Primary bone tumors are rare and are usually discovered incidentally when patients undergo imaging studies. Radiologic approach to bone tumors consists of analyzing the lesion in an organized manner. It should answer the following basic questions: Location? Size ? Degree of involvement ? Number ? Metastasis ?
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Primary bone tumors are rare and are
usually discovered incidentally when patients undergo imaging studies.
Radiologic approach to bone tumors consists of analyzing the lesion in an organized manner. It should answer the following basic questions:
Location? Size ? Degree of involvement ? Number ? Metastasis ?
Osteoclastoma
Department of Radiology
Patients’ Profile
• 28 year old male Filipino• Came in due to pain and deformity of
the right knee
• 4 mos. PTA• Onset swelling and tenderness• Limitation of movement
Patients’ Profile
• 3 mos. PTA• Admitted due to persistent pain• Increased in size, 3 x 3 inches• Arthrocentesis
Patients’ ProfileMRI: heterogenous septated ill-defined mass in the medial
femoral condyle measuring 49 x 55 x 68 mm with an associated joint effusion with gross bone destruction in the femoral condyle. Findings is suspicious for malignancy.
Patients’ Profile
• 3 weeks PTA• Cracking sound• Pathologic complete fracture at
medial condyle of the right femur• Right knee was immobilized
• 1 week PTA• Visited AP’s clinic after completing
home medications• Agreed of biopsy and curettage
Patients’ Profile
• Physical Examination:• Firm mass, 5 X 5 cm
slightly above the patella on posteromedial aspect of the right knee
Hospital Stay
• Labs taken: Bleeding parameters were normal
• CXR taken• Pre-op meds given
Hospital Stay
• Labs taken: Bleeding parameters were normal
• Pre-op meds given
• Open biopsy with frozen section, Curretage and Resection of tumor
• Procedure was uneventful• Post-op antibiotics and
• Often solitary and slow growing• Frequently seen in young adults• Affecting usually the knee and arms• Pain and limited range of motion• Presence of Multinucleated Giant
Cells
Discussion
• 18.2 % of all benign tumors• Benign with aggressive traits• No definitive cause• Areas usually affected
1. Distal femur
2. Proximal tibia
3. Proximal humerus
Discussion
• Xray- Lucent and
eccentrically located with no sclerotic borders and narrow zone of transition
- Meta - Epiphyseal regions
Discussion
•Well-defined margin•Intact cortex
Grade 1 (latent)
•Relatively well-defined margin but no radiopaque rim•Cortex is thinned and moderately expanded
Grade 2 (active)
•Indistinct borders•Cortical destruction
Grade 3 (aggressive)
Campanacci Grading System
Discussion
• CT-scan• Best for defining degree of bone
destruction• Presence of pathological fracture• Critical in surgical planning
Discussion
• MRI• Best method to assess the extent
of involvement• Low signal intensity on T1-
weighted images• Intermediate signal intensity on T2
weighted images
Discussion
T1-weighted T2 weighted
Discussion
• Radionuclide Bone Scans• Technetium Tc 99-methylene
Diphospate• Important for detecting metastatic
or multifocal lesions
Discussion
• Angiography• No role in diagnosis• Sensitive test for
assessing response to pre-operative chemotherapy
Discussion
Gross examination• appear as chocolate brown, soft,
spongy and friable lesion.• Variable degree of cortical
expansion
DiscussionMicroscopically
• presence of Multi-nucleated Giant cells on a background of network of Stromal Mononuclear Cells
Discussion
• Treatment• Curretage with Bone Grafting
• Recurrence rate is 45 %• Curretage with Bone Grafting Plus
Liquid Nitrogen or
Phenol or
Hydrogen Peroxide or
Bone Cement• Recurrence rate is 17 %
Discussion
• Treatment• Curretage with Bone Grafting Plus
Phenol Plus Bone Cement• Recurrence Rate is 3 %
• Radiation is restricted to difficult cases
Discussion
Discussion
Prognosis• Mortality rate is 4 %• Post-treatment: serial radiographs• Tumor recurrences are frequent• Long Term observation is
recommended
Differential Diagnosis
OSTEOSARCOMA CHONDROSARCOMA FIBROSARCOMA
20 – 40 years old 30 – 60 years old 30 – 50 years old
Tubular bones Tubular bones Tubular bones
Metaphyseal area Meta – Epiphyseal area More metaphyseal