COMMON MALIGNANT BONE

TUMORS
1.METASTASES

2.OSTEOID ORIGIN:OSTEOSARCOMA

3.CHONDROID ORIGIN:CHONDROSARCOMA

4.FIBROUS ORIGIN:.MALIGANT FIBROUS

HISTIOCYTOMA

5.MARROW TUMORS:1.EWINGS SARCOMA

2.PRIMARY BONE LYMPHOMA

6.NOTOCHORD ORIGIN:CHORDOMA
 METASTASES
MOST COMMON BONE TUMORS – SOLITARY
SECONDARIES

BONE METASTASES MOST COMMON WITH BREAST ,

BRONCHUS , PROSTATE , KIDNEY AND THYROID

INCIDENCE VERY HIGH – BREAST CANCER – 73% - 80%

MOST COMMON SITES : VERTEBRAE , PELVIS ,

PROXIMAL FEMORA , HUMERI , SKULL AND RIBS

RADIOLOGICAL FEATURES :

XRAYS – LYTIC AND MULTIPLE , OCCURS IN THE

MEDULLARY CAVITY OF THE BONE

POORLY DEFINES MEDULLARY DESTRUCTION

ONLY LESION OF APPROXIMATELY 20 MM CAN BE
VISUALIZED
IN OSTEOPOROSIS EVEN LARGER LESIONS CANNOT BE
VISUALIZED.
HYPERNEPHROMA – ALWAYS CAUSES LYTIC
METASTASES

PELVIC XRAY SHOWING EXPANSILE

LYTIC METASTASIS
XRAY SPINE SHOWING OSTEOBLASTIC METASTASIS

BREAST CARCINOMA – MIXED APPEARANCE

OSTEOBLASTIC CHANGE SEEN IN OSTEOSARCOMA
METS
PROSTATE – ALWAYS CAUSES
OSTEOBLASTICMETASTASES

IDENTIFICATION OF MULTIPLE METASTASES

1.TC – MDP BONE SCINTIGRAPHY
MOST COST EFFECTIVE METHOD THOUGH WHOLE
BODY MRI IS SENSITIVE BUT NOT COST EFECTIVE.

SCINTIGRAPHY FINDINGS:
“HOT SPOT”- MULTIPLE SITES OF INCREASED
SKELETAL ACTIVITY -IF BLOOD SUPPLY IS INTACT /
OSTEOBLASTIC

“COLD SPOT” - WHICH INFARCTS OR SHOWS NO

OSTEOBLASTIC RESPONSE - MOST COMMONLY SEEN
WITH RENAL METASTASES

OCCASIONALLY A COMBINATION OF BOTH HOT AND

COLD LESIONS OCCUR

“SUPER SCAN” - DIFFUSE OSTEOBLASTIC METASTATIC

DISEASE – GENERALIZED INCREASE IN SKELETAL
ACTIVITY WITH REDUCED OR ABSENT RENAL
ACTIVITY

MRI :
ANY AREA OF UNEXPLAINED NCREASED UPTAKE
SHOULD BE EXAMINED WITH MRI.

T1W – REDUCED SIGNAL INTENSITY

T2W /FSFSE– INCREASED SIGNAL INTENSITY – APPEARS

AS A HYPERINTENSE 'HALO' AROUND A LESION –
HIGHLY SPECIFIC FEATURE OF METASTASES.

SOURCE OF PRIMARY TUMOR CAN BE DETECTED BY

NON INVASIVE AND COST EFFECTIVE TECHNIQUES
LIKE USG AND X-RAY EXAMINATION.
FEATURES FOR DIFFERENTIATING BETWEEN
METASTASES AND NON-METASTATIC LESION:

POSITIVE FEATURE FOR IDENTIFYING METASTASES:

1.DIAPHYSEAL INVOLVEMENT
2.VERTEBRAL BODY INVOLVEMENT
3.PEDICLES INVOLVEMENT

FEATURES SUGGESTIVE OF NON METASTATIC LESION

1.ABSENCE OF BONE EXPANSION
2.ABSENCE OF FLORID PERIOSTEAL REACTION
3.ABSENCE OF TUMOR BONE FORMATION
4.ABSENCE OF LARGE SOFT TISSUE MASS

PRIMARY MALIGNANT TUMOR OF

OSTEOID ORIGIN
OSTEOSARCOMA
MOST COMMON PRIMARY MALIGNANT BONE
TUMOR
CLASSIFICATION :
PRIMARY AND SECONDARY

PRIMARY OSTEOSARCOMA:
1.CENTRAL – CONVENTIONAL HIGH GRADE AND
LOW GRADE
2.INTRACORTICAL OR SURFACE – PAROSTEAL ,
PERIOSTEAL OR HIGH GRADE
3.MULTICENTRIC – OSTEOSARCOMATOSIS
4.EXTRA SKELETAL OR SOFT TISSUE

SECONDARY OSTEOSARCOMA :
CAUSES –
1.PAGETS DISEASE
2.RADIOTHERAPY
3.DE- DIFFERENTIATED PART OF
CHONDROSARCOMA

ALSO ASSOCIATED WITH

1.LIFRAUMENI SYNDROME
2.FAMILIAL RETINOBLASTOMA
3.ROTHMUND -THOMPSON SYNDROME

RADIOLOGICAL FEATURES:

SURFACE OSTEOSARCOMA

SHOWING COTICAL DESTRUCTION AND

EXTRAOSSEUS MASS LOCATED IN
METAPHYSEAL REGION
CORTICAL DESTRUCTION IS COMMON
RESULTS IN EXTRA OSSEUS MASS WHICH
COMMONLY SHOWS TYPICAL OSSEUS “CLOUD
LIKE” MATRIX MINERALIZATION
METAPHYSEAL LESION WITH MOTH EATEN OR
PERMEATIVE PATTERN OF BONE DESTRUCTION

INTENSELY
SCLEROTIC INTRAMEDULLARY OSTEOSARCOMA
ALSO SHOWS CODMAN'S TRIANGLE AND
EXTRAOSSEUS MASS IN THE DISTAL FEMUR

MEDULLARY LESION IS PREDOMINANTLY LYTIC

MEDULLARY SCLEROSIS OCCURS DUE TO

MINERALIZATION OF TUMOR OSTEOID

INTRAMEDULLARY LESION SHOWS DENSE

SCLEROSIS
SUN-BURST APPEARANCE – PERIOSTEAL
REACTION USUALLY DISORGANIZED OR
PERPENDICULAR TO THE CORTEX

CODMAN'S TRIANGLE – PERIOSTEAL REACTION

LEADING TO SEPARATION AND LIFTING UP OF
PERIOSTIUM .

VARIATIONS:
ENTIRELY LYTIC
PSEUDO CYSTIC FORM
MRI – STAGING , SHOWS EXTENT OF TUMOR
CLEARLY

METASTASIS :
HEMATOGENOUS METASTASIS : LUNG ,
SUBPLEURAL , RARELY CAUSE PNEUMOTHORAX.
SCINTIGRAPHY: INCREASED UPTAKE
PLAIN FILM AND CT : CALCIFIED MASS

SKIP METASTASIS :RARE BUT ESSENTIAL TO

IMAGE ENTIRE BONE IF DETECTION IS TO BE
MADE.
CHONDROID MALIGNANT TUMOR
– CHONDROSARCOMA
CLASSIFICATION:
PRIMARY OR SECONDARY
CENTRAL OR PERIPHERAL

HISTOLOGICAL GRADING
HIGH , MYXOID , LOW ,DEDIFFERENTIATED-
DEVELOPMENT OF HIGH GRADE NON
CHONDROID NEOPLASM

AGE : 50 YRS
C/F : PAIN ,PALPABLE MASS , PATHOLOGICAL
FRACTURE

COMMON SITES: PELVIS , PROXIMAL FEMUR

AND PROXIMAL HUMERUS

RADIOLOGICAL FEATURES:

PLAIN RADIOGRAPH:
RADIOLOGICALLY OCCULT LARGE PELVIC
MASS

LOW GRADE TUMORS – MATRIX

MINERALIZATION AND ENDOSTEAL
SCALLOPING .PERIOSTEAL REACTION IS
PRESENT

CALCIFIED MASS -
CHONDROSARCOMA ARISING FROM THE ILIUM

CALCIFIC CHONDROSARCOMA ARISING FROM

THE LOWER FEMUR METAPHYSES SHOWING
CORTICAL DESTRUCTION , NO PERIOSTEAL
REACTION AND CALCIFIED TUMOUR MATRIX
MYXOID GRADE : BONE EXPANSION ALSO

JUXTACORTICAL MASS WITH 1.CALCIFICATION

(ARROWS) 2.ENDOSTEAL SCALLOPING 3.PERIOSTEAL REACTION 4.MOTHEATEN
APPEARANCE ALSO SEEN

HIGH GRADE : CORTICAL DESTRUCTION ,

PERIOSTEAL REACTION , BONE EXPANSION
DEDIFFERENTIATED – UNUSUALLY
AGGRESSIVE RADIOLOGICAL FEATURES

INSPITE OF CORTICAL SCALLOPING THE

PERIOSTEAL REACTION RESULTS IN
INCREASED CORTICAL THICKNESS.

MRI: DEFINES THE EXTENT OF SOFT TISSUE

EXTENSION WITH GREAT ACCURACY
 T2W- INCREASED SIGNAL MASS
INTERMEDIATE SI ADJACENT TO
HYPERINTENSE TUMOR MASS INDICATES
DEDIFFERENTIATED TUMOR
 T2W
IMAGE SHOWING INCRESED SIGNAL INTENSITY WITH
THE TUMOUR SURROUNDING THE BONE IN THIS CASE
OF PERIOSTEAL OSTEOSARCOMA
T1W – SLIGHTLY HYPOINTENSE TO MUSCLES
AND HYPERINTENSE
SIGNAL FOCALLY FOR MARROW
MATRIX MINERALIZATION – FOCAL AREAS OF
SIGNAL VOID

POST CONTRAST ENHANCEMENT IS MINIMAL

AND SHOWS PERIPHERL OR SEPTAL PATTERN
DUE TO DECREASED VASCULARIZATION
IDENTIFICATION OF MALIG CHANGE IN
OSTEOCHONDROMA
DESTRUCTION OF PART OF CARTILAGE CAP
USG MEAUREMENT OF CARTILAGE CAP SIZE
OF > 20 MM INDICATES MALIGNANT CHANGE IN
OSTEOCHONDROMA

MALIGANANT FIBROUS
TUMORS
MALIGNANT FIBROUS
HISTIOCYTOMA
MOST COMMON PRIMARY MALIGANANT
FIBROUS TUMOR

25 – 30% ARISE FROM PAGET'S DISEASE , POST

RADIOTHERAPY, BONE INFARCTION

LOCATION:METAPHYSES OF LONG BONES ARE

PREDOMINANTLY INVOLVED
AROUND KNEE , HUMERUS and PELVIS
AGE : 4TH DECADE , 6 – 80 YEARS
RADIOLOGICAL FEATURES:
PRIMARY – LYTIC AND DESTRUCTIVE ,
METAPHYSEAL
PERIOSTEAL REACTION UNCOMMON
SOFT TISSUE MASS MAY BE SEEN
MIMICS GCT BY EXTENDING TO
SUBARTICULAR SURFACE

NO SPECIFIC DIAGNOSTIC FEATURES FOUND

ON MRI

MARROW TUMORS
EWINGS TUMOR
PRIMARY LYMPHOMA OF BONE

EWING'S SARCOMA

AGE GROUP -< 20 YRS – 75%

< 30 YRS – 95%

SYSTEMIC SYMPTOMS – PYREXIA ,

ELEVATED ESR , SIMULATES INFECTION
AND SIGNIFIES DISEMINATED DISEASE
WITH POOR PROGNOSIS

SITE OF OCCURANCE:DIAPHYSEAL TUMOR

OCCURING IN FEMUR, HUMERUS ,PELVIC
BONES AND RIBS.

LESIONS MOSTLY SINGLE , BUT MULTIPLE

LESIONS ALSO SEEN

READILY METASTASIZES TO BONE

RADIOGRAPHIC APPEARANCE:

PERMEATIVE PATTERN OF LYTIC BONE

DESTRUCTION WITH A WIDE ZONE OF
TRANSITION.

CORTICAL DESTRUCTION PRESENT

EXTRAOSSEUS SOFT TISSUE/
SUBPERIOSTEAL MASS PRESENT

SUBPERIOSTEAL LESION CAN ERODE OUTER

CORTEX AND CAUSE SAUCERIZATION

CODMAN TRIANGLE AND HAIR ON END

APPEARANCE DUE TO PERIOSTEAL REACTION
PRESENT .CORTICAL THICKENING , BONE
EXPANSION and
PATHOLOGICAL FRACTURES RARE
EWING'S SARCOMA ARISING FROM PROXIMAL
HUMERAL METAPHYSES AND DIAPHYSES
SHOWING LYTIC MOTH-EATEN BONE
DESTRUCTION , CODMAN'S TRIANGLE AND
CORTICAL DESTRUCTION .BONE EXPANSION
SEEN .NO SCLEROSIS AS SEEN WITH
OSTEOSARCOMA ,NO CALCIFICATION AS SEEN
WITH CHONDROSARCOMA

XRAY SHOWS LAMELLAR ONION SKIN

PERIOSTEAL REACTION SEEN IN EWING'S
SARCOMA.PERMEATIVE BONE DESTRUCTION
SEEN.

OCCASIONALLY SPINAL AND FLAT BONE

LESIONS CAN CAUSE SCLEROTIC APPEARNCE
RESEMBLING OSTEOSARCOMA

CT/MRI SHOWS LARGE EXTRA OSSEUS

COMPONENT . INTRAOSSEUS COMPONENT IS
ACCURATELY DEMOSTRATED

DIFFERENTIAL DIAGNOSIS:
OSTEOMYELITIS
TRAUMA
LYTIC OSTEOSARCOMA
PRIMARY BONE LYMPHOMA IN PATIENTS
MORE THAN 30 YRS OF AGE

PRIMARY BONE LYMPHOMA

AKA 1. RETICULUM CELL SARCOMA
2.LYMPHSARCOMA OF BONE
INVOLVEMENT OF SINGLE SITE IN BONE WITH
NO OTHER SITE INVOLVED FOR SIX MONTHS
AFTER DIAGNOSIS

USUALLY A NON HODGKIN'S B-CELL

LYMPHOMA

RADIOLOGICAL FEATURES :
SIMILAIR TO EWING'S SARCOMA
PERMEATIVE LYTIC DESTRUCTIVE LESION
REPORTED IN 74%
RELATIVE ABSENCE OF CORTICAL
DESTRUCTION IS A CHARACTERISTIC FEATURE

SEQUESTRA AS SEEN IN OSTEOMYELITIS ARE

ALSO CHARACTERISTICALLY SEEN

MRI : EXTENSIVE INVOLVEMENT OF

MEDUALLY CANAL WITH LARGE
EXTRAOSSEUS MASS AND LITTLE CORTICAL
BONE DESTRUCTION

NOTOCHORD ORIGIN TUMOR

CHORDOMA
MIDLINE TUMOR , AXIAL LOCATION
AGE : 50 - 70YRS
SITE : SACROCOCCYGEAL (50%) , CLIVAL
TUMOR (40%)

SYMPTOMS : CONSTIPATION , BLADDER

DYSFUNCTION ,CRANIAL NERVE PALSIES AND
PELVIC MASS .

RADIOLOGICAL FEATURES:
SACRAL MASS , DESTRUCTIVE , SOMETIMES
OCCULT
FEW CASES – EXTRAOSSEOUS MASS
CALCIFICATION
IN CLIVUS LESION – SELLA AND CLIVUS MAY
BE DESTROYED

MRI :
T1W – LOW SI MASS WITH EXTRAOSSEUS
EXTENSION , HIGH SI occur BECAUSE OF
HEMORRHAGE AND HIGH PROTEIN CONTENT

T2W – HIGH SI LESION MASS WITH LOW SI

INTERNAL SEPTATIONS AND WELL DEFINED
MARGINS

MRI T1W
IMAGE SHOWING “THUMB SIGN”(ARROWS) OF
PONS DUE TO IMPINGEMENT OF THE TUMOUR
WHICH APPEARS ANTERIOR AND HYPODENSE
TO PONS