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Bone Tumors: in 1 Simple Chart

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Bone Tumors: in 1 Simple Chart Bone Tumors: page 1 of 31 In 1 Simple Chart AGGRESSIVE NON-aggressive NON-aggressive age Lytic Blastic Osteosarcoma ABC Chondroid: Ewing Sarcoma UBC Enchondroma Bone Tumors Osseous: <20 Osteomyelitis (Active) CB Osteoid Osteoma Mets (NB <5yo) FCD/NOF Osteoblastoma Cortical Desmoid EG Osseous & Chondroid: In 1 Simple Chart (Helms: “DNT”) FD Osteochondroma Lymphoma GCT Bone Infarct Chondrosarcoma Enchondroma Download this entire slideshow from Fibrosarcoma/MFH FD Stress Fracture 20-40 Osteomyelitis (Active) “Pitts Pit” Osteomyelitis (Chronic) When running this on your own computer PHALANX: ...Mets Enchon, Glomus you can jump from slide to slide using Epidermoid,Felon with Surface OS GCTTS,Sarcoid “Ivory Vertebra”: these buttons at bottom of each slide: Adamantinoma Gout,Met(lung) Lymphoma,Paget,Met PowerPoint Last slide Interactivity viewed Mets/Mult Myeloma Mets/MM Mets/MM (“POEMS”) Overview The >40 Osteomyelitis (Active) FD Osteomyelitis (Chronic) slide Chart 2ºOsteosarc (>60) Paget’s ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Overview of this Presentation WhyBoneTumorsareIntimidating Why Bone Tumors are Intimidating Bone Tumors are Rare Describing Bone Tumors 2009 1) Patient’s Age Building the 2) “Aggressive” Bone Tumor Chart 1,500,000 Zone of Transition New Cancer Periosteal Reaction Cases in 3) Matrix Underlined Text = USA PowerPoint Interactivity 4) Location Annual Cancer Statistics Review, updated 5/29/09, p34 http://seer.cancer.gov/csr/1975_2006/results_merged/sect_01_overview.pdf ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info WhyBoneTumorsareIntimidating Bone Tumors: Many Types Bone Tumors are Rare # Radiologists in USA = 180,000 30,000 Other 12% 2,570 15% 13% Bone Renal/GU Breast Tumors Only 1-in-12 221,000 194,000 2,570 Radiologists 273,000 192,000 0.17% will even see a 30! Lung/Oral Prostate Bone Tumor 18% 19% 13% per year GI 276,000 www.acr.org/SecondaryMainMenu Annual Cancer Statistics Review, updated 5/29/09, p34 Categories/SocioeconomicResearc http://seer.cancer.gov/csr/1975_2006/results_merged/sect_01_overview.pdf h/PracticeofRadiologyintheUS.aspx GREENSPAN: ©Ken L Schreibman, PhD/MD 2010 schreibman.info OrthoRad 15.24 ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 2 of 31 In 1 Simple Chart WhyBoneTumorsareIntimidating Bone Tumors: by Age Bone Tumors are Rare 20 Don’t see enough to be confident Many types of Bone Tumors Have Confusing (similar) Names 30% Incidence Bone Tumors “Osteosarcoma” 25% by age “Osteochondroma” 20% Occur in children 15% 10% Essentially only 2 5% bone malignancies 0% <20 20-34 35-44 45-54 55-64 65-74 75-84 >85 occur in children http://seer.cancer.gov/statfacts/html/bones.html ©Ken L Schreibman, PhD/MD 2010 schreibman.info Bone Tumors: by Age Overview of this Presentation 20 40 Why Bone Tumors are Intimidating Describing Bone Tumors 1) Patient’s Age <20 Osteogenic Sarcoma Ewing Sarcoma Everything else benign 20-40 Could be anything >40 Multiple Myeloma, Metastases ©Ken L Schreibman, PhD/MD 2010 schreibman.info Overview of this Presentation 2 Cases: Destructive lesions distal fibula Why Bone Tumors are Intimidating Benign? Describing Bone Tumors Malignant? Describing Can’t tell with radiographs… 1) Patient’s Age Thus we use the term 2) “Aggressive” vs “Non-aggressive” “Aggressive” (NOT “Malignant” vs “Benign”) Zone of Transition Periosteal Reaction Not everything that looks aggressive is malignant (e.g. osteomyelitis) ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 3 of 31 In 1 Simple Chart Aggressive vs Non-aggressive Aggressive vs Non-aggressive Zone of Transition Zone of Transition Periosteal Reactions Grow Slowly “Narrow” “Geographic” “Well Defined” Can Outline Lesion with Sharp Pencil Sclerotic Margins Grows VERY Slowly! ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Zone of Transition Zone of Transition Grow Slowly Grow Slowly “Narrow” “Narrow” “Geographic” “Geographic” “Well Defined” “Well Defined” Can Outline Lesion Can Outline Lesion with Sharp Pencil with Sharp Pencil Sclerotic Margins Sclerotic Margins Grows VERY Slowly! Grows VERY Slowly! Asymptomatic, incidental finding ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Zone of Transition Zone of Transition Grow Slowly Grow Rapidly Grow Slowly “Narrow” “Wide” “Narrow” “Geographic” “Permeative” “Geographic” “Well Defined” “Ill Defined” “Well Defined” Can Outline Lesion “Moth Eaten” with Sharp Pencil Cannot tell where Can Outline Lesion Lesion ends and with Sharp Pencil Normal Bone begins Sclerotic Margins Grows VERY Slowly! ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 4 of 31 In 1 Simple Chart Aggressive vs Non-aggressive Aggressive vs Non-aggressive Zone of Transition Zone of Transition Grow Rapidly Grows Rapidly Grows Slowly “Wide” “Wide” “Narrow” “Permeative” “Permeative” “Geographic” “Ill Defined” “Ill Defined” “Well Defined” “Moth Eaten” “Moth Eaten” Cannot tell where Cannot tell where Can Outline Lesion Lesion ends and Lesion ends and with Sharp Pencil Normal Bone begins Normal Bone begins W,S 16yoF ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Periosteal Reaction Simplifying Periosteal Reaction Grows Rapidly Grows Slowly Grows Rapidly Grows Slowly “Interrupted” “Solid” Smooth TOO Continuous COMPLI- CATED ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Simplifying Periosteal Reaction Simplifying Periosteal Reaction Grows Slowly Grows Slowly “Solid” “Solid” Smooth Smooth Continuous Continuous Looks like Healing Callus HOAHPOA Hypertrophic OPulmonarysteo- Bone Fx Bone AOrthropathysteo- Model Model Arthropathy Stable over 1y F,A 2moM 1m later V,T 49yoM ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 5 of 31 In 1 Simple Chart Aggressive vs Non-aggressive Aggressive vs Non-aggressive Simplifying Periosteal Reaction Simplifying Periosteal Reaction Grows Rapidly Grows Rapidly “Interrupted” “Interrupted” May grow so Lamellated rapidly it doesn’t Onionskin have time to Grows… ossifies… ossify Grows… ossifies… (Unossified Grows… ossifies… periosteum is not radiopaque) Courtesy of James Choi, MD ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Simplifying Periosteal Reaction Simplifying Periosteal Reaction Grows Rapidly Grows Rapidly “Interrupted” “Interrupted” Lamellated Lamellated Onionskin Onionskin Spiculated Spiculated Hair-on-end Sunburst Codman’s Triangles (Growing so rapidly, has time to ossify only at corners) ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Aggressive vs Non-aggressive Aggressive vs Non-aggressive Simplifying Periosteal Reaction Simplifying Periosteal Reaction Grows Rapidly Grows Rapidly Grows Slowly “Interrupted” “Interrupted” “Solid” Lamellated Lamellated Smooth Onionskin Onionskin Continuous Spiculated Spiculated Looks like Sunburst Sunburst Healing Callus Codman’s Codman’s Triangles Triangles (Growing so rapidly, 3w post Fx, ORIF has time to ossify 8w post Fx, ORIF =very early callus =more mature callus only at corners) S,C 15yoM ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 6 of 31 In 1 Simple Chart Overview of this Presentation Aggressive vs Non-aggressive Why Bone Tumors are Intimidating Cortical Destruction Describing Bone Tumors Similar lytic lesions Both have well 1) Patient’s Age defined, sclerotic, 2) “Aggressive” vs “Non-aggressive” medullary borders Zone of Transition IR Periosteal Reaction Cortical Destruction Cortex Absent = Cortex Intact = Aggressive Non-aggressive ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info Overview of this Presentation 2 Cases: Aggressive lesions distal fibula Why Bone Tumors are Intimidating Benign? Describing Bone Tumors Malignant? Can’t tell with radiographs… Periosteal 1) Patient’s Age Thus we use the term Reaction 2) “Aggressive” vs “Non-aggressive” “Aggressive” Zone of Transition Cortical Periosteal Reaction Radiographs Destruction Cortical Destruction MRI Soft Tissue Extension ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info 2 Cases: Aggressive lesions distal fibula Active Osteomyelitis Chronic Osteo. T2 Soft Tissue Extension Aggressive vs Non-aggressive T1 Two YEARS T2 later H,M 13yoF ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 2010 schreibman.info ©Ken L Schreibman, PhD/MD 01/10/10 www.schreibman.info Bone Tumors: page 7 of 31 In 1 Simple Chart Bone Matrix: 4 Types Bone Matrix: 4 Types Chondroid Osseous Chondroid “rings&arcs” “cloud-like” “rings&arcs” “amorphous”
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