Tumores
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1. The key factors for diagnosing bone tumors on conventional radiography include location, age, margins, periosteal reaction, transition zone, number of lesions, size, and soft tissue compromise. 2. Certain features like geographic lesions, periosteal reactions, mineralization patterns, and cortical changes provide clues about a tumor's aggressiveness and likelihood of being benign or malignant. 3. Integrating location, age, and other radiographic characteristics can lead to a short differential diagnosis or even a definitive diagnosis for many bone tumors on conventional radiographs alone.
Tumores
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- 2. Tumores oseosTumores oseos por radiografia convensional From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Received June 15, 2006; revision requested August 7; revision received December 9, 2007; accepted February 9; final version accepted April 9; final review and update by the author, October 3 RSNA, 2008
- 3. Lo mas importante para el diag. LocalizacionLocalizacion EdadEdad Otros son: 損 Margenes 損 Reaccion periostica 損 Zona de transicion 損 Numero de lesiones 損 Tama単o 損 Compromiso de partes blandas
- 4. Prevalencia por edadPrevalencia por edad Asociado a irradiacion linfoma
- 5. Tienen una tipica prevalencia por edad <20 20 a 40 --->40 a単os Una lesion bien definida con una reaccion periostica gruesa y uniforme BG Bordes mal definidos y reaccion periostica espiculada. MLG La mineralizacion del tumor: tejido condral suele ser Puntiforme, en islotes o arciforme Tejido oseso en cambio es algodonosa o irregular
- 6. Un punto importante es que la descripcion clasica para la RX convensional puede ser aplicada a la TC No as鱈 a la RM, dado que el edema de tej. Blandos y el compromiso de la medula puede provocar la sobreestimacion de la agresividad de un tumor bg.
- 7. localizacionlocalizacion Localizacion longitudinal y transversal ( cortical o medula) Pero en huesos peq. Como los metacarp. El tumor puedo ocupar todo y dificulta su identificacion. Medular y excentrico
- 8. Independientemente de si son mlg. O bg. Occurren en un sitio en particular El osteosarcoma en loc. De rapido crecimiento: metafisis ewing.: sigue la distribucion de la medula roja
- 11. margenesmargenes Los margenes y la zona de transicion con las estructuras normale son claves Una lesion focal es denominada geografica
- 12. Lesiones geograficasLesiones geograficas tipo I atipo I a Bien definida con anillo esclerotico Figure 3: Type 1a geographic lesion. (a) Diagram shows well-defined lucency with sclerotic rim. (Adapted and reprinted, with permission, from reference 1.) (b) Lateral radiograph shows intraosseous lipoma of the calcaneus, with a sclerotic
- 13. Lesiones geograficasLesiones geograficas tipo Ibtipo Ib Bordes bien definidos sin anillo esclerotico Type 1b geographic lesion. (a) Diagram shows well-defined lucent lesion without sclerotic rim. (Adapted and reprinted, with permission, from reference 1.) (b) Anteroposterior radiograph of femur shows well-defined geographic lytic focus of myeloma without a sclerotic rim. Notice the endosteal scalloping
- 14. Lesion osteolitica focal con bordes pobremente definidos Type 1c geographic lesion. (a) Diagram shows ill-defined lytic lesion. (Adapted and reprinted,with permission, from reference 1.) (b) Lateral radiograph of femur in patient with osteosarcoma shows large ill-defined lytic lesion (large black arrows). Note Codman trianglesCodman triangles (large white arrows), periosteal interruption (small white arrow), and tumor-induced new bone production (small black arrow). The diaphyseal location is unusual for Lesion geograficaLesion geografica IcIc
- 15. Las lesiones tipo I suelen ser benignas Pero una excepci坦n puede ser el tumor de celulas gigantes y aunque ms raro las mts!
- 17. Lesion geografica tpo IILesion geografica tpo II Lesion infiltrativa con bordes mal definidos Con un patron en mordedura de rata Type 2 moth-eaten lesion. (a) Diagram shows patchy lysis of medullary cavity. (Adapted and reprinted, with permission, from reference 1.) (b) Anteroposterior radiograph of osteosarcoma shows illdefined patchy lytic lesion involving medullary cavity (long solid arrows) and cortex (open arrow). Also note multilamellated periosteal reaction (short solid arrows)
- 18. Lesion geografica tipo IIILesion geografica tipo III Infiltrante mal definida con un patron con areas parcheadas y peque単as Type 3 permeated lytic lesion. (a) Diagram shows small patchy lucencies in medullary cavity.(Adapted and reprinted, with permission, from reference 1.) (b) Anteroposterior radiograph shows fine permeated pattern involving cortex and medullary space of diametaphysis of proximal portion of tibia (arrows) in a patient with Ewing sarcoma. (Image courtesy of Marcia Blacksin, MD, University of Medicine and Dentistry of New Jersey, Newark, NJ.
- 19. Es tipico de las celulas peque単as, redondas y azules .
- 20. Las lesiones tipo III suelen ser malignas pero excepciones pueden ser la osteomielitis y el tumor de cel. De Langerhans
- 21. Reaccion periosticaReaccion periostica Solida o una sola capa es bg. Dado que indica crecimiento lento
- 22. Unilamellated periosteal reaction. (a) Diagram shows single layer of reactive periosteum (arrow).(Adapted and reprinted, with permission, from reference 2.) (b) Anteroposterior radiograph of the knee in patient with hypertrophic osteoarthropathy shows thick unilamellated periosteal reaction (arrows
- 23. Reaccion periostica En capas de cebolla representa una lesion con un grado intermedio de mlg. ( un t. Que quiere explotar la cortical y no puede)
- 24. Multilamellated periosteal reaction. (a) Diagram shows multilamellated, or onionskin, periosteal reaction (arrow). (Adapted and reprinted, with permission, from reference 2.) (b) Anteroposterior radiograph in a patient with osteosarcoma shows multilamellated periosteal reaction (arrow) in proximal portion of femur. Note also large surrounding soft-tissue mass. See also Figure 6b. (Image courtesy of David Disler,MD, Commonwealth Radiology, Richmond, Va.)
- 25. Reaccion periostica La interrupcion del mismo implica un alto grado de mlg. Independientemente de si es uni o multilaminar espiculado-perpendicular-radiado Puede dar lugar al triangulo de codman( asociado gral. Al osteosarcoma
- 26. Codman triangleCodman triangle. (a) Diagram shows elevated periosteum (arrow) forming an angle with the cortex. (Adapted and reprinted, with permission, from reference 2.) (b) Lateral radiograph in patient with osteosarcoma shows the elevated periosteum forming Codman triangle (long arrow). Notice the tumor-induced new bone formation
- 27. El triang. De Codmann puede ser producido por un proceso bg. , un hematoma o infeccion
- 28. Perpendicular periosteal reaction. (a) Diagram shows spiculated, or hair-on-end, periosteal reaction (arrow). (b) Diagram shows radial, or sunburst, periosteal reaction (arrow). (Fig 10a, 10b adapted and reprinted, with permission, from reference 2.) (c) Anteroposterior radiograph in patient with osteosarcoma shows marked perpendicular periosteal reaction in proximal portion of femur. (Image courtesy of Marcia Blacksin, MD, University of Medicine and Dentistry of New Jersey, Newark, NJ.)
- 29. MineralizacionMineralizacion Pueden ser liticos osificantes o mixtos El proceso litico puede provocar un secuestro de hueso sano
- 30. Mineralizacion del cartilago Chondral mineralization. (a) Diagram shows patterns and of mineralization of cartilaginous tumor matrix: stippled (left), flocculent (middle), and ring and arc (right). (Adapted and reprinted, with permission, from reference 3.) (b) Lateral radiograph of proximal portion of tibia shows enchondroma with punctate and arclike mineralization ( arrows)
- 31. Mineralizacion de t. osificantes Diagram shows patterns of mineralization of osseous matrix with solid (left), cloudlike (middle), and ivory- like (right) opacity.
- 32. Tama単o y numeroTama単o y numero Por ejemplo el nido del osteoblastoma es > 1.5 cm mientra que el del osteoma osteoide es <1.5 cm Una lesion litica en la corteza <3cm es un defecto fibroso cortical y si es >3cm es un fibroma no osificante Lesion de 1a 2 cm condral en hueso largo es un encondroma una > 4cm condrosarcoma Los t. 1尊 son unicos. ( salvo los tumores pardos)
- 33. Si el t. Es de rapido crecimiento va a romper la corteza y el periostio como ya fue mencionado. En cambio en los t. De crecimiento lento se produce un balonamiento de la cortical que puede ser normal o fina
- 34. Aneurysmal bone cysts. (a) Anteroposterior radiograph of the pelvis shows expansile lytic lesion of right acetabulum with thinning of the cortex (arrow)and honeycomb trabeculation. Flat bones are a common location for aneurysmal bone cysts. (Image courtesy of Marcia Blacksin, MD, University of Medicine and Dentistry of New Jersey, Newark, NJ.) (b) Anteroposterior radiograph of proximal portion of tibia and fibula shows expansile lytic lesion in proximal fibular metaphysis, with mild honeycombing (black arrows). Eccentric origin of the lesion is hard to appreciate in thin bones such as the fibula; both cortices are ballooned, with focal loss laterally (white arrow). (Image courtesy of David Disler, MD, Commonwealth Radiology, Richmond, Va.) (c) Anteroposterior radiograph of distal forearm and wrist shows more typical eccentric location of aneurysmal bone cyst in distal metaphysis of the radius, although this particular lesion lacks a honeycomb appearance. Cortex
- 35. saucerizacionsaucerizacion Es cuando el proceso t. Comienza desde afuera y erosiona el hueso.. Si la matriz no se osifica esto puede ser el unico indicio del tumor. Se ve feo pero no indica mlg.
- 36. Buttress periosteal reaction. (a) Diagram shows beaklike solid periosteal buttress formation (arrow). (Adapted and reprinted, with permission, from reference 2.) (b) Anteroposterior radiograph of humerus in a patient with periosteal chondrosarcoma shows periosteal buttress (short white arrow). Note welldefined saucerization of humeral shaft (black arrows) and faint mineralization of the matrix (long white arrow).
- 37. La presencia de compromiso de partes blandas con un t. Oseo es indicativo de mlg. Los ms frecuentes son el osteosarcoma, el t. De Ewing. Y el linfoma Lateral radiograph of distal portion of femur shows osteosarcoma with amorphous tumor-induced new bone formation (black arrows). Note the large soft-tissue mass (white arrows) that displaces adjacent fat.
- 38. Asi el dg. De los t. Oseos se puede basar en la RX convensional Prestando atencion a la edad y a la localizacion del t. ( sumado a las otras caracteristicas del mismo) se puede llegar a un peq. Pool de diag. Diferenciales o al diag.unico.
- 39. Esto es todo chicos........
- 55. m