Bone Tumors

Inhaltsverzeichnis

• Diagnosis, Classification, and Nomenclature of Bone Tumors..
• A. Introduction.
• B. Diagnosis of Bone Tumors.
• C. Radiologic Examination.
• D. Pathologic Examination.
• I. Surgical Biopsy.
• II. Needle or Aspiration Biopsy.
• E. Value and Limitations of Histochemistry in the Study of Bone Tumors.
• F. Electron Microscopy.
• G. Classification and Nomenclature of Bone Tumors.
• H. Histological Typing of Primary Bone Tumors and Tumorlike Lesions (WHO).
• References.
• Radiologie Approach to Bone Tumors..
• A. Location.
• B. Cortex.
• C. The Periosteum.
• D. Destruction of Bone.
• E. Margination or Zone of Transition.
• F. Increase in Bone Density.
• G. Matrix Calcification.
• H. Expansion of the Cortex.
• I. Trabeculation.
• J. Size.
• K. Shape.
• L. The Joint Space.
• M. The Age of the Patient.
• N. The Incidence of the Various Tumors.
• References see page 67.
• General Concepts and Pathology of Tumors of Osseous Origin..
• I. Osteoma.
• II. Osteoid Osteoma.
• III. Benign Osteoblastoma.
• IV. Osteogenic Sarcoma or Osteosarcoma.
• A. Benign Tumors of Osseous Origin.
• III. Osteoblastoma.
• B. Malignant Tumors of Osseous Origin.
• I. Osteogenic Sarcoma (Osteosarcoma, Central Osteosarcoma).
• II. Primary Multicentric Osteogenic Sarcoma.
• III. Osteogenic Sarcoma Developing in Abnormal Bone.
• IV. Osteogenic Sarcoma as a Complication of Paget’s Disease.
• V. Osteogenic Sarcoma Arising in Previously Irradiated Bone.
• VI. Osteogenic Sarcoma Associated with Fibrous Dysplasia.
• VII. Osteogenic Sarcoma in Osteogenesis Imperfecta.
• VIII. Soft Tissue Osteogenic Sarcoma.
• Parosteal Osteosarcoma..
• A. Clinical Features.
• I. Age and Sex.
• II. Localization.
• III. Symptoms.
• IV. Roentgenographic Features.
• V. Angiographic Features.
• VI. Differential Diagnosis.
• VII. Histopathological Features.
• B. Treatment.
• Cartilaginous Tumors and Cartilage-Forming Tumor-like Conditions of the Bones and Soft Tissues..
• B. Solitary Osteochondroma.
• I. Pathogenesis.
• II. Site.
• III. Clinical.
• IV. Roentgen.
• V. Histology.
• 1. Gross.
• 2. Microscopic.
• C. Radiation-Induced Osteochondromas.
• D. Multiple Osteochondromatosis.
• I. Clinical.
• II. Roentgen Features.
• III. Course.
• E. Solitary Enchondromas.
• III. Clinical Features.
• IV. Roentgen Features.
• V. Differential Diagnosis.
• VI. Histology.
• VII. Treatment and Course.
• F. Multiple Enchondromatosis.
• II. Clinical.
• III. Roentgen Features.
• IV. Histology.
• G. Dysplasia Epiphysealis Hemimelica.
• VI. Course.
• H. Juxtacortical (periosteal) Chondroma.
• II. Roentgen.
• III. Differential Diagnosis.
• V. Course.
• I. Chondroblastoma.
• II. Prevalence and Site.
• III. Age and Sex Distribution.
• IV. Symptoms.
• V. Roentgen Findings in Chondroblastoma.
• VII. Pathologic Findings.
• 1. Gross Features.
• 3. Electron Microscopic Findings.
• VIII. Treatment and Results.
• J. Chondromyxoid Fibroma.
• II. Clinical Features.
• III. Sites of Localization.
• VI. Pathologic Findings.
• VII. Treatment, Recurrence, Malignant Transformation.
• K. Chondrosarcoma.
• I. Incidence.
• II. Age and Sex.
• IV. Sites.
• V. Roentgenographic Features.
• L. Peripheral Chondrosarcoma.
• I. Histologic Criteria.
• II. Clinical Course.
• M. Mesenchymal Chondrosarcoma.
• II. Course.
• III. Histology.
• N. Dedifferentiation of Chondrosarcoma.
• II. Pathology.
• 1. Microscopic.
• III. Roentgen.
• IV. Course.
• O. Extraskeletal Cartilage Tumors of the Soft Tissues.
• I. Malignant Soft Tissue Cartilage Tumors.
• IV. Treatment and Prognosis.
• V. Benign Soft Tissue Cartilage Tumors.
• VI. Pathogenesis.
• VII. Clinical.
• VIII. Site.
• IX. Pathology.
• X. Roentgen.
• P. Synovial Chondromatosis.
• V. Synovial Chondrosarcoma.
• Q. Summary.
• Giant Cell Tumor of Bone..
• B. Pathologic Features.
• C. Roentgenographic Features.
• D. Treatment and Prognosis.
• Marrow Tumors..
• A. Ewing’s Sarcoma.
• I. Introduction.
• II. Incidence.
• III. Age.
• IV. Sex Incidence.
• V. Bones Involved.
• VI. Clinical Presentation.
• VII. Laboratory Data.
• VIII. Radiologic Features.
• 1. Periosteal Reaction.
• a) Onion-Skin Pattern of Subperiosteal Bone Formation.
• b) Right-Angled Spiculation (Sunray Appearance).
• c) Codman’s triangle.
• 2. Destruction of Bone.
• 3. Reactive New Bone Formation.
• 4. Soft-tissue Swelling.
• 5. Pathologic Fractures.
• 6. Other Appearances.
• 1. Gross •.
• X. Treatment.
• XI. Prognosis.
• XII. Differential Diagnosis.
• B. Reticulum Cell Sarcoma of Bone.
• II. History.
• III. Incidence.
• IV. Age.
• V. Sex Incidence.
• VI. Bones Involved.
• VII. Clinically.
• VIII. Laboratory Data.
• IX. Radiologic Features.
• 1. Location of Tumor in Bone.
• 2. Destruction of Cancellous Bone.
• 3. Destruction of Cortical Bone.
• 4. Reactive Proliferation of Bone.
• 5. Cortical Thickening.
• 6. Periosteal Reaction.
• 7. Soft-Tissue Involvement.
• 8. Pathologic Fracture.
• X. Pathology.
• XI. Treatment.
• XII. 5-Year Survival Rate.
• XIII. Metastases.
• XIV. Differential Diagnosis.
• C. Multiple Myeloma and Solitary Plasmacytoma.
• I. Incidence and Pathogenesis.
• II. Age.
• III. Sex.
• IV. Bones Involved.
• V. Clinical and Laboratory Data.
• VI. Diagnosis and Classification.
• VII. Radiologic Features.
• 1. Destructive Osteoclastic Lesions.
• a) Sharply Defined “Punched Out” Lesions.
• b) Expansile Lytic Areas.
• c) Generalized Osteoporosis.
• d) Pathologic Fractures.
• 2. Mixed Osteolytic and Osteoblastic Lesions.
• 3. Purely Osteoblastic Lesions.
• 4. Other Radiologie Features.
• VIII. Pathology.
• IX. Treatment.
• X. Prognosis.
• 1. Renal Disease in Multiple Myeloma.
• 2. Amyloid.
• XI. Differential Diagnosis.
• D. Lymphoma of Bone.
• IV. Sex.
• VIII. Radiologie Features.
• 1. Lymphosarcoma.
• 2. Hodgkin’s Disease.
• IX. Pathologic Features.
• Vascular Tumors of Bone..
• A. Hemangiomas.
• Roentgenographic Appearance.
• I. Diffuse Skeletal Hemangiomatosis.
• II. Massive Osteolysis.
• B. Lymphangioma.
• C. Glomus Tumor.
• D. Hemangiopericytoma.
• E. Hemangioendothelioma (Angiosarcoma).
• Connective Tissue Tumors of Bone..
• A. Chondrogenic Series.
• B. Fibrogenic Series.
• C. Fibrosarcoma.
• D. Lipoma.
• E. Liposarcoma.
• Chordoma..
• B. Embryology.
• I. General Considerations.
• II. Formation of Notochord.
• III. Origin of Notochord.
• IV. Chordal Ectopia and Chordal Remnants.
• 1. Ecchordosis Physaliphora.
• 2. Other Notochordal Remnants.
• 3. Relationship of Notochordal Remnants to Chordoma.
• C. Pathology.
• I. Gross Pathology.
• 1. General Considerations.
• 2. Classification of Chordoma.
• 3. Topographic Distribution of Chordoma.
• 4. Gross Pathology of the Intracranial Chordomas.
• 5. Gross Pathology of Nasopharyngeal Chordomas.
• 6. Gross Pathology of Vertebral Chordomas.
• 7. Gross Pathology of Sacrococcygeal Chordomas.
• 8. Histology of Chordoma.
• a) Histogenesis.
• b) Cytology.
• 9. Metastasis.
• 10. Chordoma in Unusual Locations.
• D. Clinical Findings.
• 1. Age and Sex.
• 2. Symptomatology.
• a) Clinical Findings in Intracranial Chordomas.
• b) Clinical Findings in Nasopharyngeal Chordoma.
• c) Clinical Findings in Vertebral Chordoma.
• d) Clinical Findings in Sacrococcygeal Chordoma.
• E. Roentgenologic Findings.
• I. Intracranial Chordomas.
• 1. Plain Film Findings (Including Body-Section Radiography).
• 2. Calcifications.
• 3. Angiography.
• a) Carotid Angiography.
• b) Vertebral Angiography.
• 4. Pneumoencephalography.
• 5. Brain Scan (Technetium 99m pertechnetate).
• 6. Computerized Tomographic (CT) Scan.
• II. Nasopharyngeal Chordomas.
• III. Vertebral Chordomas.
• 1. Plain Film Findings.
• 2. Myelography.
• IV. Sacrococcygeal Chordoma.
• V. Diagnosis.
• VI. Treatment.
• Adamantinoma (Malignant Angioblastoma), Schwannoma (Neurilemmoma), Neurofibroma..
• A. Adamantinoma Long Bones and Ameloblastoma — Jaw.
• I. Nomenclature.
• III. Pathology.
• IV. Roentgenology.
• V. Treatment.
• B. Schwannoma (Neurilemmoma).
• C. Neurofibroma.
• Tumor-like Lesions..
• A. The Solitary Bone Cyst.
• IV. Pathology.
• V. Pathogenesis.
• VI. Roentgenology.
• VII. Differential Diagnosis.
• VIII. Treatment and Prognosis.
• B. Aneurysmal Bone Cyst.
• C. Juxta-Articular Bone Cyst (Intraosseous Ganglia).
• II. Etiology.
• V. Roentgen Appearance.
• D. The Fibrous Cortical Defect or Nonosteogenic Fibroma.
• III. Clinical Manifestations.
• 1. Laboratory Findings.
• 2. Other Clinical Findings.
• IV. Location and Bilaterality.
• VI. Pathology.
• VII. Roentgenology.
• VIII. Roentgenologic Course and Prognosis.
• IX. Differential Diagnosis.
• E. Eosinophilic Granuloma.
• IV. Pathogenesis.
• V. Radiographic Findings.
• 1. Skull.
• 2. Mandible.
• 3. Spine.
• 4. Long and Flat Bones.
• VIII. Treatment and Course.
• F. Fibrous Dysplasia.
• 1. Monostotic Fibrous Dysplasia.
• 2. Polyostotic Fibrous Dysplasia and Albright Syndrome.
• 3. Associated Disorders.
• 4. Malignant Transformation.
• V. Etiology.
• VIII. Treatment.
• G. Myositis Ossificans.
• 1. Other Terms.
• 2. Etiology.
• 3. Clinical.
• 4. Pathology.
• 5. Roentgen Appearance.
• 6. Treatment.
• II. Myositis Ossificans Progressiva.
• H. Brown Tumors of Hyperparathyroidism.
• III. Etiology.
• 1. Primary Hyperparathyroidism.
• 2. Secondary Hyperparathyroidism.
• IV. Clinical.
• V. Pathology.
• VI. Roentgen Findings.
• Metastatic Bone Disease..
• A. Incidence.
• B. Localization.
• C. Method of Diagnosis.
• I. Clinical Evaluation.
• II. Roentgenographic Examination.
• III. Bone Scanning.
• D. Mechanisms of Metastasis.
• E. Roentgenographic Diagnosis.
• I. Patterns of Destruction.
• II. Osteolytic Metastases.
• III. Osteoblastic Metastases.
• IV. Periosteal New Bone Formation.
• V. Roentgenographic Characteristics.
• VI. Spinal Metastases.
• VII. Rib Metastases.
• VIII. Skull Metastases.
• IX. Peripheral Metastases.
• X. Metastatic Disease in Children.
• Conclusion.
• Study of Bone Tumors with Radionuclides..
• A. Radionuclides.
• I. Isotopes of Calcium.
• II. Isotopes of Strontium.
• III. Fluorine-18.
• IV. Miscellaneous Radionuclides.
• V. 99mTc Labeled Phosphate Compounds.
• VI. Bone Marrow Imaging Agents.
• B. Instrumentation.
• C. Mechanisms of Localization.
• D. Indications for Radionuclide Imaging of the Skeleton.
• E. Malignant Tumors.
• I. Osteosarcoma.
• II. Malignant Tumors of Cartilaginous Origin.
• III. Malignant Tumors of Vascular and Connective Tissue Origin.
• IV. Malignant Tumors of Marrow Origin.
• 1. Ewing’s Sarcoma.
• 2. Myeloma.
• 3. Leukemia.
• 4. Lymphoma.
• F. Benign Tumors and Tumorlike Abnormalities.
• 1. Osteoid Osteoma and Osteoblastoma.
• 2. Chondroma.
• 3. Giant Cell Tumor.
• 4. Aneurysmal Bone Cyst.
• 5. Fibrous Dysplasia.
• 6. Paget’s Disease.
• 7. Eosinophilic Granuloma.
• 8. Miscellaneous Lesions.
• G. Conclusion.
• Angiography of Bone Tumors..
• B. Vascular Anatomy.
• I. Nutrient Arteries.
• II. Periosteal and Perichondral Arteries.
• III. Metaphyseal and Epiphyseal Arteries.
• IV. Arterial Supply of Bone Lesions.
• C. Arteriography.
• I. Technique.
• II. Pharmacoangiography.
• III. Subtraction.
• IV. Complications.
• V. General Roentgenographic Findings.
• D. Bone-Forming Tumors.
• IV. Osteosarcoma.
• V. Parosteal Osteosarcoma (Juxtacortical Osteosarcoma).
• E. Cartilage-Forming Tumors.
• I. Chondroma.
• II. Osteochondroma.
• III. Chondromyxoid Fibroma ..
• IV. Benign Chondroblastoma.
• V. Chondrosarcoma.
• VI. Mesenchymal Chondrosarcoma.
• F. Giant Cell Tumor and Aneurysmal Bone Cyst.
• G. Vascular Tumors.
• I. Hemangioma.
• II. Lymphangioma.
• III. Hemangiopericytoma.
• H. Other Connective Tissue Tumors.
• I. Lipoma.
• II. Desmoplastic Fibroma.
• III. Fibrosarcoma.
• IV. Liposarcoma.
• I. Marrow Tumors.
• I. Ewing’s Sarcoma and Reticulum Cell Sarcoma.
• II. Myeloma.
• J. Other Tumors.
• I. Chordoma.
• II. Adamantinoma of Long Bone.
• III. Neurolemmoma (Schwannoma, Neuronoma).
• K. Tumorlike Lesions.
• I. Metaphyseal Fibrous Defect (Nonossifying Fibroma).
• II. Fibrous Dysplasia.
• III. Myositis Ossifìcans.
• L. Metastatic Bone Lesions.
• I. Osteolytic Metastasis.
• II. Osteoblastic Metastasis.
• High-Resolution Radiographic Techniques for the Detection and Study of Skeletal Neoplasms..
• A. Radiographic Techniques.
• B. Comparison of Images Using Magnification Techniques.
• I. Optical Magnification.
• II. Optical Vs. Radiographic Magnification.
• III. Radiographic Magnification.
• Summary and Conclusions.
• Author Index — Namenverzeichnis.