Describing Bone Tumour X-rays

 

Pattern of bone destruction

 

Geographic

- narrow transition from normal to abnormal bone

- margin of the lesion is well defined and easily separated from surrounding bone

- least aggressive

- usually indicative of slow growing lesions / benign tumours

 

Moth-eaten

- wider zone of transition from normal to abnormal

- less well defined lesional margin

- more aggressive

- characteristic of more rapidly growing lesion / malignant bone tumours & osteomyelitis

 

Permeative

- wide zone of transition

- lesion is poorly demarcated

- not easily separated from surrounding normal bone

- aggressive bone lesion with rapid growth potential

- malignant tumours such as Ewing's

 

Visible tumour matrix

 

Calcification

- chondromas, chondroblastoma, chondrosarcoma, chondromyxoid fibroma

- synovial sarcoma

 

Osteoid

- osteosarcomas, ossifying fibromas, osteomas, osteoblastomas

 

Ground Glass

- fibrous dysplasia

 

Cortical erosion

 

Enchondroma / chondrosarcoma

- can lead to endosteal scalloping & new periosteal bone may be laid down

 

ABC

- can expand the cortex rapidly

 

Malignant tumours

- can expand through cortex and lift periosteum

 

Periosteal response

 

Periosteal reaction

- slow growing tumour can evoke a periosteal response

- can get buttress at junction of normal & expanded bone

 

Onion skin pattern

- Ewing's

- multiple layers of periosteal new bone formation

 

Codman's triangle

- OS, Ewing's, infection

- lifting of periosteum at edge of lesion with bone formation

 

Sunburst pattern

- OS

- rays of periosteal bone formation radiating away from the bone

 

Hair on end

- Periosteal osteosarcoma

 

Soft Tissue Mass

 

Primary malignant bone neoplasm

Metastasis

Infection