Bone Pathology 1 Practical 1. OSTEOMA M/c in men Age: 50-60yrs M/c asymp., Sx’s dep. in location...
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Transcript of Bone Pathology 1 Practical 1. OSTEOMA M/c in men Age: 50-60yrs M/c asymp., Sx’s dep. in location...
Bone Pathology 1
Practical 1
OSTEOMA
• M/c in men• Age: 50-60yrs• M/c asymp., Sx’s dep. in location• M/c in: Sinuses, inner/outer tables of skull,
some facial bones• Solitary, radiodense, homog. opacity
w/smooth & lobular margins• Related to Gardner’s Syndrome
Enostosis= “Bone Island”=Enostoma
• At all ages,m/c in adults• M/c asymp.• In all skeleton, except skull. M/c @
pelvis,humerus, vertebra,ribs• Don’t cross articulation• Well demarcated,round-oval, homog.
radiopaque w/speculated margin(brush border).Normal adjacent cortex.
• Epiphyseal/metaphys.; medullary
Osteopoikilosis
• Multiple bone islands• Autosomal dominant; sclerosing dysplasia• m/c in males• Rare before 3yrs of age• M/c asymp., mild joint pain• Small radiopacities(multiple)• Metaephyseal reg. of long bones• Adjacent to acetabulum of pelvis +
scapular glenoid;also carpals and tarsals
Osteoid Osteoma
• M/c in male• Age: 10-25yrs• Sx.’s: Pain > severe @ night relieve by
aspirin,localized swelling, dec. ROM, painful limp, weakness w/muscle atrophy
• 50-60%: femur(*prox.) + tibia• 20%:hands & feets• 10%Vertebral lesions(*lumbar)-m/c from
*neural arch(TVP base,lamina,pedicle)In scoliosis @ concave side.
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Osteoid Osteoma,cont...
• M/c @ cortex• Centrally located, oval to round
radiolucent foci(nidus)-*< than 1cm surrounded by uniform bone sclerosis
• Metaphyseal/dyaphys. in long bones• Differentials: Garre’s Sclerosing
Osteomyelitis, Brodie’s Abscess,*Stress Fracture
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Nidus
Osteoblastoma
• M/c in males• Age: 10-30yrs.• Sx.’s: Local pain; in spine lesions: muscle
spasm,scoliosis & neurolog. Sx.’s• M/c @ Spine(*target-lumbars)-1arily
post.elements(pedicles + lamina)• Tubular bones m/c lower extremities• Diaphyseal/metaphys. of long bones• Cortical or medullary, may be subperiostal
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Osteoblastoma, cont...
• Well circumscribed, expansile lesion, *radiolucent or mottled mixed lytic-blastic w/cortical thinning(eggshell like). *Nidus >2cm. Osteosclerosis may be, but soft tissue is infrequent.
• Different. Dx.’s: osteoid osteoma,simple or aneurysmal bone cyst, eosinophilic granuloma,enchondroma and fibrous dysplacia
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Osteosarcoma• “2nd m/c 1ary malignancy of bone”• M/c in male• M/c in 2nd & 3rd decades(10-25yrs)• Sx.’s: Pain,swelling,dec. ROM, warmth,
pyrexia.Lab. Anal.:high lev. alkaline phosphatase
• M/c @ long tubular bones: *femur(40%),tibia(16%),humerus(15%) Around knees- 50-70% cases
• *Metaphyseal, extension to diaph/epiphys.
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Osteosarcoma,cont...
• Mixed pattern of osteolysis & sclerosis w/extensive bone prod.-seen as cumulus cloud appearance. Permeative pattern of destruction, wide zone of transition w/cortical disruption,*soft tissue extension + *aggresive periostal Rx’n.(*sunburst).Pathological fracture may be present.
• m/c intramedullary; metaphyseal• Differ.Dx’s: Ewing’s sarcoma & metastasis2
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Osteochondroma• “M/c benign skeletal tumor”-50%of all• HME(heredit.mult.exostoses)w/fam.history• Bony excrescences covered by cartil. cap• M/c in males• 70-80% before 20yrs• M/c asymp., w/painless,non-tender slow
growing mass• Femur(30%),humerus(20%),tibia(17%),pel
vis,scapula,ribs,spine• Metaphyseal, other regions are rare
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Osteochondroma,cont...• Metaphys/diametaphys. osteocartilaginous
excrescence:pedunculated or sessile.• Oriented *Away from articulat.Calcification
may be seen(cauliflower,spotty).Cart.cap in adults:<or=1cm(if >2cm-danger!);children:3cm,normal
• Other possible Sx.’s:fracture,osseous deformity,vasc.injury,bursa,neurol. compromise,malignant transformation
• Differ. Dx’s: Osteochondromas-generally diagnostic. 2
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Multiple Hereditary Exostosis
Enchondroma• “M/c benign tumor of the hand”• No gender predilection• Age: 10-30yrs• Sx.’s: m/c asymp., painless swelling• 40-65% @ hand(*prox.phalanges &
metacarpals are m/c).25% in Long bones,>frequent in lower extremities
• Well defined,expansile,medullary w/*calcification(50%cases) and endosteal erosion(scalloping)that lead to cortical thinning
ChondroblastomaCodman’s Tumor
• “2nd m/c benign tumor of patella”• M/c in males• Age: 10-25yrs• Sx.’s: mild,dull pain,often refer to adjacent
joint,local tenderness & occasionally swelling.Musc. atrophy w/weakness may present.
• M/c in distal/prox femur(*trochanter), prox/tibia, prox.humerus(*tuberosity) & ilia.
• Medullary based; epiphys. often w/metaphyseal extension
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ChondroblastomaCodman’s Tumor
• Round-oval shaped well-defined lytic lesion. Fluffy cotton wool matrix calcif. Sclerotic rim.
• Stippled or punctuate calcific.(50%cases) & periostitis in metaphys.(30-50%cases)
• Differ. Dx.’s: Giant Cell Tumor(GCT), Brodie’s Abscesses, Eosinophilic granuloma
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Chondromyxoid Fibroma• No gender predilection• Age:Under 30 and 6th-7th decades• Sx’s:Progressive local.pain,may be swelling• 50%-prox.metaphysis of tibia(*tuberosity) Also
at femur,humerus,fibula,ribs,pelvis & tubular bones
• Large eccentric, well defined,ovoid lytic lesion, narrow transition zone, endosteal scalloping & trabeculation(soap-bubbly).Extensive(“bite defect”).Calcif. is RARE.
• Differ.Dx:ABC,GCT,enchondroma,chondro&osteo-blastomas,fibrous dysplacia,NOF
Chondrosarcoma• “3rd m/c 1ary malignancy of bone” • “M/c 1ary malignant tumor of tubular bone
of hand & chest wall”• M/c in men• Age: 40-60yrs• Sx’s: Pain w/assoc. swelling 2ary to soft
tissue mass• In any bone forming from cartil.; m/c @
pelvis + prox. femur-50%cases; also in humerus, scapula,ribs, bones around knee
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Chondrosarcoma• Aggressive,large,expansile,radiolucent,ill-
defined borders, wide zone of transition w/endosteal scalloping or complete cortical dissolution, erratic calcif.(may be stippled, fluffy-cotton wool or arcs & rings in appearance) *Soft tissue mass(can become very large)w/scattered calcif. Periosteal rx’n(laminated or speculated appearance.
• Matrix calcif.-65%cases• Metaphyseal, but can occur purely epiphyseal• Differ.Dx:Enchondroma,chondromyx.fibroma +
metastatic disease45
Fibrous Cortical DefectNon-Ossifying Fibroma
• M/c in males• Age: FCD:4-8yrs; NOF:8-20yrs• 90% @ Lower extremities; 55% near knee• FCD:small,eccentric,metaphys.,rim of sclerosis
parallel to long axis.*Post.distal femur m/c site• NOF:solitary,well-def.,often multilocular-bubbly,
oval shaped,radiolucent,2-7cm,eccentrical @metaphysis of long bone(*distal tibia) w/cortical expansion +thinning
Fibrosarcoma• No gender predilection• Age: 30-50yrs• Sx’s: Local pain,limited ROM. 1/3 assoc.
w/pathol. fracture• 70%Long tubular bones(femur-40%& tibia16%)• Metaphys. or diametaphys. m/c• Large aggressive, >5cm lesion, permeative to
mothern pattern of destruction, wide zone of transition, cortical dissolution,extremely large soft tissue mass, periosteal rx’n is rare
• Dif.Dx:Liechtenstein’n rule...b/c wide charact.
Giant Cell TumorOsteoclastoma
• “M/c benign tumor of sacrum”• “M/c neoplasm of patella”• M/c in females• Age: 3th-4th decades• Sx’s: Pain,local tenderness w/swelling,
dec. ROM @ adjacent articulation• >75% @ long tubular bones; m/c distal
femur,prox.tibia,*distal radius & humerus• 7% in spine(*sacrum)
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Giant Cell Tumor=Osteoclastoma
• Metaphyseal orig. w/epiphyseal extension to a subchondral location
• Eccentric(60%) or soap-bubbly(40%); well defin. or poorly demarcated.Cortical thinning and expansion.Not common: sclerotic border; No matrix calcif.
• Aggressive GCT often seen purely osteolytic• Differ.Dx:Chondroblastoma,ABC,Fibrous
dysplacia,Eosinophilic granuloma,brown tumor of hyperthyrodism
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Malignant Fibrous Histiocytoma• M/c in men• Age: any, m/c 5th to 7th decades• Sx’s: Pain & tenderness in assoc. w/large
mass of soft tissue. Palpable tender mass.• 75%@ ends of long bones.m/c in lower
extremities. 50% near knee.M/c in tibia, femur, pelvis, humerus
• Metaphyseal origin w/extension to epiphysis, diaphysis
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Malignant Fibrous Histiocytoma
• Permeative to motheaten pattern of bone destruction assoc. w/cortical erosion & soft tissue mass.Periostitis is limited.
• Differ.Dx: *Fibrosarcoma, Osseous Metastasis
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Simple (Unicameral) Bone Cyst
• M/c in men• Age: <14yrs(80% of cases)• Sx’s: M/c asymp.; > than 60% pathological
fracture• 75% @ prox. humerus and femur. M/c in
upper extremities. Also pelvis & calcaneus.
• Active:within metaphysis,adjacent to growth plate; latent: diaphysis, away from growth plate
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Simple (Unicameral) Bone Cyst• Metaphyseal lesion• Elongated, well-circumscribed, expansile,
radiolucent, endosteal scalloping & fine septations(bubbly appearance);cortical disruption, soft tissue mass, periosteal rxn. No calcif.“Hinged fragment sign” + “Fallen fragment sign”
• Calcaneal lesion:purely lytic,asymp,rarely frac-tured.Differ.Dx:lipoma,GCT,chondroblastoma
• Diff.Dx:chondroblastoma,chondromyxoid fibroma,enchondroma,eosinophilic granuloma, fibrous dysplacia+ lipoma
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Aneurysmal Bone Cyst• “M/c benign tumor of clavicle”• M/c in females• Age: 5-20yrs• Sx’s: Acute pain that rapidly progress,
patholog. Fractures are common.Spinal lesions involving neural arch.
• Long tubular bones(femur & tibia) & spine(T-L) • *Metaphyseal,can be extension to diaphys./epi• Eccentric,well-defined osteolytic,fine internal
septae, prominent expansion + thinned cortices
Adamantinoma
• “Exceedingly infrequent”• No gender predilection• Age: 10-40yrs• Sx’s: Localized pain assoc. w/swelling• 85% @ mid-shaft of tibia• Differ.Dx’s: Fibrous dysplacia & ossifying
fibromas
Ewing’s Sacroma
• “4th m/c 1ary malignancy of bone”• “M/c malignant lesion of pelvis in children”• M/c in men• Age:10-25yrs• Sx’s: Pain & Swelling localized,palpable
mass in 1/3 cases, *simulate infection• M/c in long tubular bones (*femur), pelvis• *Diaphseal or metaphyseal(>charac. of
osteosarcoma)
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Ewing’s Sacroma• An ill-def. permeative to motheaten
pattern of bone destruction, wide zone of transition,cortical desolution, *laminated or onion skin periostal rxn, prominent soft tissue mass. *Sunray pattern.
• Differ.Dx’s: *osteosarcoma, lymphoma and infection
Hemangioma• “M/c benign tumor of spine”• M/c in females • M/c >40yrs• Sx’s: M/c asymp.,assoc. w/painful swelling• M/c in spine(T-L) & skull(frontal/parietal)• Spine:”corduroy cloth”, mild osteopenia• Skull:“spoked wheel”, geographic, lytic
defect w/dense spicules• MRI:high signal in both(T1+T2)• Differ.Dx:osteoporosis,Paget’s disease,
renal osteodystrophy
Lipoma• No gender predilection• Age: all(4th decade-mean)• Sx’s: Aching pain aggravated by activity-60%,
others: asymp.• M/c in fibula,femur,tibia + calcaneus• Metaphyseal m/c• Well-def.lucent, surround by thin sclerotic
border,int. septae, dystrophic calcif. ”doughnut shaped”-central sclerosis + lucent zone around it
• Diff.Dx:SBC,ABC,FD,enchondroma, clear cell chondrosarcoma
