Primary bone tumors are rare and it is very difficult to
make an accurate radiological diagnosis of the type of
tumor. It can also be difficult in some cases to
distinguish tumor from infection
Benign Tumors
These are often painless, unless fractured. Size does
not indicate whether a tumor is benign or malignant.
Benign tumor have well-defined, clear edges. The
cortex is usually unbroken, unless fractured. There is
seldom any periosteal reaction, unless fractured. Such
tumors are often best left alone: if doubtful and about
the diagnosis, refer the films for a specialist opinion.
Fibrous cortical defect –arises in the cortex and
extends to the medulla. Seen in the diaphyses of long
bone, it is most common in the lower limb.
Enchondroma –common lesion in long bone,
particularly the fingers. There is an area of bone
expansion from within the medulla, with scalloped
internal borders. Calcification may be present.
Giant cell tumor –occurs in young people, usually in
their early twenties. An expanding lesion at the end of a
long bone, with loss of trabeculae, ill-defined (internal)
edges and thin septa crossing the lesion. Such tumors
can easily fracture as they grow larger.
Malignant Tumors
They are usually single.
Metastic bone tumors are more common; they are
often multiple.
Malignant tumors(primary or secondary) may destroy
bone; form new bone around the tumor; increase or
decrease the density of the bone; they are ill-defined
and invasive; they are often accompanied by a mass
and may be painful.
Osteogenic sarcoma – a disease of children and young
adults. They are depicted with ill defined destruction of
cortex and trabeculae, new bone sclerosis endosteally, and
bone spicules extending into a soft-tissue mass. At the
lower edge there is triangular area of periosteal new bone
formation.
Metastases –can occur in any bone, anywhere. They are
usually (but not always) locally painful. They are usually
destructive (lytic) and fractures may result when the bone
is weakened. Occasionally they are dense(particularly
when the primary tumor is in the prostate or the female
breast). There is seldom much periosteal new bone (as
compared with primary bone tumors). Most important,
they are almost always multiple, occurring in different
bones. It is seldom possible to recognize from which the
metastases arise. They all look much the same.
Differential
Diagnosis of
Tumors by Age
BONE INFECTION (OSTEOMYELITIS)
In early stages (10-14 days), they are no x-ray changes: the
diagnosis must be made clinically (local pain, fever,
leukocytosis) aided by blood culture.
Childhood esteomyelitis progresses through four stages:
a. Initially there is an area of bone destruction near the
metaphysis.
b. In a few days this extends into the shaft and transversely,
attacks the adjacent cortex and elevates the periosteum.
c. As the disorder progresses there is permeative destruction
(osteoporosis), more cortical destruction, and obvious periosteal
new bone paralleling the original cortex.
d. In the late stage a thick periosteal envelope develops, with
sclerosis, expanded bone, and sequestrum, (arrowed) that may
need surgical removal.
Soft-tissue infection can spread into bone and cause
local osteomyelitis.
Soft-tissue infection near bone may also cause changes
in the bone without actual bone infection. There may
be increased or decreased bone density.
Classification of osteomyelitis according to:
ACUTE CHRONIC
Duration Symptoms <4 weeks Symptoms >4 weeks
Source of Infection Spread from infectious Posttraumatic or
focus postoperative spread
Secondary bacteremia from neighboring skin
ulcer.
Host factors Rare Often with diabetes
melitus (arterial occlusive
disease
Acute
