Pattern Of Bone Destruction
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Pattern of Bone Destruction •
GEOGRAPHIC BONE DESTRUCTION Cause (a) slow-growing usually benign tumor : (b)rarely malignant: plasma cell myeloma, metastasis (c) infection: granulomatous osteomyelitis
well-defined smooth / irregular margin short zone of transition •
MOTH-EATEN BONE DESTRUCTION Cause (a) rapidly growing malignant bone tumor : (b) osteomyelitis
less well defined / demarcated lesional margin longer zone of transition mnemonic H LEMMON : o o o o o o o •
Histiocytosis X Lymphoma Ewing sarcoma Metastasis Multiple myeloma Osteomyelitis Neuroblastoma
PERMEATIVE BONE DESTRUCTION Cause aggressive bone tumor with rapid growth potential (eg, Ewing sarcoma) : poorly demarcated lesion imperceptibly merging with uninvolved bone long zone of transition
Size, Shape, and Margin of Bone Lesion Primary malignant tumors are larger than benign tumors elongated lesion (= greatest diameter of >1.5 times the least diameter): Ewing sarcoma, histiocytic lymphoma, chondrosarcoma, angiosarcoma sclerotic margin (= reaction of host tissue to tumor)
Tumor Position in Transverse Plane •
•
•
•
CENTRAL MEDULLARY LESION o Enchondroma o Solitary bone cyst ECCENTRIC MEDULLARY LESION o Giant cell tumor o Osteogenic sarcoma, chondrosarcoma, fibrosarcoma o Chondromyxoid fibroma CORTICAL LESION o Nonossifying fibroma o Osteoid osteoma PERIOSTEAL / JUXTACORTICAL LESION o Juxtacortical chondroma / osteosarcoma o Osteochondroma o Parosteal osteogenic sarcoma
Tumor Position in Longitudinal Plane •
•
•
EPIPHYSEAL LESION o Chondroblastoma (prior to closure of growth plate) o Intraosseous ganglion, subchondral cyst o Giant cell tumor (originating in metaphysis) o Clear cell chondrosarcoma o Fibrous dysplasia o Abscess mnemonic CAGGIE : o Chondroblastoma o Aneurysmal bone cyst o Giant cell tumor o Geode o Infection o Eosinophilic granuloma [after 40 years of age throw out “CEA†and insert metastases / myeloma] METAPHYSEAL LESION o Nonossifying fibroma (close to growth plate) o Chondromyxoid fibroma (abutting growth plate) o Solitary bone cyst o Osteochondroma o Brodie abscess o Osteogenic sarcoma, chondrosarcoma DIAPHYSEAL LESION o Round cell tumor (eg, Ewing sarcoma) o Nonossifying fibroma o Solitary bone cyst o Aneurysmal bone cyst
Enchondroma Osteoblastoma Fibrous dysplasia mnemonic FEMALE : o Fibrous dysplasia o Eosinophilic granuloma o Metastasis o Adamantinoma o Leukemia, Lymphoma o Ewing sarcoma o o o
Tumors Localizing to Hematopoietic Marrow • • • •
Metastases Plasma cell myeloma Ewing sarcoma Histiocytic lymphoma
GEOGRAPHIC BONE DESTRUCTION Cause (a) slow-growing usually benign tumor : (b)rarely malignant: plasma cell myeloma, metastasis (c) infection: granulomatous osteomyelitis
well-defined smooth / irregular margin short zone of transition •
MOTH-EATEN BONE DESTRUCTION Cause (a) rapidly growing malignant bone tumor : (b) osteomyelitis
less well defined / demarcated lesional margin longer zone of transition mnemonic H LEMMON : o o o o o o o •
Histiocytosis X Lymphoma Ewing sarcoma Metastasis Multiple myeloma Osteomyelitis Neuroblastoma
PERMEATIVE BONE DESTRUCTION Cause aggressive bone tumor with rapid growth potential (eg, Ewing sarcoma) : poorly demarcated lesion imperceptibly merging with uninvolved bone long zone of transition
Size, Shape, and Margin of Bone Lesion Primary malignant tumors are larger than benign tumors elongated lesion (= greatest diameter of >1.5 times the least diameter): Ewing sarcoma, histiocytic lymphoma, chondrosarcoma, angiosarcoma sclerotic margin (= reaction of host tissue to tumor)
Tumor Position in Transverse Plane •
•
•
•
CENTRAL MEDULLARY LESION o Enchondroma o Solitary bone cyst ECCENTRIC MEDULLARY LESION o Giant cell tumor o Osteogenic sarcoma, chondrosarcoma, fibrosarcoma o Chondromyxoid fibroma CORTICAL LESION o Nonossifying fibroma o Osteoid osteoma PERIOSTEAL / JUXTACORTICAL LESION o Juxtacortical chondroma / osteosarcoma o Osteochondroma o Parosteal osteogenic sarcoma
Tumor Position in Longitudinal Plane •
•
•
EPIPHYSEAL LESION o Chondroblastoma (prior to closure of growth plate) o Intraosseous ganglion, subchondral cyst o Giant cell tumor (originating in metaphysis) o Clear cell chondrosarcoma o Fibrous dysplasia o Abscess mnemonic CAGGIE : o Chondroblastoma o Aneurysmal bone cyst o Giant cell tumor o Geode o Infection o Eosinophilic granuloma [after 40 years of age throw out “CEA†and insert metastases / myeloma] METAPHYSEAL LESION o Nonossifying fibroma (close to growth plate) o Chondromyxoid fibroma (abutting growth plate) o Solitary bone cyst o Osteochondroma o Brodie abscess o Osteogenic sarcoma, chondrosarcoma DIAPHYSEAL LESION o Round cell tumor (eg, Ewing sarcoma) o Nonossifying fibroma o Solitary bone cyst o Aneurysmal bone cyst
Enchondroma Osteoblastoma Fibrous dysplasia mnemonic FEMALE : o Fibrous dysplasia o Eosinophilic granuloma o Metastasis o Adamantinoma o Leukemia, Lymphoma o Ewing sarcoma o o o
Tumors Localizing to Hematopoietic Marrow • • • •
Metastases Plasma cell myeloma Ewing sarcoma Histiocytic lymphoma
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