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Benign Bone Tumors (Miscellaneous (Fibrous dysplasia - geographical, mixed…
Benign Bone Tumors
Cartilage
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Enchondroma - Tubular bones of hand and foot. Femur, tibia, humerous
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Chondroblastoma - Epiphysis extending to metaphysis. Age between 5-25. Around the knee, proximal femur and humerous. DDx Brodie's abscess
Chondromyxoid fibroma - rare. Between 10-30 y - Metaphyseal. eccentric, sclerotic margin, lobulated
Bone
Osteogenic
Osteoblastoma - rare. Under 30y. Lytic with periosteal reaction. size >1.5cm. May have extracortical mass
Osteoid Osteoma - Nidus. reactive solid periosteal reaction and medullary sclerosis. Vascular groove sign: vascular channels in the adjacent periosteal reaction. Clinical: night pain relived by medication
Giant Cell
Giant cell tumor - Subarticular or apophyseal. Lytic exapnsile. trabeculations. geographic non-sclerotic margin. Between 20-50 y. Cortical destruction and extraosseous component in 50%. MRI: areas of high SI in T1 in hge. area of low SI in T2 due to hemosidrin deposition
Fibrous
Fibrohistiocytic
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Non ossifying fibroma - Identical histology to FCD. Larger,. Occurs in distal femur and proximal tibia. associated with pathological or stress fracture, so painful.
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Benign fibrous histiocytoma - rare. Identical histology to NOF. lytic subarticular (like GCT). between 30-50y. sclerotic margin
Fibrogenic
Desmoplastic fibroma - rare. Metadiaphyseal. Locally aggressive. 2 types: ill-defined moth eaten, and expanding trabeculated
Other Tissues
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Lipogenic
Intraosseuos lipoma - Calcenous and femur. Lytic expansile with endosteal scalloping. CT and MRI: fat matrix
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Hemangioma - Capillary hemangioma in vertebrae and long bones. Cavernous in skull vault. Fine or coarse vertical trabeculations along the axis of bone. CT: dense dots in fat matrix. MRI: Linear areas of signal void
Miscellaneous
Aneurysmal bone cyst - 20y. Lytic expansile metaphyseal with egg shell covering and trabeculations. Thin sclerotic margin. Multiple fluid fluid levels. Types: primary: long bone and spine. secondary: with NOF, GCT, FD, blastomas
Simple bone cyst - between 5-15y. Proximal humerus then femur metaphysis, extending to diaphysis. lytic expansile, no periosteal reaction. pathological fracture. Fallen fragment sign: a fragment of bone falls into fluid content after fracture (pathognomonic). MRI: fluid with or without fluid-fluid level if hge is present
Fibrous dysplasia - geographical, mixed lytic sclerotic, ground glass mineralization, expansion. Rind sing: thick sclerotic margin. Shepherd crook deformity: varus deformity of proximal femur
Monostotic FD - before 30y. proximal femur, ribs, craniofacial.
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McCune Albright's syndrome - Polyostotic FD, Cafe au lait, endocrine disturbance (precocious puberty)
Mazabraud's syndrome - Myxomas in soft tissue, polyostotic FD
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Osteofibrous dysplasia - rare. histology resembles FD and adamantinoma. Tibia 90%. age < 10y. Tibia expansion and bowing with sclerotic rim then ground glass mineralization.
Lanagerhans cell histiocystosis - idiopathic proliferation of histiocytes (langerhans cells). Lytic, aggressive pattern. between 5-15y
Current classification - localized (single system disease), disseminated (multi-system)
Classic classification - Eosinophilic granuloma, Letterer-Siwe disease, Hand-Shuller-cristian disease.
Erdheim Chester disease - rare. over 40y. bilateral symmetrical metaphyseal and diaphyseal medullary sclerosis