Professional Documents
Culture Documents
Musculoskeletal Tumors
57 kg
Neurofibromatosis involving
the whole R
lower
extremity
Challenges in Diagnosis
Rare (< 1% from all malignant neoplasm)
Treatment choice can be drastic (amputation)
Radiograph interpretation have its limitation in
differentiating between malignant and benign
lesion: ABC can looked malignant, intraosseous
sarcoma can be seen as benign.
Kilpatrick S, Renner JB, Diagnostic Musculoskeletal Surgical Pathology, 1-4, 2004, Saunders
FNA
Clinical Info
Imaging
Plain
Radiograph
Ultrasound
Scintigraphy
MRI
CT Scan
Sundaram M, McDonald DJ (1989) The Solitary tumor or tumor like lesion of bone. Topics Magn Reson
Imaging 1(4):17-29
Pattern of destruction
Lesion Margin
Geographic, moth-eaten, permeative
Cortex Penetration
Presence of a sclerotic rim
Presence and extent of expanded
cortical shell
Lodwick et al. Radiology 134:577-583,1980
Permeative
Geographic
Dari Jenis
BATAS lesi
3 Jenis
Destruksi
tulang
Destruksi:
Moth eaten
Non-aggressive
Aggressive
Periosteal reaction
Uninterupted
Interupted
Interupted
Prof. Enneking:
Tell me the age Ill tell you the pathology
Location
What bone?
Epi/Met/Dia?
Cortex/Med/
par-ost/para-ost?
Multiple/single?
Calcification
Chondroblastic vs.
Osteoblastic
Calcification
Chondroblastic vs.
Osteoblastic
Role of CT scan
Examine the present
or absence of nidus
Demonstrating lesion
in flat bones
Confirming any
cortical break in
lesion with thin cortex
Help characterized
type of matrix
calcification
Guide to Biopsy
Examples:
MRI of
Bone tumor
Soft tissue
tumors
Plain Film
MRI
Lipoma
Probable
hemangioma/
Other
IM lipoma
Doppler US
Biopsy
Arteriography/ MR
angio
Plain Radiography
To exclude a palpable
lesion caused by an
underlying skeletal
deformity:
* Exuberant callus
* Bony exostosis
* Bone tumor with
soft tissue mass.
Plain Radiography
Soft tissue calsification
characteristic of a specific
diagnosis:
* Phleboliths
* Synovial
osteochondromatosis.
* Myositis ossificans.
Spesific Diagnosis
in MRI
Lipomatous lesions
Angiomatous lesions
Tumorlike lesions
Peripheral nerve lesions
Fibrous lesions
Synovial lesions
Lipoma
Hemangioma
Larger
Deeper
More heterogenous
Bone & neurovascular
involvement
Infiltration to adjacent
compartment
Neurofibroma
Ultrasound + Doppler
Doppler and high resolution
ultrasonography challenges the role
of MRI.
It has a few advantages compare to
MRI; low cost, real time scanning
and more available examination.
Angiomatous lesions
Lipomatous lesions
Neurogenic tumors
cystic masses
Hemangioma
Phleboliths of hemangioma
Lipoma
Hypoechoic
Homogenous
Well defined margin
Oval
Long axis parallel to skin
Compressible
Neurogenic tumors
Big Bursitis
Huge
Bakers Cyst
A case study:
Triple
Diagnosis
Clinical
Findings
Radiology
Pathology
Thank You
Agresifitas
+
Umur
Lokasi
Jenis kalsifikasi
AGRESIF GANAS
NON AGRESIF JINAK
1. Batas Lesi
2. Jenis reaksi
periosteal
3. Besarnya
massa
jaringan
lunak
Batas Lesi
3 Jenis margin
3 Jenis Destruksi
Benign/
Malignant
Periosteal
reactions: