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4	Patterns of Bone Destruction Geographic Moth-eaten Permeative
5	Geographic Bone Destruction Destructive lesion with sharply defined border Implies a less-aggressive, more slow-growing, benign process Narrow transition zone
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7	Geographic Lesions Examples Non-ossifying fibroma Chondromyxoid fibroma Eosinophilic granuloma
8	Moth-eaten Appearance Areas of destruction with ragged borders Implies more rapid growth Probably a malignancy
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10	Moth-eaten Appearance Examples Myeloma Metastases Lymphoma Ewing’s sarcoma
11	Permeative Pattern Ill-defined lesion with multiple “worm-holes” Spreads through marrow space Wide transition zone Implies an aggressive malignancy Round-cell lesions
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13	Permeative Pattern Round cell lesions Lymphoma, leukemia Ewing’s Sarcoma Myeloma Osteomyelitis Neuroblastoma
14	Patterns of Destruction
15	Periosteal Reactions Benign None Solid More aggressive or malignant Lamellated or onion-skinning Sunburst Codman’s triangle
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21	Periosteal Reactions
22	Tumor Matrix Osteoblastic Fluffy, cotton-like or cloud-like densities Osteosarcoma Cartilaginous Comma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibroma
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25	Expansile Lesions of Bone
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34	In the Transverse Plane Central Enchondroma Eccentric GCT, osteosarcoma, chondromyxoid fibroma Cortical Non-ossifying fibroma, osteoid osteoma Parosteal Parosteal osteosarcoma, osteochondroma
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36	In the Longitudinal Plane Epiphyseal GCT, chondroblastoma Metaphyseal Osteomyelitis, osteo- and chondrosarcoma Diaphyseal Round cell lesions, ABC, enchondroma
37	Tumor Types Characteristic Locations Simple bone cyst Proximal humerus Chondroblastoma Epiphyses Giant Cell tumor Epiphyses
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41	Tumor Types Characteristic Locations Adamantinoma Tibia Chordoma Sacrum, clivus Osteoblastoma Spine, posterior
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45	Tumor Types Characteristic Locations Parosteal sarcoma Distal femur Periosteal sarcoma Tibia
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49	Pelvic Lesions Chondrosarcoma Solitary plasmacytoma Chordoma
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53	Expansile Rib Lesions Plasmacytoma Metastases Chondrosarcoma Eosinophilic granuloma Neurofibromatosis Fibrous dysplasia
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60	Lesions of the Spine Osteoblastoma Expansile, with punctate densities within Chordoma ABC Metastatic disease
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66	Sclerotic Cortical Lesions Osteoid osteoma Brodie’s abscess Stress fracture
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70	Sclerotic Cortical Lesions
71	Lytic Lesions in Children Eosinophilic granuloma Neuroblastoma Leukemia
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75	Lytic Lesions in Adults Metastatic lesions Lung Renal Thyroid Multiple myeloma Primary bone tumor
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79	Blastic Lesions in Children Medulloblastoma Lymphoma
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82	Blastic Lesions in Adults Metastatic disease Breast – female Prostate – male Lymphoma Paget’s disease Etcetera-mastocytosis, fluorosis
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88	Benign Lesions Without Sclerotic Boarders Giant Cell tumor Brown tumor Osteolytic phase of Paget’s Disease
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92	Soft Tissue Extension Usually implies malignancy More likely to form discrete soft tissue mass Benign conditions with soft tissue extension Osteomyelitis Usually infiltration of fat
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94	Multiple Lesions More often benign Malignancies with multiple lesions Metastatic disease Multiple myeloma Lymphoma Ewing’s sarcoma (rarely) Osteosarcoma (rarely)
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99	Benign vs. Malignant
100	Click Here for More Information
101	The End
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