Name
Category
Cause
Radiographic Features
Simple Bone Cyst
Bone cyst
-Secondary to
trauma (bone
bruising)
Aneurysmal
Bone Cyst
Bone Cyst
-Trauma?
Osteoma
1° Benign
Bone tumor
N/A
Osteoid Osteoma 1° Benign
Bone tumor
N/A
Primary
Osteosarcoma
N/A
-Eucentrically located in the
bone
-Reactive bone formation trying
to maintain structural integrity
-Radiolucency with sclerotic
border
-"Soap-bubble appearance" with
septa in between cavities
(fibrinous tissue)
-Large radiolucency and thin
sclerotic border
-Eccentric lesion (expansile)
-Densely sclerotic (white) with
well-formed bony projections
(may have periosteal lifting)
-Cortex in-tact
-Nidus (area of radiolucency)
within the tumor area from
vascular overgrowth
-1cm in diameter
-Excessive reactive bone
formation around nidus
-Long zone of transition
-Disruption of cortex, invades
soft tissue, Codman's Triangle
Periosteal lifting (sunburst
appearance)
1° Malignant
Bone Tumor
Clinical
Features/Notes
-Asymptomatic until
pathological fracture
-Maybe palpable mass
-25% may expand the bone
-Fluid filled cyst
MC site, age, gender
-Protrustion or bulges (very
large in size b/c Flow in of
blood > Flow out)
-Pain and swelling
-Pathological fracture
-Neurologic deficits (in spine)
Rare: Gardner's syndrome
can make pre-cancerous
polyps in colon
Onset <20 yrs, Males =
Females
-Humerus and femur
-Pain at night from the PGE2
found at 12x normal levels at
night (increased vasodilation)
-Pain relieved by aspirin
-M:F (2:1), 5-25 years
-Spine, tibia and femur in
diaphyseal/metaphyseal
region
-Pain around the knee,
inflammation, insidious onset
-pain worse at night (deep
boring pain)
Age <20 years, More
common in males
-Found in metaphyseal area
of long bones (60% in knee,
then humerus)
-Aggressive tumor --> 20%
by diagnosis is metastasized
(to lungs, bone, brain)
Male: female (3:1)
-Humerus and femur
Face, skull, sinuses, tibia
Name
Category
Cause
Radiographic Features
Clinical
Features/Notes
MC site, age, gender
Secondary
Osteosarcoma
1° Malignant
Bone Tumor
Paget's Disease
or Chronic
Osteomyelitis
Same as primary osteosarcoma
-From pre-existing bone
pathology or carcinogenic
influence on bone.
-Only 25% of all
osteosarcomas are 2°
osteosarcomas
Males>Females (>25 yrs)
-Common in flat bones
(Ribs)
Osteochondroma 1° Benign
Bone Tumor
N/A, no family
history
1° Benign
Bone Tumor
Familial history
Endochondroma
1° Benign
Bone Tumor
N/A
-Narrow zone of transition
-Cortical thinning, lytic changes
-Endosteal "scalloping" from
faint calcification from Wolff's
law
Chondrosarcoma
1° Malignant
Bone Tumor
Primary: N/A
Secondary:
benign tumor
-Localized bone destruction,
50% stippled calcification
-"Flocculent appearance"
-Mottled areas of increased
radiodensity, may expand bone
-Exostosis (bony) with
cartilage cap covered by
fibrous membrane
-Can be solitary (1), multiple
(<6), or HME
-bony growths
-Painless lumpy joints,
possibly palpable
-May affect growth plate
-25% undergo malignant
degeneration
(chondrosarcoma)
-Asymptomatic unless there
is notable expansion or
fracture
-Solitary lesions enclosed by
vascular fibrous stroma
-"Island of Cartilage" with
cartilaginous matrix
-Soft tissue mass, fracture
-Primary: 75% of
chondrosarcoma
Metaphyseal region
Hereditary
Multiple
Exocytosis (HME)
-Sessile presentation (bony
bump with cartilage cap and
fibrous membrane)
-Pundunculated stalk projection
off the bone, away from joint
space (Cauliflower appearance)
Widespread sessile and
pedunculated presentation
(cauliflower appearance)
-Metaphyseal region
-Males: Females (3:1)
-Foot and Hand region
Primary - Males: Females
(2:1), ribs, shoulder, pelvic
girdle
Name
Category
Cause
Radiographic Features
Clinical
Features/Notes
MC site, age, gender
Fibrous Dysplasia
1° Benign
Bone Tumor
N/A
Monostotic and Polyostotic:
-Well-defined radiolucent lesion
-"Rind sclerotic lesion" (Thinning
of cortex
-Ground glass matrix (micro
bone formation, hazy cloud)
-Any age
-Medullary area in femur,
tibia, ribs and facial bones
-Long lesion go from
metaphyses to metaphyses
Fibrous Cortical
Defect
1° Benign
Bone Tumor
N/A
-Short zone of transition, some
ground glass matrix
-"Blister on bone" lesion, small
area of bony cortex (replaced
with soft yellow-gray tissue)
Monostotic: asymptomatic,
bone may be enlarged or
deformed
-Polyostotic: limb length
disrepencies, dwarfism,
pathological fractures,
abnormalities in skeleton
- Nocturnal leg pain*
-Pathological fracture is rare
-Composed of fibroblast, and
giant cells
-No new bone formation
Fibrosarcoma
1° Malignant
Bone Tumor
N/A
1° Malignant
Bone tumor
(Blood tumor)
N/A
-Low grade pain and swelling
(joint) for up to 2 years
-Sheets of malignant fibrous
tissue that develops slowly
over time
-Non-specific local pain and
tenderness (from the rapid
expansile lesion that causes
periosteal tearing)
-Functional disability
-Pathological fracture
-Multi-nucleated cells within
bone marrow, phagocytic-like
cells
Males > Females, 30-40s yrs
Giant Cell Tumor
-Possible soft tissue mass
-Periosteal lifting, wide zone of
transition, permeative osteolysis
(cortex and trabeculae
destroyed)
-Large expansile lesion of
epiphyses, with thinning of the
cortex, periosteal lifting
-"Soap-bubble" appearance that
is not eccentric, fills epiphyses
and diaphyses
-Multi-lobular in appearance
-Tumor is radiolucent with septa
present
Tibia, fibula, femur (cortical
bone, eccentric lesion)
-Age: 20-40 yrs
-Benign (80-85%) - M:F (2:3)
-Malignant (15-20%) - M:F
(3:2)
-In knees and wrists
Name
Category
Cause
Radiographic Features
Multiple
Myeloma
**MC
malignant 1°
bone tumor
1° Malignant
Bone tumor
(Blood tumor)
N/A
-Tend not to have soft tissue
findings
-No periosteal lifting
-"Punched out lesions" or "MothEaten" lysis
-osteolytic destruction
Hemangioma
*MC benign
tumor of
spine
1° Benign
Bone Tumor
Congenital
vascular
variant
Ewing's
Sarcoma
1° Malignant
Bone tumor
Possible
genetic link?
-"Corduroy" cloth appearance of
vertebral bodies (Vertical
trabeculae do weight-bearing)
-Coarse vertical striations
separated by radiolucencies (only
see it if it occupies >80% of the
vertebrae)
-"Onion skin" or spiculated
periosteal lifting
-Permeative osteolysis with wide
zone of transition
-Disruption of Cortex:
"Saucerization" (shaving of
cortex)
-Large soft tissue mass
Clinical
Features/Notes
-Lack of cardinal signs (but
increased ESR)
-Fatigue, anemia, pale, pain
that is intermittent but
becomes continuous
-Night sweats, weight loss,
cachexia
-Recurrent infections
-osteopenia (deossification of
bone)
-Production of Bence-Jones
proteins that proliferate
rapidly
-Renal disease
-Generally clinically silent
-Localized pain, muscle
spasm, neurologic problems
(rare)
-Caused by blood vessel
proliferation that remodel
the bone.
-Highly aggressive
malignancy in kids
-Tumor is highly necrotic
-Looks like osteomyelitis with
a fever for 1-2 days
MC site, age,
gender
-Vertebral bodies**,
skull, pelvis
-50-70 yrs
-Males>Females
-History of being a
farmer (exposure to
pesticides)
N/A
-5-30 yrs, M>F (2:1)
-Any bone in the *middiaphyses of long bones
and pelvis
-Arises in medullary
cavity
Name
Category
Cause
Radiographic Features
Metastatic
Disease
**MC
malignant
tumor of
bone
2° Malignant
Bone tumor
70% from
metastatic
origin (breast,
lung, prostate
and kidney)
-Osteolytic activity (70%)
-Osteoblastic activity (15%)
-Mixed osteolytic and
osteoblastic (10%)
-Permeative destruction, no
periosteal response, no
expansion
-Soft tissue mass is rare
-Multiple sites of involvement**
(Multiple bones)
Clinical
Features/Notes
-Weight loss, anemia, fever
present in advanced disease
-Skeletal pain (deep boring
pain) as bone is being
replaced with other
substances that may cause
vertebral collapse
-May have increased alk.
phos. in osteoblastic lesions
MC site, age,
gender
**Vertebrae most
commonly affected,
goes to the axial
skeleton and flat bones
-Females: 70% from
breast tissue (C-T
region)
-Males: 60% from
prostate tissue
(lumbars)
-40-50yrs