Lecture 10: Benign Tumours Flashcards
What condition is this?
Describe the lesion?
Haemangioma
Medulla:
-Corduroy cloth (The corduroy sign refers to a vertically oriented, thickened trabeculations in the spine. )
- Round Osteolucent or oval osteolucent appearance in frontal bones
- Other bones may show: Honeycomb appearance, expansile when in long bones, can show mixed osteolytic, osteosclerotic appearance.
Endplate:
-Vertebral endplates unaffected
Periosteal:
- Often has fine dense spicule raditating from the centre “Sunburst or spoke wheel appearance”
- Axial CT will show a “polka dotted” apperance due to the thickened vertebral trabeculae
- Flattend endplate
- Squaring/ picture frame?
Simple Bone Cyst
Nature?
incidence?
location?
Clinical features?
- *Nature:**
- not a neoplasm, fluid filled lined with fibrous tissue
- *Incidence:**
- 80% 3-14 years
- *Location:**
- 50% proximal humerous
- 25% proximal femur
- *Clinical features:**
- Pathological fracture
- fluid filled cavity in metaphysis
- Lined by ibrous connective tissue with mesothelial surface
- Can expand 6-8cm
What is this lesion?
**Aneurysmal Bone Cyst
Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
What is this lesion? What are other DDX?
**Simple bone Cyst
Radiological appearance:**
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
DDX:
Brodies abscess
Suppurative osteomyelitis
Pseudocyst
Osteoid osteoma
Location ?
Clincal features?
Radiological appearance?
DDX?
Location:
- 50% femur or tibia
- Predilection for femoral neck
- 10% spine
Clinical features:
Classic: pain worse at night dramatically relieved by aspirin . Increasingly severe, deep, aching pain of insidious onset.
Radiological appearence:
- See lucent nidus with surrounding scleoris
- Solid peristeal response becomes eveident
DDX:
Brodies abscess
Stress # (ie callus)
Pain pattern may mimic disc though negative neuro findings
Aneurysmal Bone Cyst
Radiographical appearance?
DDX?
- *Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
Osteochondroma
Radiological
- Pedunculated: commonly originate from metaphysis (e.g. distal femur or proximal tibia)
- Stalk continuous with bone cortices and has osteo-cartilage cap. - Sessile broad based, long asymmetrical widening of bone
- Cauliflower: Large lobulated cap, common sites pelvis and ribs
- Pathological #’s are common
DDX:
Malignant degeneration of:
Osteochondroma, Chondrosarcoma parosteal sarcoma
What is this condition?
Osteoblastoma
“Observe the expansile lytic lesion of the posterior tubercle of the atlas *arrow* The geographic destruction leaves clearly defined peripheral cortical margin, suggesting the bengin nature of the tumor”
- Expansile lesion, clearly defined eggshell thin cortical rim
- Most are lucent some may be mottled and generally 4-6cm in diameter
What is this lesion?
- *Chondroblastoma**
- Oval or round lytic lesion in epiphysis with a sharp zone of transition.
- Geographic and usually eccentric though may be centrally placed
- Fluffy cotton wool appearance
What lesion is this? What condition is this?
Osteoid osteoma
*Hallmark photo*“Well-defined radiolucent tumor nidus within the medullary component of the diaphysis of the 5th met. Reactive sclerosis and appositional periostel new bone surround the tumour nidus”
- Lucent nidus with surrounding scleoris
- Solid periosteal response becomes evident
What is this lesion?
Simple Bone Cyst
Radiological appearance:
-Lucent geographic lesion
-Path #’s
-NO Cortical disruption
-Broad at the metaphyseal end
-Narrowing at the diaphyseal end
-Expansile but expansion does not extend beyond the epiphyseal diameter.
Osteoma
Nature?
Location?
Clinical features?
Nature:
-asymptomatic benign tumour of membranous bone
Location:
Usually frontal or ethmoid sinuses
Clinical features?
May interfere with sinus drainage –> chronic sinisitus
-create retro-oribtal pressure, headaches
What lesion is this?
Aneurysmal Bone Cyst
- *Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
- *DDX:**
- Osteoblastoma in spine
- SBC (simple bone cyst)
Osteoid Osteoma
Nature?
Composed of?
- *Nature:**
- Painful with soft nodular centre surrounded by relative sclerosis
- An osteoid osteoma is composed of three concentric parts
1. Nidus: meshwork of dilated vessels, osteoblasts, osteoid and woven bone. May have a central region of mineralisation
- Fibrovascular rim
- Surrounding reactive sclerosis
The nidus releases protglandins = pain
*is osteolytic but looks sclerotic*
Osteoblastoma
Radiological apperance?
DDX?
Radiological appearance:
- *Spine:**
- Expansile lesion
- Clearly defined eggshell thin cortical rim
- Most are lucent some may be mottled and generall 4-6cm in diameter
- In extremities see lytic expansile lesion in the metaphyses or diaphysis
- *DDX:**
- Osteoid osteoma (pain relieved by aspirin)
- Malignant osteosarcoma
- Anuerysmal bone cyst (much more expansile)
What is this lesion?
- *Chondroblastoma**
- Oval or round lytic lesion in epiphysis with a sharp zone of transition.
- Geographic and usually eccentric though may be centrally placed
- Fluffy cotton wool appearance
What condition is this?
What is this lesion? What are the three types?
- *Osteochondroma
- ** Exostoses are defined as benign growths of bone extending outwards from the surface of a bone.
- *Radiological**
- 1. Pedunculated:* commonly originate from metaphysis (e.g. distal femur or proximal tibia)
- Stalk continuous with bone cortices and has osteo-cartilage cap.
- 2. Sessile broad based,* long asymmetrical widening of bone
- 3. Cauliflower:* Large lobulated cap, common sites pelvis and ribs
-Pathological #’s are common
What lesion is this?
“Simple bone cyst of the proximal one-third of the femur was present. This lesion was drained of its serous fluid and struts of bone were placed within the hollow cavity”
*may result in a full hip reconstruction*
- *Radiological appearance:**
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
Primary Benign Tumours and secondary tumours originate from?
- *Primary:** Originates in bone or from bone -derived cells and tissues
- *Secondary:** originates in other sites and spread (mets) to the skeleton (BLTKP BOWL)
Bone Island (enostosis)
- *Nature:** Solitary discrete sclerotic area. Is a focus of compact bone located in cancellous bone
- **Enostoses are likely congenital or developmental and are through to repersent either hamartous lesions or failure of osteoclastic activity during bone remodeling.
Location:
Common ilieum, ischium, and sacrum.
Proximal femur
NEVER the skull*
What is this lesion?
Simple bone Cyst
- Radiological appearance:*
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
Aneurysmal Bone Cyst
- *Nature:**
- non-neoplastic solitary bone lesion
- Blood filled cystic cavity
- secondary abc can occur in the presence of fiant cell, osteosarcoma and fibrous dysplasia
- *Location:**
- 80% in spine and long bones. Usually eccentric
- *CF:**
- Acute onset of pain at the site of lesion following minor trauma. Severity increases rapidly.
Chondroblastoma
Radiologial appearance?
- Oval or round lytic lesion in epiphysis with a sharp zone of transition.
- Geographic and usually eccentric though may be centrally placed
- Fluffy cotton wool appearance
What lesion is this?
Describe it?
**Aneurysmal Bone Cyst
Radiographical appearance:**
- Expanding lytic lesion may reache 8-10 cms
- Eggshell thin periosteal shell
- Usually eccentric creasting saccular protrustions resulting in cortical bulge (ballooning)
-Can appear soap bubble in apperance
DDX:
- Osteoblastoma in spine
- SBC (simple bone cyst)
Hamartoma
Is a benign, focal malformation that resembles a neoplasm in the tissue of its origin.
This is not a mlignant tumour, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at the site, but which are growing in a disorganised mass.
Bone Island
Radiographic appearance
DDX:
- *Margin:**
- Well circumscribed, round or ovoid opaque lesions
- Sclerotic in nature with periosteal response uncommon.
- Not expansile in nature
- Compact lamellar bone within spongiosa
- Metabolic activity cotinuous within the lesion
- *-Intra-medullary lesion**:
- Align with long axis of trabecula and don’t protrude from the cortical surface.
- *Border:**
- Sharply demarcated and may have radiating spicules
DDX:
Ostoeblastic metastisis
Osteoid osteoma (usually painful)
Osteoma (protrudes from cortex)
Actively growing bone island
Chondroblastoma
Nature:
Benign, may undergo malignant degeneration
Incidence:
Young persons lesion
10-25
- *Location:**
- Epiphyseal region of long bones
- Rare in metpahysis
- 90% medulla, 10% in cortex
DDX:
-Brodies abscess
-Ischaemic necrosis
-Giant cell tumour
** classif differences? **
What is this condition?
Describe the lesion?
Bone island
“There is an oval radiopacity within the ischium which repersents a large bone island.
Of notice there is an ovarion shield seen obscuring the pelvic basin and a portion of he pelvic brim”
**Hemangioma
Nature?
Incidence?
Location ?**
Nature:
Made up of capillaries, cavernous or venous blood vessels
Incidence:
Commonest primary bening tumour of the spine
Adults >40-60
Female > male
Location
Spine 50% TL MOST COMMON
Skull 20% USUALLY FRONT
Osteochondroma
Nature
Incidence
Location
Nature:
-Exostosis from cortical surface
-Hyaline cartilage cap
Incidence:
-Most common primary benign skeltal tumour
-Usually discovered before age 20
Location:
Long bones: femurs, humerus, tibia, pelvis, scapula and ribs
What is this lesion?
Describe the lesion?
Osteoblastoma
Radiological appearance:
Spine:
-Expansile lesion
-Clearly defined eggshell thin cortical rim
-Most are lucent some may be mottled and generall 4-6cm in diameter
-In extremities see lytic expansile lesion in the metaphyses or diaphysis
Osteoblastoma
- *Nature:**
- Usually solitary.
- Histologically similar to osteoid and osteoma
- *Location:**
- Common: in neural arches of spine, Sp, Tp and Lamina
- Long bones
- *Clinical features :**
- Pain that is moderately severe and unremitting
think. .. “just keeps blasting” - Pain not relieved by aspirin
What is this lesion?
Osteoblastoma
“Destruction of the lamina and lucency of C2 body is apparent”
- Expansile lesion, clearly defined eggshell thin cortical rim
- Most are lucent some may be mottled and generally 4-6cm in diameter
Haemangioma
Radiologial appearance?
DDX?
Medulla:
-Corduroy cloth (The corduroy sign refers to a vertically oriented, thickened trabeculations in the spine. )
- Round Osteolucent or oval osteolucent appearance in frontal bones
- Other bones may show: Honeycomb appearance, expansile when in long bones, can show mixed osteolytic, osteosclerotic appearance.
- *Endplate:**
- Vertebral endplates unaffected
- *Periosteal:**
-Often has fine dense spicule raditating from the centre “Sunburst or spoke wheel appearance”
-Axial CT will show a “polka dotted” apperance due to the thickened vertebral trabeculae
- Flattend endplate
- Squaring/ picture frame?
DDX?
Paget’s disease
Osteoporosis
Simple Bone Cyst
Radiographic
DDX
- *Radiological appearance:**
- Lucent geographic lesion
- Path #’s
- NO Cortical disruption
- Broad at the metaphyseal end
- Narrowing at the diaphyseal end
- Expansile but expansion does not extend beyond the epiphyseal diameter.
- In the calcaneous characteristic simple bone cyst appearance is geographic, completely lytic lesion at base of calcaneal neck.
- Located inferior to the anterior part of posterior facet (joint articulation)
DDX:
Calcaneous:
Chondroblastoma and giant cell tumour: tend to be central lesion as seen in axial projection
Osteoma
Radiological Features?
Radiological features:
Borders: well cicrumscribed sclerotic appearance within the bone less than 2cms in diameter. Not expansile in nature.
