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Radiology pediatric bone tumors

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  • 1. Hamartomatous fibro-osseous metaplasia Age: 10-70; common in 2nd- 3rddecade Common locations: femur, tibia, pelvis, ribs, skull 70% monostotic

2. Radiography: Variable: fibrous matrix- ground glass osteoid matrix-sclerotic Zone of transition narrow (sclerotic rim) 3. -Sclerotic lesion in femursecondary to presence ofincreased woven bone-Pathologic fracture 4. 90% unilateral 3% Albrights Syndrome precocious puberty, caf-au-lait spots, polyostotic bonelesions Femur- Sheppards crook varus deformity Cherubism- expanding facial bones, sinuses Pregnancy- lesions may enlarge 5. Monostotic: UBC Polyostotic: Olliers disease, mets Rib lesions: EG, Ewings, mets Skull base: meningioma- skull base hyperostosis,Pagets 6. -Differential Dx: UBC- FD may appear verycystic on MR-UBC cold on bone scan; FD- warm 7. Occurs only in the tibia and fibula Infants and children X-ray: mixed lucent/sclerotic, thickened cortex(anterolateral), anterior bowing, synchronoustibia/fibula DDX: adamantinoma (epithelial nature) slightly older age >20 8. Epiphyseal lesion Age: 2 y.o. and < 20 y.o. Histo: fibroblasts and giant cells Usually regress with age; rarely seen in 30s Usually an incidental finding 16. Radiography Unilateral or bilateral Osteolytic lesion; well defined; sclerotic margin; oval,scalloped, lobulated, eccentric, Metadiaphyseal, cortically based, Periosteal reaction absent- unless path fracture Femur: posteromedial; healing begins in diaphysealregion 17. Jaffe-Campanacci Syndrome Multiple NOFs Caf-au-lait spots Mental retardation precocious puberty, hypogonadism, cryptorchidism, ocularanomalies, cardiovascular anamolies 18. T1T2T1 GAD 19. Uncommon: long bones, spine, hands, feet,pelvis, shoulder Age: 5- 20 y.o. Usually metaphyseal Highly vascular expansile lesion; multiple cavities-filled with blood Primary or secondary lesion; solid component 20. Radiography Expansile, geographic lytic lesion; eccentric Usually metaphyseal Margin- sharp, nonsclerotic; outer margin thinned, maybe imperceptible radiographically MRI/ CT fluid-fluid levels DDX: UBC, NOF, FD, Osteoblastoma- spine,Telangiectatic osteosarcoma 21. Long bones- (prox humerus/ femur) metaphyseal-move toward diaphysis with bone growth Age: 1sttwo decades of life Bone cyst- serosanguineous fluid Bony septations Pathologic fractures 2/3s of cases 22. Radiography Well-defined lytic lesion- central in medullary space;bone expansion, sharp margin Periosteal reaction only in presence of path fracture-fallen fragment sign Radiolucent with trabeculation DDX: FD, ABC, NOF 23. Nonneoplastic lesion of bone(reticulohistiocytosis) Usually solitary- EG Multiple- Hand-Schuller-Christian Systemic- Letterer-Siwe Long bones, skull, spine, ribs, pelvis Age: 1sttwo decades (5 10 y.o.) 24. Radiography Variable: osteolytic oval, slow growing lesionoccasionally aggressive appearing Medullary space; centrally located Periosteal reaction 10% of cases Nucs scan negative 1/3 of cases 25. Metaphyseal- epiphyseal lesion; long bones Age: 20 - 50 y.o. (growth plate closed) rare underage 15 y.o. Progressive potentially malignant lesion Histo: Giant cells and mononuclear spindleshaped cells 26. Radiography Lytic lesion; arises in metaphysis and extends intoepiphysis; growth plate closed Well defined, nonsclerotic margin, abuts articularsurface, eccentric, usually large (> 4-6cm) Radiographic appearance does not help in determining ifbenign or malignant 27. Exostosis; bony projection with a cap of hyalinecartilage; aberrant cartilage Metaphyseal, points away from joint; long bones,around knee Age: 2nddecade; growth stops when growth platecloses Single or multiple; sessile, pedunculated Malignant potential; increase with multiple lesions 28. Radiography Bony projection; contiguous medullary space and cortex;overlying cartilage cap Pedunculated/ sessile Pain- malignant transformation/ mechanical problems,bursa formation Cartilage cap; normally < 1-2 cm 29. DDX: Single lesion: Parosteal osteosarcoma (no continuity ofmedullary space and cortex) Multiple: Enchondromatosis; FD Malignant Transformation: Chondrosarcoma; Pain; Growth after growth plate closes Cartilaginous cap > 2cm thick 30. T1T2T1 GAD 31. Similar to osteoblastoma; < 2 cm in size Femur/ tibia/ bones of the hands/ feet/ spine Usually cortical;Fibrovascular nidus (< 1cm);adjacent reactive bony sclerosis Night pain relieved by aspirin Age: < 25 y.o. 32. Radiography Round/ oval radiolucency (nidus