- Age
- Location
- Destruction pattern
- Opacity lesion (Calcification, Bone forming, Cartillage)
- Lucency lesion
- Periosteal Reaction
- Soft tissue involvement
- Bone forming tumor
- Cartillaginous forming tumor
- Fibroconnective tissue tumor
- Locally aggressive tumor
- Metastasis
- 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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