Lecture 10: Benign Tumours Flashcards by caitlin gill

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?

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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

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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)

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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

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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

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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)

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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

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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

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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

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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

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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.

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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

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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)

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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*

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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)

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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.