1 Important Bone Tumors

Author: Dr Ayush Goel

Important Bone Tumors:

1. Osteosarcoma: 
  • Age: 10-20 yrs (except when its secondary e.g. in Paget's disease in old age)
  • Metaphyseal
  • Sunray periosteal reaction
    • note: sunburst calcification on abdominal X-ray is seen in Pancreatic serous cystadenoma
  • Codman triangle 
    • note: codman tumor is chondroblastoma
  • Radioresistant
2. Ewing's sarcoma
  • Age: 10-20 yrs
  • laminated periosteal reaction: onion skin
  • location: diaphyseal
  • Radiosensitive
3. Giant cell tumor (GCT) = osteoclastoma
  • Epiphyseal
    • other epiphyseal lesions - Chondroblastoma, Geode
  • Soap bubble appearance
  • Metaepiphyseal: Seen after fusion of epiphysis (age 20-50 yrs)
4. Vertebral hemangioma
  • X-ray and Sagittal CT: Corduroy cloth appearance
  • Axial CT: Polka dot appearance
5. Adamantinoma
  • Mandible (Ameloblastoma): 3rd-5th decade
  • Tibial diaphysis: 10-20 yrs, typically anterior cortex
  • Pituitary (Both pituitary stalk and enamel arise from oral epithelium)
6. Above 60 years, multiple lytic lesions
  • Multiple myeloma 
    • Normal alkaline phosphatase, cold on bone scan
    • punched out lytic lesions
  • Metastases
    • Increased alkaline phosphatase, hot on bone scan i.e. high uptake
7. Metastases
  • Sclerotic/osteoblastic
    • Commonly from: Prostate and Breast (can have mixed)
    • Other: Stomach, Carcinoid
  • Lytic and expansile
    • Commonly from Kidney and Thyroid
8. Hyperparathyroidism
  • subperiosteal bone resorption
    • radial aspect of proximal and middle phalanges of the 2nd and 3rd fingers
    • lamina dura: floating teeth
  • Salt and pepper skull = pepper pot skull
  • Brown tumor
  • erosion of lateral end of clavical
  • rugger jersey spine (secondary hyperparathyroidism due to renal osteodystrophy)
    • note: picture frame vertebra is seen in Paget's disease of bone (also Cotton wool skull in Paget's)
    • note: sandwich vertebra is seen in osteopetrosis
9. Eosinophilic granuloma
  • children
  • beveled edges
  • vertebral plana
  • floating teeth (also seen with hyperparathyroidism)

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