Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.
-
Upload
winifred-hoover -
Category
Documents
-
view
219 -
download
0
Transcript of Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.
![Page 1: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/1.jpg)
Primary bone tumours of the Spine:Imaging and Pathology
David Ritchie
Robin Reid
![Page 2: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/2.jpg)
Incidence: primary spinal (38) and sacral (14) tumoursSBTR (2000-09), 52 patients
Benign 21 Malignant 31
ABC 6 (1) Chordoma 10 (4)
Osteoblastoma 6 (1) Ewings 8 (3)
Osteoid osteoma 5 Chondrosarcoma 5 (1)
Giant Cell Tumour 1 (1) Myeloma 3 (1)
Eosinophilic Gran 1 Plasmacytoma 2 (1)
Chondroma 1 Osteosarcoma 2 (1)
Fibrous Dysplasia 1 Haemangioendoth 1
(x) Sacral tumourC spine (7), D spine (21), L spine (10)
![Page 3: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/3.jpg)
Spine – Tumours - Location
ANTERIOR – Malignant• Metastases
• Myeloma
• Lymphoma
Exceptions• Eosinophilic granuloma
• Haemangioma
• Giant cell tumour
POSTERIOR - Benign
• Osteoblastoma
• Osteoid osteoma
• Aneurysmal bone cyst
• Osteochondroma
Exceptions• Sarcoma
![Page 4: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/4.jpg)
KM, SBTR 4706
17F, 2/12 Hx of intermittantthoracolumbar painWorse at night
![Page 5: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/5.jpg)
![Page 6: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/6.jpg)
![Page 7: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/7.jpg)
![Page 8: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/8.jpg)
Aneurysmal bone cyst
• Children/ young adults
• Metaphysis of long bones, spine
• Sponge-like mass, blood filled spaces
• Septa, fibroblasts, giant cells, osteoid
• Mitoses, but normal
• No endothelial lining
• Recur in 25%
![Page 9: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/9.jpg)
![Page 10: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/10.jpg)
![Page 11: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/11.jpg)
![Page 12: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/12.jpg)
Aneurysmal Bone Cyst SBTR 4278, RW
Clinical and Imaging• 80% 1st - 2nd decades
• Benign expansile lesion containing thin-walled blood filled cavities
• Thin cortical shell and foci of cortical destruction
• Absent matrix
• Fluid-fluid levels caused by blood product sedimentation
Differential diagnosis • Osteoblastoma
• Giant cell tumour
• Telangiectatic osteosarcoma
• Brown tumour of hyperparathyoidism
T2W
T1W
![Page 13: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/13.jpg)
SS, SBTR 439450M, Increasing LBP, Right buttock pain radiating to kneeNo bladder or bowel problems
![Page 14: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/14.jpg)
![Page 15: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/15.jpg)
![Page 16: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/16.jpg)
AE1/3 and S100AE1/3 and S100
![Page 17: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/17.jpg)
ChordomaChordoma
• NeuroaxisNeuroaxis– Base of skullBase of skull– SacrumSacrum– VertebraeVertebrae
• Arises from notochord remnantArises from notochord remnant
• Local recurrence and extension usualLocal recurrence and extension usual
• Metastasis in <10%Metastasis in <10%
![Page 18: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/18.jpg)
![Page 19: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/19.jpg)
Chordoma
Differential diagnosis
• Metastasis / Lymphoma / Myeloma • Chondrosarcoma• Giant cell tumour • Osteosarcoma
Clinical
• 50% of 1º malignant sacral tumours• 50% of chordomas arise in sacrum• 4-7th decades, 2M:1F• Slow growing painful mass • Low grade but recurrence common• Metastases late (5 – 43%) • 5 year survival rate 60-80%
T2W
STIR
Recurrent / metastatic chordoma
![Page 20: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/20.jpg)
Surgery for Sacral Tumours
• Preserve power/sensation legs - S1 roots • Preserve bowel / bladder function - S2 roots • Retention of sexual function - S3 root - M, S2 - F
Stability of the lumbo-sacral junction
Preservation of neurological function
Raque et al. Treatment of neoplastic diseases of the sacrum. J Surg Oncol 2001; 76: 301
![Page 21: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/21.jpg)
DH, SBTR 4604P,10.2841CHI 0710726171Chordoma LV3
![Page 22: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/22.jpg)
PC, SBTR 4591
31M, 2yr Hx mid thoracic / periscapular pain Scoliosis
![Page 23: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/23.jpg)
![Page 24: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/24.jpg)
![Page 25: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/25.jpg)
![Page 26: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/26.jpg)
Osteoid Osteoma
• Central nidus (<1cm) of vascular/gritty tissue• Subperiosteal or cortical lesions provoke
intense reactive new bone formation• Nidus: active osteoblasts forming bone
osteoclastic remodelling, very vascular• Natural history: sometimes recur following
incomplete excision• Rare spontaneous regression suggests
osteoid osteoma may not be neoplastic
![Page 27: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/27.jpg)
![Page 28: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/28.jpg)
![Page 29: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/29.jpg)
![Page 30: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/30.jpg)
![Page 31: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/31.jpg)
Osteoid Osteoma
Clinical and Imaging
• Benign bone forming tumour • 10% in axial skeleton • 90% in 2nd – 3rd decades, 3M:1F• Night pain relieved by non-steroidal analgesia• Usually arise posterior elements• Nidus <15mm, lucent but often mineralisations• Reactive sclerosis / peri-tumoral oedema • CT best cross-sectional imaging technique
Differential diagnosis
• Chronic infection• Bone island
![Page 32: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/32.jpg)
SPINE
T2W CT
28M, LBPR sciatica
![Page 33: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/33.jpg)
Osteoblastoma
• “Giant osteoid osteoma” 2-10cm• 1% of bone tumours• Wide age range, mainly 10-30 years• Spine (posterior elements), long bones• Swelling, dull pain,nerve compression,
Histology as in osteoid osteoma• Local recurrence after curettage (?
multifocality)
![Page 34: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/34.jpg)
![Page 35: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/35.jpg)
![Page 36: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/36.jpg)
![Page 37: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/37.jpg)
OsteoblastomaClinical and Imaging• Uncommon benign bone forming tumour
• Histologically similar to osteoid osteoma
• 90% in 2nd – 3rd decades, 2M:1F
• 3 imaging patterns
– Large “osteoid osteoma”
– Expansile mineralised lesion
– Occasionally aggressive
Differential diagnosis • Osteoid osteoma• Aneurysmal bone cyst• Osteosarcoma
![Page 38: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/38.jpg)
![Page 39: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/39.jpg)
![Page 40: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/40.jpg)
![Page 41: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/41.jpg)
![Page 42: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/42.jpg)
![Page 43: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/43.jpg)
SR, SBTR 4623
• 72F
• Bilateral lower limb pain & loss of power and paraesthesia both thighs
![Page 44: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/44.jpg)
![Page 45: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/45.jpg)
Ritchie
![Page 46: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/46.jpg)
![Page 47: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/47.jpg)
![Page 48: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/48.jpg)
![Page 49: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/49.jpg)
Chondrosarcoma – conventional
• de novo (primary) or from a pre-existing enchondroma or exostosis (secondary)
• Central,within the medullary canal or peripheral on bone surface
• 10% of malignant primary bone tumours• predominantly middle aged and elderly • Males: females; 2:1• axial skeleton, pelvis, ribs, shoulder girdle
proximal femur and humerus. Hands and feet rare
![Page 50: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/50.jpg)
Proportion of tumours
% metastatic rate
grade 1 64% 5%
grade 2 21% 14%
grade 3 15% 75%
![Page 51: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/51.jpg)
Chondrosarcoma
Clinical and Imaging• 7 - 12% of primary malignant spinal tumours• 4th – 6th decades• Low grade - geographic growth pattern• High grade - permeative growth pattern• CT detects mineralisation in 90% • MR – Unmineralised cartilage shows lobules of
high signal on T2W separated by low signal septae
• Calcifications may display signal voids
T1W
T2W
CTDifferential diagnosis• Chordoma • Metastasis• Myeloma • Giant cell tumour
![Page 52: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/52.jpg)
SBTR 4322, CH, 18F,4/12 Hx right buttock / thigh pain and inguinal paraesthesia More recently bilateral thigh and buttock pain Urinary problems and decreased perianal tone
![Page 53: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/53.jpg)
![Page 54: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/54.jpg)
![Page 55: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/55.jpg)
![Page 56: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/56.jpg)
![Page 57: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/57.jpg)
![Page 58: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/58.jpg)
Osteosarcoma
a malignant tumour whose cells form osteoid or bone
![Page 59: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/59.jpg)
![Page 60: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/60.jpg)
CH
![Page 61: Primary bone tumours of the Spine: Imaging and Pathology David Ritchie Robin Reid.](https://reader031.fdocuments.us/reader031/viewer/2022032600/56649db45503460f94aa54cb/html5/thumbnails/61.jpg)
OsteosarcomaClinical and Imaging• 5% of primary malignant spinal
tumours
• 4th decade (older than long bone)
• Associated with Paget’s, DXRT
• Mixed lytic / sclerotic appearance
• Aggressive, soft tissue extension
• Osteoid mineralisation
T1W T2W
T1WCT
Differential diagnosis
• Ewings• Chondrosarcoma • Metastasis• Osteoblastoma• Lymphoma