Exam 3: General Tumor Info

Differential diagnosis by predictive factors:

-age

-incidence

-skeletal location

-interosseous location

-tumor appearance

-clinical presentation

Tumor Incidence:

1. metastatic disease = 75% of all malignancies

2. multiple myeloma = MC primary malignant bone tumor in ADULTS

3. osteosarcoma = MC primary malignant bone tumor in KIDS

4. osteochondroma = MC benign osseous tumor

5. hemangioma = MC benign spinal tumor

Where are some of the common locations of bone neoplasia in the body?

-hemopoietic tissue

-notochordal remnants

-areas of rapid bone growth

-abundance of interosseous nerves

Long zone of transition is more _____ and a short zone is more _____

malignant ; benign

What are the positions of a lesion in a longitudinal plane?

diaphyseal, metaphyseal, epiphyseal

What are the positions of a lesion in a horizontal plane?

-central/medullary

-eccentric

-cortical

-parosteal

-soft tissues

What are the types of "holes in a bone" present in bone destructive lesions?

-geographic

-moth eaten

-permeative

Geographic Bone Destruction

-big hole/solitary lesion >1cm

-LEAST aggressive pattern and typically BENIGN

-indicative of a slow growing lesion

-SHORT zone of transition

-margin is well-defined and can be smooth or lobulated

Moth-Eaten Bone Destruction

-numerous small/medium holes/lesions 2-5mm in size

-moderate degree of aggressiveness/zone of transition

-longer zone of transition than geographic

-margins are not well defined

Permeative Bone Destruction

-numerous small holes (1mm in size)

-MOST aggressive growing lesion

-LONGEST zone of transition

-poorly demarcated or imperceptible borders

Types of cortical changes:

-buttressing/cortical thickening

-endosteal scalloping

-splitting or tunneling

-thinning with or without expansion

-penetration with or without periosteal reaction

Patterns of Periosteal Reactions

-buttressing/solid

-single layer

-multiple layers/laminated/onion skinned

-spiculated

-codman's triangle

Buttressing/Solid Periosteal Reaction

-additional layers of new bone are added to the exterior creating a expanded osseous contour

-usually associated with slow growing (benign) lesions

-can also be present in stress fractures

Laminated/Onion Skinned Periosteal Reaction

-multiple layers of new bone

-alternating layers of lucency and opacity with alternating growth

-can be thin or thick

-can be seen in slow or aggressive lesions

Laminated/onion skinned periosteal reactions are classically associated with:

ewing's sarcoma

Spiculated Periosteal Reaction

-linear radiating spicules of new bone

-when perpendicular to the bone it is known a "hair on end"

-when radiating from a central focus it is known as "sunburst"

Spiculated periosteal reactions are often associated with highly aggressive lesions such as _____

osteosarcomas

Codman's Triangle

-triangular elevation of periosteum seen at the peripheral lesion-cortex junction

-lifts periosteum at an angle

-MOST aggressive form of periosteal reactions

-can be seen in infection, benign/malignant tumors or other disorders

Types of Tumor Matrix:

-cartilaginous

-osseous

-fibrous

-vascular

-muscular

-others

Cartilaginous matrix appearances:

-ring or arc like

-flocculent

-small crystals

-popcorn like

-stippled

Benign Cartilage Tumors

-enchondroma

-osteochondroma

-chondroblastoma

-chondromyxoid

Malignant Cartilage Tumors

chondrosarcoma

Osseous Tumor Matrix

-bone producing tumors

-variable size radiodense areas

-may occupy parts of or entire lesion

-can be homogenous or inhomogenous

-increased density changes/sclerosis

Benign Osseous Tumors

-osteoma

-osteoblastoma

-osteochondroma

-osteoid osteoma

Malignant Osseous Tumors

osteosarcoma

Benign Fibrous Tumors

-fibrous dysplasia

-desmoplastic fibroma

-non ossifying fibroma

-fibrous cortical defect

-ossifying fibroma

Malignant Fibrous Tumors

fibrosarcoma