Tumor and Tumor-like Lesion of Bone

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Tumor and Tumor-like Lesion of Bone
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Osteoma

• Osteoma is a benign mass protruding from osseous
  tissue

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Osteoma

• Most common tumor of the paranasal sinuses, most
  frequently seen in the frontal sinus and ethmoids
• Two varieties are described the dense 'ivory'
  type and 'cancellous' osteoma

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(a)
(b)
Osteoma Lateral radiograph of the skull (a)
and axial CT scan (b) demonstrate an ossific
nodule (arrow) arising from the outer table of
the calvarium
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Giant cell tumor

• Giant cell tumor is a locally aggressive neoplasm
• The sites affected most frequently are the long
  tubular bones

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Giant cell tumor

• Clinical manifestation
• Earliest manifestations include pain, local
  swelling, limitation of motion and pathologic
  fractures

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Imaging feature

• On radiographs, the long and short tubular bones
  reveal eccentric osteolytic lesions
• With MR imaging, intraosseous fluid levels may
  be seen

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Giant cell tumor a, b. AP (a) and lateral (b)
radiographs of the knee demonstrate an eccentric
osteolytic lesion in the proximal tibia. The
lesion has a non-sclerotic border and abuts the
articular surface of the tibia.
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c. Sagittal T1-weighted MR image of the knee
demonstrates the low signal intensity mass in the
proximal tibia. d. Fat-suppressed T1-weighted MR
image after gadolinium adminstration demonstrates
enhancement of the mass in the proximal tibia.
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Giant cell tumor osteolytic lesion in the distal
radius soap bubble expandability Soft tissue
swelling
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Bone cyst

• Bone cyst is a usually cavitary lesion of bone.
• Bone cysts may occur after trauma and in
  osteoarthritis

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• These cysts occur most frequently in long tubular
  bones, especially the metaphysis, and in the bony
  pelvis

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Imaging feature

• Radiographically, these lesions appear
  radiolucent and are located centrally, with
  cortical thinning and mild expansion of the bone
• CT scanning and MR imaging with contrast
  enhancement reveal presence of fluid within the
  lesion

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• Complications of simple bone cysts include
  complete and incomplete fractures,
• and (rarely) malignant transformation

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Bone cyst Simple bone cyst. AP radiograph of
the shoulder demonstrates a pathologic fracture
through the simple bone cyst in the humeral
metaphysis. Note the "fallen fragment" within
the bone cyst.
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Osteosarcoma

• Osteosarcoma is a malignant neoplasm of bone
  composed of proliferating tumor cells that in
  most instances produce osteoid or immature bone

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Clinical feature

• 75 of cases occurring between the ages of 10
  and 25 years
• 86 occur in the long bones with the distal
  femoral metaphyseal region
• The next commonest sites are the upper tibia and
  humerus

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Clinical feature

• The commonest presentation is pain in the
  affected area or, occasionally, a pathological
  fracture
• This tumor metastasises early, particularly to
  the lungs and other bones

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Imaging feature

• On the radiograph, the tumor may be purely lytic
  or sclerotic , or a mixture of the two

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Imaging feature

• Pure lytic lesions vary from areas of diminished
  bone density to completely lytic areas with very
  little reaction from the bone
• They may have a very thin periosteal reaction
  overlying the lesion with very little evidence of
  new bone formation

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Imaging feature

• The sclerotic osteogenic sarcomas may produce a
  region of dense sclerosis with loss of the inner
  cortical margins
• The periosteal reaction may be laminated or
  spiculated with so-called 'sunburst' appearance

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Imaging feature

• More often the tumors are both lytic and
  sclerotic with destruction of the bone and
  cortex, and extension into the soft tissues
• There may be a variable amount of calcification
  in the soft tissues
• a prominent periosteal reaction with a Codman's
  triangle

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• MRI
• The lytic areas of the tumor show a low signal on
  T1 and high signal on T2
• The extension in the medullary cavity is very
  accurately determined by MRI, as is the soft
  tissue extent

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Osteosarcoma AP (a) and lateral (b) radiographs
of the femur demonstrate a large soft tissue mass
with an aggressive periosteal reaction creating
the sunburst appearance. Patchy osteosclerosis
and osteolysis in the distal femur
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Osteogenic sarcoma Osteolytic sarcoma of the
fibular head. There is a small amount of
calcification within the tumor.
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Osteogenic sarcoma Osteoblastic sarcoma in the
upper metaphyseal region of the tibia. There is
sclerosis, breach of the cortex and sclerotic
extension of the tumor into the tissues. The
cortical margin is lost
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Osteogenic sarcoma Radiograph of a distal
femoral osteogenic sarcoma. On the
radiograph there is a mixed sclerotic and lytic
lesion with a layered periosteal reaction
anteriorly and showing calcification.  
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Osteogenic sarcoma The large soft tissue
component is well seen on the MR. There is high
signal within the lesion and in the medullary
cavity