Bone lesion approach Flashcards
Primary bone lesions are common or rare
Rare
Initial approach
Location and age of the patient
Which lesions are found in those under 30
Eosinophilic granuloma Aneurysmal bone cyst Non - ossifying fibroma Chondroblastoma Simple bone cyst Infection
When over 40 what are the additionla diagnoses to consider?
Infeciton
mets
myeloma
lymphoma
Under 30s describe where Ewings Osteoid osteoma Osteochondroma Aneurysmal bone cyst enchondroma osteosarcoma Chondroblastoma Simple bone cyst would exist
Draw these out
.https://portal.e-lfh.org.uk/LearningContent/Launch/313872
In the over 30s where are
Metastasis myeloma lymphoma metastasis myeloma HPT Enchondroma chondrosarcoma Giant cell tumour Geode
found
https://portal.e-lfh.org.uk/LearningContent/Launch/313872
Single vs multiple lesions
if multiple lesions then differentials are
metastases
myeloma
lymphoma
What exxample is there of a non malignant lesion behaving as an aggressive lesion?
Langerhans cell histiocytosis
infection
What to cover when describing a bone lesion?
Whether the lesion is lytic or sclerotic The pattern of bone destruction Matrix mineralisation The zone of transition (ZT) The cortical response Any periosteal reaction Any soft tissue component
Pattern of bone destruction related to what
intensity and degree of aggression of a destructive bone process
Geographic pattern relates to what?
slow graoth, single focus
well defined margins
least aggressive
Moth eaeten pattern of destruction related to what?
rapidly growing lesions but not fast enough for all the bone to be destroyed.
Can be agressive or non aggressive
Osseous lesions description
Immature, cloud like ossification to mature well defined bony masses
Osseous - exmaple of benign and malignant
Osteoid osteoma and osteosarcoma
Chondral lesions description
Punctate calcification in rings and arcs, c shaped
Examples of chondral bone lesions for benign and malignant
benign (endochroma, chondroblastoma, chondromyxoid fibroma) malignant is chondrosarcoma
description of fibrous lesion
ground glass due to numerous fine spicules of bone
examples of fibrous lesions
benign - fibrous dysplasia and non ossifying fibroma. Malignant is fibrous sarcoma
why do lesions get a sclerotic margin?
the host response to the lesion, if the lesion is slow growing enough that sclerosing can happen at the edges
Expansion with intact cortex implies
slow growth
Scalloping (endosteal) implies
growth of lobules of tumour (especially chondral and fibrous)
Trabeculation is frequent in
in simple cysts and GCTs
Causes of focal periosteol reaction?
Trauma (fracture), infection, tumour
Osteoid osteoma what kind of periosteol reaction?
Solid / cortical thickening
Ewings sarcoma type of periosteal reaction
onion skin
Osteosarcoma type of preiosteol reaction
spiculated
Aneurysmal bone cyst type of periosteal reaction
periosteal buttress
Solid cortical thickening is what assocition?
benign
How does solid corticol thickening come abour?
end point of another pattern of periosteal reaction such as asoteoi dosteoma, chronic osteomyelitis or trauma
Exra osseoous involvement is a dewcription for
malignant features
what other modalities are useful to image bone lesions and why
CT - pattern and edge of the calcifications,
MRI - oedema and soft tissue component,
Scintigraphy - mets
