2. Benign Tumors Flashcards
A round/oval, well circumscribed uniformly opaque calcific radiopacity that arises in membranous bones
Osteoma
usually less than 2 cm
MC benign tumor of nose and paranasal sinuses
Osteoma
found in paranasal sinuses, inner and outer skull tables
Osteoma
Fills the entire sinus
and may cause ocular disturbances, headaches, and sinusitis
Giant Osteomas
Mandibular Osteoma will cause
Mechanical and cosmetic problems
Osteomas may be associated with what syndrome?
Gardner’s Syndrome
Colonic polyposis, soft tissue fibromas, and multiple osteomas that are protuberant, oval, dense.
Gardener’s Syndrome:
Discrete area of sclerosis in located anywhere (except skull)
Bone Island (Enostoma)
Bone islands are symptomatic or Asymptomatic?
Asymptomatic and clinically insignificant
what distinguishes a Bone Island from blastic metastasis?
Brush border
bone islands affect what part of the bone?
Epiphysis and metaphysis but NOT the diaphysis
A giant bone island is larger than
1.0cm
DDx for Bone Island: (Enostoma)
- Blastic metastasis
- Osteoid osteoma
- Osteoma
- Osteopoikilosis
Bone Island are possibly caused by cortical bone that has failed to undergo __________ during the process of endochondral
ossification
medullary
resorption
Bone islands typically appear
as
round-to-ovoid sclerotic
intramedullary foci
The long axis of the bone
island is aligned ______ to
the long axis of the bone
parallel
Bone islands are composed of
cortical bone and appear as what signal intensity?
low signal intensity on MRI on all pulse sequences
Do bone islands typically appear “hot”
on bone scans?
NO
Radiolucent nidus with surrounding reactive
sclerosis in 10-25 yo.
Osteoid Osteoma
Pain from an osteoid osteoma is relieved by
aspirin
Gradual severe deep aching pain than can be referred to a nearby joint, worse at night, with Limited ROM, painful limp, stiffness, and weakness
Osteoid Osteoma
Painful rigid scoliosis from an Osteoid Osteoma is usually on the ______ side
of curve
concave
What bones does an osteoid osteoma affect?
50% in tibia and femur and 10% in spine
Osteoid Osteomas are
usually less than
1.0 cm
Highly vascularized fibrous connective tissue in osteoid osteomas
nidus (may not be seen)
may need what to Dx osteoid osteoma?
CT
Intramedullary OO do not produce much sclerosis
except the sclerosis
outside of the capsular bone region
Helps show bone edema around the nidus
MRI
Very high levels of have _________ been found in the
osteoid osteoma lesion
prostaglandins
– Aspirin also relieves pain (worse at night)
– Nidus >1.0 cm in size
– No angiographic vascular blush
Brodie’s Abscess
success in 92 % of Osteoid Osteoma cases
Thermocoagulation
Osteoid Osteoma spinal lesions in the posterior arch need
surgery
Central sclerotic focus in a radiolucent nidus, characteristic
of of
osteoid osteoma
a safe and effective method for treatment of osteoid osteoma
at any location
Percutaneous thermocoagulation
2-10 cm expansile lesion with a eggshell-thin cortical margin found in 10-20 yo
Osteoblastoma
Osteoblastomas are usually located in the?
posterior neural arch of the spine
Pain that is usually NOT at night and NOT relieved by aspirin
Osteoblastoma
Osteoblastoma my be
sclerotic
Osteoblastoma treatment for small and large lesions
Excision/curettage for small lesions and Radiation therapy for inoperable spinal lesions
Small percentage of osteoblastomas become
malignant
cortical expansion and mass with
ossific matrix
Osteoblastoma
Osteoblastoma will show ____ signal intensity in the surrounding soft
tissues consistent with _____
high, edema
Arises from residual islands of cartilage left in metaphysis as physis grows away in the hands (50%) and feet in 10-30 yo
Solitary Enchondroma
m/c benign tumor of hand
Solitary Enchondroma
Usually a painless tumor in the hands (50%) and feet
May see pathologic Fx
Solitary Enchondroma
Sudden onset of pain without trauma signals
malignant transformation of a Solitary Enchondroma to a
chondrosarcoma
Geographic radiolucent expansile
lesion centrally placed in the metaphysis with ENDOSTEAL SCALLOPING
Solitary Enchondroma
50% of Solitary Enchondroma’s have __________ due to
cartilagenous matrix
punctate calcification
Neuroarterial lesion in hand causing pressure erosion of tuft
Glomus (vascular) tumor
Post trauma introduction of epidermoid tissue into bone
Inclusion cyst
skin puncture causes fibrous outer lining and filled with a soft,cheese-like material (keratin)
Epidermal Inclusion Cyst
functions to regulate skin circulation
normal glomus unit (neuromyoarterial apparatus)
m/c site of glomus tumors is ______ and
75% of the lesions occur in the ____
subungual, hand
Solitary Enchondroma malignantly transforms to a Chondrosarcoma when located close to or within
axial skeleton
If pathologic Fx of Solitary Enchondroma, treat with…
casting, curettage, or replace with bone chips, or cement packing (calciumphosphate)
should benign lesions should be irradiated?
no
Expansile, lytic lesion in the proximal phalanx of the fifth digit with a distinct zone of transition, thinning of the cortex, and a
pathologic fracture
Solitary Enchondroma
Fluffy calcific matrix within the medullary canal
Solitary Enchondroma
Malignant degeneration of Enchondromas are more likely with large lesions and
with endosteal scalloping involving over
50% of the cortex
other reported
features of malignant transformation of an enchondroma include
Enlarging radiolucent area, pathologic Fx, or
disappearance of preexisting calcification areas
Multiple Enchondromatosis, aka
Ollier’s disease
Unpainful, Unossified remnants of cartilage in diaphyses and metaphyses that likes small bones of hands and feet
Multiple Enchondromatosis (Ollier’s dz)
MRI is helpful to detect malignant degeneration/transformation of Multiple Enchondromatosis (Ollier’s dz), which occurs at what percent?
10-50%
In Multiple Enchondromatosis (Ollier’s dz), when patients have pain or Rapid growth
malignant transformation should be suspected
Enchondromas are metabolically active or inactive?
ACTIVE
Loss of calcification in a focal region suggests what?
malignant degeneration with destruction of the
underlying enchondroma by sarcomatous tissue
Multiple radiolucent
metaphyseal lesions
Multiple Enchondromatosis (Ollier’s dz)
Enchondromatosis of bone and soft
tissue cavernous hemangiomas m/c affects hands
Maffucci’s Syndrome
Maffucci’s Syndrome has a ___ greater incidence of malignant
transformation than Ollier’s Disease
25%
In Maffucci’s Syndrome, areas of radiolucency
represent _________, and opaque spots represent ________.
enchondromas, phleboliths
hemangiomas from Maffucci’s may occur in
other organs, including the
GI tract
A painful primary benign bone tumor of cartilage origin in 10-25 yo
Chondroblastoma (Codman’s tumor)
Arises from cells of the physis
Chondroblastoma (Codman’s tumor)
Chondroblastoma (Codman’s tumor) are eccentric in location in the medullary canal of the
Femur, proximal tibia and proximal humerus
Eccentric, medullary oval/round lytic lesion in epiphysis with a marginal sclerotic rim and short zone of transition
Chondroblastoma (Codman’s tumor)
Matrix Calcification and possibly solid periosteal reaction
Chondroblastoma (Codman’s tumor)
DDx of Chondroblastoma (Codman’s tumor)
Brodie’s abscess, AVN, and Giant Cell Tumor
treatment for Chondroblastoma (Codman’s tumor)
surgical curettage and bone chip packing
A cartilagenous tumor in 10-30 yo and 50-70 yo composed of chondroid, fibrous, and myxoid tissues
Chondromyxoid Fibroma
Chondromyxoid Fibroma are usually found on the Proximal Third of the
Tibia
Eccentric oval/round geographic lesion with endosteal scalloping and sclerosis along medullary side
(Trabeculated/soap bubble)
Chondromyxoid Fibroma
large, lucent, slightly expansile, eccentric,
metaphyseal lesion with thin sclerotic borders
Chondromyxoid Fibroma
Fibrous Cortical Defects could be associated with
avulsion Fx at a muscle attachment
Posterior-medial surface of distal femur
Fibrous Cortical Defect
a large lesion (>8 cm) due to faulty ossification in 8-20 yo
Non-Ossifying Fibroma
a thin, lytic, eccentric, and ovoid diametaphyseal lesion (2-7 cm) due to faulty ossification in 8-20 yo
Non-Ossifying Fibroma
NOF is m/c at the
distal tibia
Non-Ossifying Fibroma is also called a
Fibrous Xanthoma of Bone
Dense sclerotic border along medullary side
and periosteal reaction with pathologic fx
NOF
NOF has high or low uptake on bone scan?
high
Peripheral sclerotic border with a central lucency
NOF
Fluid filled cyst lined with thin layer of fibrous tissue in 3-14 yo
Simple Bone Cyst
Simple bone cyst, Aka
unicameral (one house) bone cyst
2/3 of Simple Bone cysts undergo
pathologic Fx
Simple Bone Cyst usually hit the proximal
humerus and femur
A Simple Bone Cyst that originates in the metaphysis is considered ____
and one in the diaphysis is ____.
active, latent
Geographic or cystic radiolucency that is broad at the metaphyseal end, and narrower at diaphyseal end with Endosteal scalloping and Light/incomplete septation
Simple Bone Cyst
Simple Bone Cyst have a truncated __________ appearance
cone shaped
There is no matrix calcification with a
Simple Bone Cyst
2 SIGNS of simple bone cyst
Fallen Fragment Sign and Hinged Fragment Sign
A small, detached, floating bone
fragment that changes position in cyst with
movement
Fallen Fragment Sign
fragment is attached at one end but opposite end moves with
movement
Hinged Fragment Sign
Oval, geographic radiolucent lesion in subtalar region of
anterior calcaneus
Calcaneal (Simple Bone) Cyst
Calcaneal (Simple Bone) Cysts usually occurs at the
base of the calcaneal
neck
The major DDx for calcaneal cysts are a
lipoma and trabecular thinning
pseudotumor
Cystic cavity filled with blood in 5-20 yo that is not a true cyst and not an aneurysm but likely post-traumatic
Aneurysmal Bone Cyst (ABC)
Acute pain with rapid increasing severity in 5-20 with spinal stenosis and epidural mass effect
ABC
what explains the neuro changes and spinal stenosis in ABC’s?
ABCs like the posterior neural arch of the spine
Aneurysmal Bone Cysts like what areas?
tubular bones and neural arch of T and L spine
M/C benign bone tumor of clavicle
ABC
Expanding cyst
with eggshell and soap bubble appearance around 8-10 cm in size
Aneurysmal Bone Cyst
Fine septations with thin calcific rim and small flecks of calcification
ABC
Rarest primary benign bone tumor
Intraosseous Lipoma
Lytic lesion with well defined/sclerotic border with a calcific radiopacity of central necrosis in wide age range
Intraosseous Lipoma
Intraosseous Lipomas may be expansile with
endosteal scalloping
Usually asymptomatic and usually found incidentally
Intraosseous Lipoma
Intraosseous Lipoma are m/c in
metaphyses of long bones (tibia/fibula), calcaneus, and metatarsals
Dystrophic calcification in Intraosseous Lipomas is known as
Cockade Sign
Composed of newly formed capillary, cavernous,
or venous blood vessels usually seen over 40 yo
Hemangioma
MC benign bone tumor of spine
Hemangioma
Many hemangioms are not seen on plain film, but seen on
MRI
neuro symptoms from spinal hemangioma are usually from
cord compression
Because the spinal canal vs. cord size is smallest, most symptomatic spinal lesions are in the
mid thoracic spine
may result in death during tooth extraction
due to exsanguination of blood
Hemangioma in Maxilla and Mandible
75% of Hemangiomas are located in the
spine and skull
types of hemangiomas
Capillary and Cavernous
most common type of Hemangiomas
Cavernous
Large, thin walled blood vessels and sinuses surrounded by resorbed bony trabeculae usually in skull and vertebral body
Cavernous Hemangioma
Usually solitary with coarse vertical striations in vertebral body separated by
radiolucent zones called Corduroy Cloth Appearance
Spinal Hemangioma
Corduroy Cloth Appearance
Spinal Hemangioma
Angiomatous vessels replace resorbed bone rendering the vertebral body osteopenic
Spinal Hemangioma
Skull Hemangiomas are
m/c located in the
frontal bone
Sunburst or Spoke-Wheel Appearance
Skull Hemangiomas
Skull Hemangiomas usually destroy the
outer table of skull
Palpable soft tissue mass with phleboliths, usually in forearm/lower leg/paravertebral area,
Soft Tissue Hemangioma
Corduroy Cloth Appearance results in vertebral body being stronger or weaker than neighboring vertebral
bodies
STRONGER
do we restrict activities due to vertebral hemangioma?
NO
Polka Dot Appearance on CT
Hemangioma
Jailhouse Appearance and Corduroy Cloth Appearance on MRI:
Hemangioma
nonvascular matrix tissues of hemangioma
- Fat
- smooth muscle
- bone trabeculae
fibrous tissue - clotted blood products
A greater proportion of fat (T1) in vertebral hemangiomas
is associated with a
reduced likelihood of symptoms
Neural compression in hemangiomas is more likely with a greater
proportion of
hypervascular or hemangiomatous
tissue (T2)
Low T1 signal and high T2 signal for a vertebral hemangioma indicates
more aggressive behavior and common with vertebral collapse
MC benign skeletal growth or tumor
Solitary Osteochondroma
Bony exostosis projecting from external surface and usually has hyaline lined cartilagenous cap
Solitary Osteochondroma
50% of all neoplasms
and 75% occur before age 20
Solitary Osteochondroma
Solitary Osteochondromas are asymptomatic unless
blood vessels, nerves, or joints are disturbed
Solitary Osteochondroma occurs in
any bones preformed in cartilage
Cortex and medullary cavity blend imperceptibly with host bone
Solitary Osteochondroma
what indicates malignant degeneration/transformation of a solitary osteochondroma?
- a cartilage cap >2cm in adults and >3cm in children
- Break in cortex or growing soft tissue mass
Solitary Osteochondroma point away from the joint due to
muscle pull
what is m/c affected by a Solitary Osteochondroma?
Knee metaphysis
Cauliflower and coat hanger Exostoses
Solitary Osteochondroma
Measures cartilagenous cap thickness
MRI
Multiple osteochondromas in 2-10 yo
Hereditary Multiple Exostoses (HME)
Painless lumpy joints that are usually bilateral and symmetric
Hereditary Multiple Exostoses (HME)
- Shortening of ulna
- Outward bowing of radius
- Subluxation of radioulnar joint
Bayonet Hand Deformity
Bayonet Hand Deformity
Hereditary Multiple Exostoses (HME)
– Cauliflower pelvic lesions
Hereditary Multiple Exostoses (HME)
malignant transformation of HME
5-25%, m/c to pelvis and shoulder
HME treatment is usually
surgical resection for cosmetics rather than for symptoms