Thursday, October 14, 2010

Musculoskeletal Tumor

ภาพรังสีของ Bone tumor ต้องดู
  1. Age
  2. Location
  3. Destruction pattern
  4. Opacity lesion  (Calcification, Bone forming, Cartillage)
  5. Lucency lesion
  6. Periosteal Reaction
  7. Soft tissue involvement
ต่อไปเราจะมาดูแยกเป็นกลุ่มๆ กัน คือ
  1. Bone forming tumor
  2. Cartillaginous forming tumor
  3. Fibroconnective tissue tumor
  4. Locally aggressive tumor
  5. Metastasis
  6. Other
 Bone forming tumor
  • Benign
    • Osteoma
      • Age : 30
      • Location : Cortical , M/C @ Frontal and Ethmoid sinus
      • Finding : A small well-defined osteoblastic lesion project to lumen or space area
    •  Enostosis
      • Age : All
      • Location : Central medullary, M/C @ Pelvis, Femur, Rib
      • Finding : well-defined circular sclerotic lesion in medulla + radiated spicule
    • Osteoid Osteoma
      • Age : 7 - 25 (อายุน้อยๆ)
      • Location : Cortical lesion of Diaphysis, M/C @ Femur, Tibia, Lumbar Spine
      • Clinical : Night pain, Relieve when take ASA.
      • Finding : Cortical-based sclerotic lesion with internal nidus (Internal translucency area)
    • Osteoblastoma
      • Age : < 30 ปี
      • Location : แบบไหนก็ได้, M/C @ Spine, Diaphysis of  femur
      • Finding : Well-defined expansile osteolytic lesion with bony sclerosing ring + Internal Ossification
    • Ossifying fibroma
      • Age : < 20 ปี
      • Location : แบบไหนก็ได้, M/C @ Mandible, Maxilla, Tibia, Fibula
      • Finding : Well-defined expansile osteolytic (Early)/Sclerotic (Late) lesion with bony sclerosing ring +Anterior/Anterolateral bowing of long bone
  • Malignant
    • Conventional Osteosarcoma
      • Age : 10 - 30 ปี
      • Location : Medullar part of Long bone metaphysis, M/C @ Femur, Humerus
      • Finding : Ill-defined intramedullary osteolytic and osteoblastic lesion with Codman's triangle or Sunburst Periosteal reaction, Soft tissue mass breakthough bone cortex was seen. No pathological fracture.
    • Telagiectatic osterosarcoma
      • Age : เหมือน Conventional
      • Location : เหมือน Conventional
      • Finding :  Ill-defined or Well-defined intramedullary purely osteolytic lesion without Periosteal reaction, Soft tissue mass breakthough bone cortex was seen. Pathological fracture can be seen 25-30%
Cartillage-forming tumor
  • Benign
    • Enchondroma
      • Age : 20-30 ปี
      • Location : Centrally medullary, M/C @ Diaphysis of Hand & Foot, Metaphysis of long bone
      • Finding : Well-defined, expansile osteolytic lesion with scalloped sclerotic peripheral margin with Calcified chondroid matrix
    • Chondroblastoma
      • Age : 10 - 30 ปี
      • Location : Eccentric medullary lesion, M/C @ Epiphysis of Femur
      • Finding : Well-defined eccentric osteolytic lesion with sclerotic margin. Calcified chondroid matrix can be seen about 50%
    • Chondromyxoid fibroma
      • Age : 10 - 30 ปี
      • Location : Eccentric medullary, M/C @ Metaphysis of tibia, femur
      • Finding : Well-defined eccentric osteolytic lesion with  cortical expansion, endosteal sclerosis, and coarse trabeculation
    • Osteochondroma
      • Age : Child-Adolescent
      • Location : Juxtacorticol, M/C @ Metaphysis of Femur, Humerus, Tibia
      • Finding : Small bone ,protrude through external surface of metaphysis of major bone and point  away from joint, covered with regular, well-defined hyaline cartillagenous cap.
  • Malignant
    • Chondrosarcoma
      • Age : 30 - 60 ปี
      • Location : Eccentric medullary, M/C @ Metaphysis of Femur
      • Finding : Ill-defined osteolytic lesion with Soft tissue and chondriod matrix mass breakthrough bony cortex. Periosteal Reaction can be seen.
Fibroconnective tissue tumor
  • Benign
    • Fibrous cortical defect / Nonossifying fibroma
      • Age : > 2 ปี
      • Location : Eccentric cortical, M/C @ Metaphysis of Lower extremity
      • Finding : Well-defined eccentric osteolytic lesion with sclerotic rim @ cortex. No Periosteal reaction. + Fracture.
  • Malignant
    • Fibrosarcoma
      • Age : 20 - 60 ปี
      • Location : Eccentric Medullary, M/C @ Metaphysis of Long bone, esp. Knee
      • Finding : Any type of osteolytic lesion breakthrough cortex, Soft tissue mass can be seen. Usually no periosteal reaction.
Locally Aggressive tumor
  • Giant cell tumor
    • Age : 20 - 40 ปี
    • Location : Eccentric medullary, M/C @ Metaphysis of Proximal tibia
    • Finding : Eccentric expansile geographic osteolytic lesion. No sclerotic rim or periosteal reaction. Malignant transformation can be seen. + Cortical destruction.
Metastasis
  • Age : > 30 ปี
  • Location : Intramedullary, M/C @ Metaphysis of Long bone, Skull, Body of vertebra
  • Source : Brest, Prostate, Lung, Neuroblastoma, Ewing's, Osteosarc, 
  • Finding : Multiple purely osteolytic / Mixed Osteolytic-osteoblastic / Purely osteoblastic lesion, vary in size and shape. No periosteal reaction or soft tissue mass.
  • Most sensitive = MRI
  • Cover all lesion = Bone Scintigraphy
  • Initial investigation choice = Bone Scintigraphy
Other
  • Benign
    • Bone cyst
      • Age : < 20 ปี
      • Location : Central medullary, M/C @ Metaphysis of Long bone
      • Finding : Central medullary geographic osteolytic lesion with cortical thinning and mild expansion elongated along logitudinal axis + Pathologic fracture (อาจมี เศษกระดูกที่หักอยู่ใน Cyst = Fallen fragment sign)
    • Aneurysmal bone cyst
      • Age : < 30 ปี
      • Location : Central medullary, M/C @ Metaphysis of Long bone
      • Finding : Well-defined expansile osteolytic lesion. + Extension to adjacent soft tissue. 
    • Fibrous Dysplasia
      • Age: 10 - 30 ปี
      • Location : Central medullary, M/C @ Diaphysis of long bone.
      • Finding : Expansile geographic osteolytic lesion present in ground glass appearance.
      • May be seen deformity of Femoral neck + Proximal shaft = "Shepherd's crook deformity"
  • Malignant
    • Ewing's Sarcoma
      • Age : < 30 ปี
      • Location : Central medullary, M/C @ Metadiaphysis of Lower extremity
      • Finding : Medullary permeative/Moth-eaten osteolytic lesion, Cortical destruction and soft tissue mass can be seen. Present of periosteal reaction (any type).

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