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Bony Lesions / Bone Tumor

Bony Lesions

Bone lesions should not be defined radiographically as malignant or benign, but rather aggressive or nonaggressive. Some malignant lesions can have a nonaggressive appearance and many benign lesions can have a very aggressive appearance.

Criteria that should be assessed when evaluating a bony lesion:

Demographics: lesions of bone have a specific propensity based on age and occasionally gender

Location: the location of the lesion within the skeleton is critical because specific lesions have a propensity to affect certain locations in the skeleton.

Longitudinal location: Most common tumor sites:

Epiphysis: chondroblastoma, giant cell tumor (GCT), aneurysmal bone cyst (ABC). GCT and ABC usually arise from the metaphysis and extend into the epiphysis.

Metaphysis: osteochondroma, chondrosarcoma, nonossifying fibroma, enchondroma (long bones), osteosarcoma, chondromyxoid fibroma, ABC, GCT.

Diaphysis: enchondroma (phalanges), osteoid osteoma, osteoblastoma, Ewing’s sarcoma, fibrous dysplasia.

Axial location: The location of the lesion should be defined as central intramedullary, eccentric intramedullary, cortically based, or surface (periosteal) centered.

Zone of transition: the transition zone between the lesion and the adjacent uninvolved bone should be classified as:

Narrow: well-defined margins that can be traced out with a pencil. This is a nonaggressive feature.

Wide or ill-defined: poorly defined margins, not easily traceable with a pencil. This is an aggressive feature.

Pattern of bone destruction: the pattern of bone replacement should be assessed and characterized as:

Geographic: well-defined lesion of bone. Geographic lesions have a narrow zone of transition by definition. This is a nonaggressive feature.

Blastic or sclerotic: densely sclerotic lesion of bone. Can be aggressive or nonaggressive

Permeative: ill-defined bony destruction. This is an aggressive feature.

Bubbly: multilocular lucencies, with or without expansile appearance. This is usually a nonaggressive feature.

Presence of matrix: If present, matrix falls into one of following categories:

Types of Nonaggressive Primary Bone Tumors by Matrix Appearance:

CLEAR

FIBROUS

CHONDROID

OSTEOID

Unicameral bone cyst

Fibroxanthoma

Enchondroma

Osteoma

Aneurysmal bone cyst

Fibrous dysplasia

Osteochondroma

Osteoid osteoma

Giant cell tumor

Chondroblastoma

Osteoblastoma

Eosinophilic granuloma

Chondromyxoid fibroma

Bone Tumor

Important determinators in the analysis of a potential bone tumor are:

  1. The morphology of the bone lesion on a plain radiograph

    • Well-defined osteolytic

    • ill-defined osteolytic

    • Sclerotic

  2. The age of the patient

--> the plain radiograph is the most useful examination for differentiating these lesions.
CT and MRI are only helpful in selected cases.


Pubmed

UpToDate

Images


Video:

Bone Tumor Imaging


Web:

List of bone tumors and lesions - Radiology Assistant

Bayesian Bone Tumor Diagnosis

Healthline

OrthoInfo

MedlinePlus


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