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:
» Margenes
» Reaccion periostica
» Zona de transicion
» Numero de lesiones
» Tamaño
» Compromiso de partes blandas
5. • Tienen una tipica prevalencia por edad
• <20 –20 a 40 --->40 años
• 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 así 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.
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
9.
10.
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 excepción puede ser el tumor de
celulas gigantes y aunque màs raro las mts!
16.
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 pequeñas
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 pequeñas, redondas y azules
.
20. • Las lesiones tipo III suelen ser malignas
pero excepciones pueden ser la
osteomielitis y el tumor de cel. De
Langerhans
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.)
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. Tamaño y numeroTamaño 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. 1º 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 màs 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.
