Important Bone Tumors

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Author: Dr Ayush Goel

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Important Bone Tumors:

1. Osteosarcoma: 

• Age: 10-20 yrs (except when its secondary e.g. in Paget's disease in old age)
• Metaphyseal
• Sunray periosteal reaction
• note: sunburst calcification on abdominal X-ray is seen in Pancreatic serous cystadenoma
• Codman triangle 
• note: codman tumor is chondroblastoma
• Radioresistant

2. Ewing's sarcoma

• Age: 10-20 yrs
• laminated periosteal reaction: onion skin
• location: diaphyseal
• Radiosensitive

3. Giant cell tumor (GCT) = osteoclastoma

• Epiphyseal
• other epiphyseal lesions - Chondroblastoma, Geode
• Soap bubble appearance
• Metaepiphyseal: Seen after fusion of epiphysis (age 20-50 yrs)

4. Vertebral hemangioma

• X-ray and Sagittal CT: Corduroy cloth appearance
• Axial CT: Polka dot appearance

5. Adamantinoma

• Mandible (Ameloblastoma): 3rd-5th decade
• Tibial diaphysis: 10-20 yrs, typically anterior cortex
• Pituitary (Both pituitary stalk and enamel arise from oral epithelium)

6. Above 60 years, multiple lytic lesions

• Multiple myeloma 
• Normal alkaline phosphatase, cold on bone scan
• punched out lytic lesions
• Metastases
• Increased alkaline phosphatase, hot on bone scan i.e. high uptake

7. Metastases

• Sclerotic/osteoblastic
• Commonly from: Prostate and Breast (can have mixed)
• Other: Stomach, Carcinoid
• Lytic and expansile
• Commonly from Kidney and Thyroid

8. Hyperparathyroidism

• subperiosteal bone resorption
• radial aspect of proximal and middle phalanges of the 2nd and 3rd fingers
• lamina dura: floating teeth
• Salt and pepper skull = pepper pot skull
• Brown tumor
• erosion of lateral end of clavical
• rugger jersey spine (secondary hyperparathyroidism due to renal osteodystrophy)
• note: picture frame vertebra is seen in Paget's disease of bone (also Cotton wool skull in Paget's)
• note: sandwich vertebra is seen in osteopetrosis

9. Eosinophilic granuloma

• children
• beveled edges
• vertebral plana
• floating teeth (also seen with hyperparathyroidism)

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