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Lecture 1: Presentation and staging msk tumour Slide 1 Lecture 1: Presentation and staging msk tumour Slide 2 Lecture 1: Presentation and staging msk tumour Slide 3 Lecture 1: Presentation and staging msk tumour Slide 4 Lecture 1: Presentation and staging msk tumour Slide 5 Lecture 1: Presentation and staging msk tumour Slide 6 Lecture 1: Presentation and staging msk tumour Slide 7 Lecture 1: Presentation and staging msk tumour Slide 8 Lecture 1: Presentation and staging msk tumour Slide 9 Lecture 1: Presentation and staging msk tumour Slide 10 Lecture 1: Presentation and staging msk tumour Slide 11 Lecture 1: Presentation and staging msk tumour Slide 12 Lecture 1: Presentation and staging msk tumour Slide 13 Lecture 1: Presentation and staging msk tumour Slide 14 Lecture 1: Presentation and staging msk tumour Slide 15 Lecture 1: Presentation and staging msk tumour Slide 16 Lecture 1: Presentation and staging msk tumour Slide 17 Lecture 1: Presentation and staging msk tumour Slide 18 Lecture 1: Presentation and staging msk tumour Slide 19 Lecture 1: Presentation and staging msk tumour Slide 20 Lecture 1: Presentation and staging msk tumour Slide 21 Lecture 1: Presentation and staging msk tumour Slide 22 Lecture 1: Presentation and staging msk tumour Slide 23 Lecture 1: Presentation and staging msk tumour Slide 24 Lecture 1: Presentation and staging msk tumour Slide 25 Lecture 1: Presentation and staging msk tumour Slide 26 Lecture 1: Presentation and staging msk tumour Slide 27 Lecture 1: Presentation and staging msk tumour Slide 28 Lecture 1: Presentation and staging msk tumour Slide 29 Lecture 1: Presentation and staging msk tumour Slide 30 Lecture 1: Presentation and staging msk tumour Slide 31 Lecture 1: Presentation and staging msk tumour Slide 32 Lecture 1: Presentation and staging msk tumour Slide 33 Lecture 1: Presentation and staging msk tumour Slide 34 Lecture 1: Presentation and staging msk tumour Slide 35 Lecture 1: Presentation and staging msk tumour Slide 36 Lecture 1: Presentation and staging msk tumour Slide 37 Lecture 1: Presentation and staging msk tumour Slide 38 Lecture 1: Presentation and staging msk tumour Slide 39 Lecture 1: Presentation and staging msk tumour Slide 40 Lecture 1: Presentation and staging msk tumour Slide 41 Lecture 1: Presentation and staging msk tumour Slide 42 Lecture 1: Presentation and staging msk tumour Slide 43 Lecture 1: Presentation and staging msk tumour Slide 44 Lecture 1: Presentation and staging msk tumour Slide 45 Lecture 1: Presentation and staging msk tumour Slide 46

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Lecture 1: Presentation and staging msk tumour

  1. 1. Radiological presentation and staging of MSK tumours Nor Azman MZ
  2. 2. Radiological presentation • Plain radiograph very important for bone tumours • For soft tissue tumour radiographs are useful to identify osseous or mineralising lesions and what is the tumour effect on bone • MRI is superior in the assessment of a soft tissue mass.
  3. 3. RADIOGRAPHIC EVALUATION 1. What is the age? 2. Where is the lesion? location 3. What is the lesion doing to the bone? Pattern of destruction 4. How is the bone responding? Periosteal Reaction 5. What is in the lesion? Matrix 6. How many lesions?
  4. 4. What is the age?
  5. 5. Where is the lesion? location
  6. 6. Location Location can provides clues to its identity – Medullary – Medullary eccenteric – Cortical – Juxtacortical LOCATION BENIGN BONE TUMOR JUXTACORTICAL TUMOR
  7. 7. Location • Epiphyseal : PGCAT – PVNS – GCT – Chondroblastoma – ABC – Tuberculous & other infections • Metaphyseal – NOF, UBC, OSC, CSC • Diaphyseal – ES, EG, Osteoid Osteoma – metastasis
  8. 8. OSTEOID OSTEOMAOSTEOCHONDROMA Location : Juxtacortical
  9. 9. RADIOGRAPHIC EVALUATION 1. What is the age? 2. Where is the lesion? location 3. What is the lesion doing to the bone? Pattern of destruction 4. How is the bone responding? Periosteal Reaction 5. What is in the lesion? Matrix 6. How many lesions?
  10. 10. What is the lesion doing to the bone? • Pattern of destruction – Geographic – Moth-eaten – Permeative
  11. 11. Geographic Bone Destruction • Destructive lesion with sharply defined border • Implies a less-aggressive, more slow-growing, benign process • Narrow transition zone e.g – Non-ossifying fibroma – Chondromyxoid fibroma – Eosinophilic granuloma
  12. 12. Geographic
  13. 13. Moth-eaten Appearance • Areas of destruction with ragged borders • Implies more rapid growth • Probably a malignancy e.g Myeloma Metastasis Lymphoma Ewing sarcoma
  14. 14. Permeative Pattern • Ill-defined lesion with multiple “worm-holes” • Spreads through marrow space • Wide transition zone • Implies an aggressive malignancy – Round-cell lesions Leukemia Lymphoma, leukemia Ewing’s Sarcoma Myeloma Osteomyelitis Neuroblastoma
  15. 15. Less malignant More malignant
  16. 16. RADIOGRAPHIC EVALUATION 1. What is the age? 2. Where is the lesion? location 3. What is the lesion doing to the bone? Pattern of destruction 4. How is the bone responding? Periosteal Reaction 5. What is in the lesion? Matrix 6. How many lesions?
  17. 17. How is the bone responding ? Periosteal reaction – Benign • None • Solid – Malignant • Lamellated • Sunburst • Codman’s triangle
  18. 18. SUNBURST CODMANS LAMELLATED /ONION PEEL Periosteal Reaction SOLID Less malignant More malignant
  19. 19. RADIOGRAPHIC EVALUATION 1. What is the age? 2. Where is the lesion? location 3. What is the lesion doing to the bone? Pattern of destruction 4. How is the bone responding? Periosteal Reaction 5. What is in the lesion? Matrix 6. How many lesions?
  20. 20. WHAT IS THE LESION ? MATRIX • Osteoblastic – Fluffy, cotton-like or cloud- like densities Osteosarcoma • Cartilaginous – Comma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibroma • Ground glass appearance – Fibrous dysplasia
  21. 21. RADIOGRAPHIC EVALUATION 1. What is the age? 2. Where is the lesion? location 3. What is the lesion doing to the bone? Pattern of destruction 4. How is the bone responding? Periosteal Reaction 5. What is in the lesion? Matrix 6. How many lesions?
  22. 22. How many lesions? • Multiple bony lesion
  23. 23. DD for holes in the bone • FOGMACHINE – Fibrous dysplasia – Osteoid osteoma, osteoblastoma, osteosarcoma – Giant cell tumour – Myeloma – Aneurysmal Bone Cyst, adamantimoma – Chondromyxoid fibroma, chondroblastoma, chondrosarcoma – Hystiocytosis – Infection – Nonossifying fibroma – Enchondroma, Ewing sarcoma
  24. 24. Staging
  25. 25. Staging Purpose • Determine tumor type • Determine prognosis • Guide treatment • Compare results between study groups • Delineate extent of local and distant disease
  26. 26. Staging Studies • Plain Radiograph • MRI • CT scan • Chest CT • Bone Scan
  27. 27. Plain Radiographs Evaluate: • Rate of tumor growth • Tumor interaction with surrounding non- neoplastic tissue • Internal composition of tumor
  28. 28. MRI Visualize entire bone and adjacent joint Best test for intraosseous extent and soft tissue extent Identify skip metastases Tumor proximity to neurovascular structures Occasionally helpful in diagnosis of bone or soft tissue tumors (experienced radiologist)
  29. 29. CT • Good for evaluating cortical details and destruction • Subtle cortical erosions (endosteal;periosteal) • not detectable on plain x-ray or MRI • Subtle calcifications / ossification (Visible tumor matrix mineralization)
  30. 30. Chest CT • Presence of metastatic disease
  31. 31. Bone Scan • Whole body bone scan • Sites of bony mets • Active lesion??
  32. 32. Staging • Benign Staging System • Stage 1: Latent – Grow slowly with growth of individual and then stop; tendency to heal spontaneously (ex. NOF; UBC) • Stage 2: Active Progressive growth • Stage 3: Aggressive
  33. 33. Grading G1 G2 LG Chondrosarcoma High Grade Chondrosarcoma Secondary Chondrosarc Conventional Osteosarcoma Parosteal Osteosarcoma Ewing’s Sarcoma/PNET Adamantinoma MFH Angiosarcoma
  34. 34. Staging Soft Tissue Sarcomas • Important Prognostic Characteristics –Tumor Size (>5cm, worse prognosis) –Tumor Depth (Deep, worse prognosis) –Grade (High grade, worse prognosis) –Presence of Mets
  35. 35. Grading Soft Tissue Sarcomas (Biological Behavior) • Tumors that are definitionally high grade – Ewing’s Sarcoma – PNET – Rhabdomyosarcoma – Angiosarcoma – Pleomorphic Liposarcoma – Soft Tissue Osteosarcoma – Mesenchymal Chondrosarcoma
  36. 36. Grading Soft Tissue Sarcomas (Biological Behavior) – Tumors that are definitionally low grade • Well Differentiated Liposarcoma • Dermatofibrosarcoma Protuberans • Infantile Fibrosarcoma • Angiomatoid MFH
  37. 37. Evaluating response to chemoRx
  • AnmolMuskan2

    Jun. 10, 2021
  • AbhayChoudhary15

    Nov. 7, 2019

For students in orthopaedics

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