osteoid osteoma when they occur in Intracapsular areas

Limited amount of reactive sclerosis

Another Osteoid osteoma in the femur

One more osteoid osteoma in the femur

What do you see on a bone scan that indicates is it an osteoid osteoma

Double density sign

-super dense in the middle and lighter color on the outer parts of it

List the possible causes of increased density of pedicle/lamina area on a vertebrae

Missing pedicle

tumor (osteoblastoma- primary tumor or osteoid osteoma)

Blastic Mets

Facet arthrosis

Pars defect on opposite side

Osteoid osteoma effecting the pedicle in the spine

What the nidus looks like for an osteoid osteoma when looking vertically though it on a CT