Dr.

Rosalina,SpRad

Normal Anatomy
cortex

diaphysis

metaphysis

epiphysis

physis

Medullary
space

Physeal scar

Childhood

Adult

Criteria to Classify Lesions

Age
Location of lesion
Which bone?
Location within bone

Soft tissue involvement

Less reliable

Size
Pattern of bone destruction

Criteria to Classify Lesions

Zone of transition
Margin of lesion
Visible tumor matrix
Polyostotic or monostotic

Malignant Bone Tumors by

Age
1-30
Ewings
Osteosarcoma

30-40
Fibrosarcoma and MFH
Malignant Giant Cell Tumor
Reticulum Cell Sarcoma

Osteosarcoma

AGE
20
Location metaphysis
Margins
3
Periosteal Reaction
irregular
Matrix
bone
Other
DX osteosarcoma

Malignant Bone Tumors by

Age
40+
Mets
Myeloma
(Chondrosarcoma)

Location
Location and age are important

parameters
Most primary tumors arise in areas of rapid

growth
distal femur, proximal tibia, humerus, etc.

Metastases occur in well-vascularized red

marrow
spine, iliac wings, etc.

Location
Enchondroma: phalanges
Osteosarcoma & giant cell tumor: around the

knee
Hemangioma: skull and spine
Chordoma: sacrum and clivus
Adamantinoma: mid-tibia

Location

Pattern of Bone Destruction

Geographic
Well-defined margin
Least aggressive

Pattern of Bone Destruction

Permeative
Poorly demarcated, difficult to visualize
Moth Eaten
Subcategory with larger holes
If mixed, work up as aggressive

Permeative
Ewing
Eosinophilic

Granuloma
Infection
Myeloma,
metastasis
Lymphoma
Osteosarcoma

Motheaten
Myeloma,

metastases
Infection
Eosinophilic
Granuloma
Osteosarcoma
Chondrosarcoma
Lymphoma

Reaction of Bone to Tumor

Margin between tumor and native bone

can be visible on the plain radiograph

Slowly progressive process is walled-

off by native bone, producing distinct

margins
Rapidly progressive process destroys

bone, producing indistinct margins

Zone of transition
Wide
Aggressive

Narrow
Less aggressive

Non-ossifying fibroma-Narrow Zone

Margin Sclerosis
Sclerotic margin
Generally non-aggressive

Lack of sclerotic margin

Suggests more aggressive
Exceptions

Margin

increasing aggressiveness

1A: Sclerotic margin

Simple cyst (UBC)

Enchondroma
Fibrous Dysplasia
Chondroblastoma
Giant Cell Tumor
Chondrosarcoma

1B: Well-defined, non-sclerotic

Giant Cell Tumor
Enchondroma
Chondroblastoma
Myeloma,
Metastatsis
Fibrous Dysplasia
Chondrosarcoma

Giant Cell Tumor:

Well-defined, Non-sclerotic

1C: Lytic, ill-defined margins

Chondrosarcoma
Osteosarcoma
Giant Cell Tumor
Metastasis
Infection
Eosinophilic
Granuloma
Lymphoma

Periosteal Reaction
Limited usefulness
Thick, uninterrupted
Long standing process, often non-aggressive
Stress fracture, Chronic infection, Osteoid osteoma

Spiculated, lamellated
Aggressive process
Tumor likely

Types of
Periosteal
Reaction

Malignant type reaction

Codman Triangle

Periosteal reaction
Codman
Triangle
Advancing tumor margin
destroys periosteal new
bone before it ossifies
Tumor

Tumor Matrix
Chondroid matrix
Calcified rings, arcs, dots (stippled)
Enchondroma, osteochondroma,

chondroblastoma, chondrosarcoma

Osteoid matrix
Dense, homogenous, cloudlike
Osteoid osteoma, bone island,

osteosarcoma

Tumor Matrix
Fibrous Matrix
Diffuse uniform mineralization:

ground glass
Fibrous dysplasia

Matrix

Enchondroma

AGE
56
Location metaphyseal
Margins
1A
Periosteal Reaction
none
Matrix
chondroid
Other
DX enchondroma

Polyostotic vs. Monostotic

Benign polyostotic
Fibrous Dysplasia, Pagets, histiocytosis,

multiple exostosis, multiple

enchondromatosis

Malignant polyostotic
Mets, Myeloma, Ewings with mets,

Osteosarc with mets and MFH.

Biopsy
Sample away from necrotic or

non-aggressive area
Avoid contaminating compartments
Knee- suprapatellar bursa is large
Pelvis- avoid gluteal musculature which

will need for coverage

Unicameral Bone Cyst

AGE
13
Location metadiaphysis
Margins
1A-1B
Periosteal Reaction
none
Matrix
none
Other trabecular struts
DX
UBC

Aneurysmal Bone Cyst

Aneurysmal Bone Cyst

AGE
Location
Margins
Periosteal Reaction
Matrix
Other
DX

adult
metaphysis
1B
none
none
fx
ABC

Non-ossifying fibroma

Giant Cell Tumor

Giant Cell Tumor

AGE
45
Location metaphysis
Margins
1B
Periosteal Reaction
none
Matrix
none
Other epi involvement
DX
GCT

Osteoid Osteoma

Osteoid Osteoma

AGE
45
Location
diaphysis
Margins
1B
Periosteal Reaction
thick
Matrix
faint
Other
DX osteoid osteoma

Multiple Myeloma

AGE
66
Location
diaphyseal
Margins
1A
Periosteal Reaction minimal, thick
Matrix
none
Other
2nd lesion
DX
wait..

Multiple Myeloma

AGE
Location
Margins
Periosteal Reaction
Matrix
Other
DX

66
diaphyseal
2
none
none
wait..

Multiple Myeloma

AGE
Location
Margins
Periosteal Reaction
Matrix
Other
DX

66
flat bone
1B
none
none
multiple
myeloma

Ewings Sarcoma

AGE
Location
Margins
Periosteal Reaction
Matrix
Other
DX

12
diaphysis
3
lamellated
none
Ewing

Ewings sarcoma

onion-skin

Osteosarcoma

Osteosarcoma

AGE
16
Location
diaphysis
Margins
3
Periosteal Reaction
spiculated
Matrix
bone
Other
fx
DX osteosarcoma

Osteomyelitis

Primary lymphoma

Primary lymphoma

Metastatic Adenocarcinoma

Osteosarcoma gross

Osteosarcoma X-ray

Osteochondroma:

Osteochondroma:

Osteochondroma

Chondrosarcoma

Chondrosarcoma - gross

Metastatic tumors:

Osteoblastic Metastasis:
Prostate

Osteoblastic Metastasis:
Prostate

Osteolytic Metastasis: Breast ca

Osteolytic Metastasis: Breast ca

Ewings Sarcoma:

TUMOR KOLON

Kolon, haustrae

KARSINOMA KOLOREKTAL
Salah satu karsinoma paling sering ditemui
Familial tendencies
Insiden meningkat pada penderita dengan adenoma polip dan

ulkus ulseratif
Tumor meluas dengan invasi lokal, melaui pembuluh darah dan

limfatik
Staging Dukes
Adenokarsinoma - histologi

Perdarahan per rektum gejala utama

Gambaran radiologis barium enema :

1.

Penonjolan ke dalam lumen

apple-core' stricture,

Napkin ring

irregular polypoid lesions

plaque- or saddle-like tumour

fungating besar (agak jarang) dan predominan di caecum

Stenosis anular tapi tumor infiltratif difus

2.

Deformitas dinding kolon

3.

Kekakuan / rigiditas dinding kolon