Primary bone tumors of adulthood

Abstract

Imaging plays a crucial role in the evaluation of primary bone tumors in adults. Initial radiographic evaluation is indicated in all cases with suspected primary bone tumors. Radiographs are useful for providing the diagnosis, a short list of differential diagnosis or at least indicating the degree of aggressiveness of the lesion. More detailed information about the lesion, such as cortical destruction or local spread, can be obtained using cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging. This article discusses the characteristic features of the more common primary bone tumors of adulthood, and also the pre-treatment evaluation and staging of these lesions using imaging techniques.

Figure 1

Osteoid osteoma. (a) Anteroposterior and (b) lateral radiographs of the tibia show florid sclerosis and periosteal new bone formation around the lesion. The central nidus is barely visible.

Figure 2

Conventional osteosarcoma. Anteroposterior radiograph of the femur shows a predominantly osteosclerotic lesion of the distal diaphysis. There is cortical destruction and aggressive periosteal reaction.

Figure 3

Telangiectatic osteosarcoma. Axial (a) T1- and (b) T2-weighted MR images of the mid-tibia lesion shows multiple fluid–fluid levels within the large tumor mass. There is extensive soft tissue invasion with involvement of the major neurovascular structures and calf muscles.

Figure 4

Secondary chondrosarcoma developing in diaphyseal aclasis. Anteroposterior radiograph shows a destructive lesion arising from the upper femoral shaft. There is an associated large soft mass with numerous calcifications typical of cartilaginous origin. Note modeling deformity of the femoral neck due to diaphyseal aclasis.

Figure 5

MR imaging appearance of the cartilaginous component of an osteochondroma. Axial (a) T1-, (b) T2-and (c) enhanced fat-suppressed T1-weighted MR images of the mid cervical spine show a large lobulated tumor arising from the neural arch. The central fatty marrow containing stalk of the lesion is T1-hyperintense and T2-hypointense. The cartilage cap is T1-isointense, markedly T2-hyperintense and shows the typical rim and septal enhancement pattern. Scattered small areas that are hypointense on all sequences represent cartilage matrix calcification. The lesion compresses the adjacent muscles posteriorly but the spinal canal is unaffected.

Figure 6

Fibrosarcoma. Anteroposterior radiograph of the tibia shows multiple osteolytic lesions in the upper shaft. The borders are ill-defined and there is cortical destruction.

Figure 7

Malignant fibrous histiocytoma. Anteroposterior radiograph of the ilium shows a large osteolytic lesion with extensive soft tissue involvement. Peripheral calcification is present.

Figure 8

Primary bone lymphoma. (a) Anteroposterior and (b) lateral radiographs of the tibia show an ill-defined osteolytic lesion in the upper shaft. Cortical destruction is seen.

Figure 9

Multiple myeloma. Radiographs of the (a) skull, (b) humerus and (c) fibula show multiple small punched-out osteolytic lesions.

Figure 10

MR in staging of osteosarcoma of the tibia. (a) Coronal T1-weighted MR image shows a pathological fracture through the distal tibial lesion. The superior-inferior medullary lesion extent and soft tissue component are well depicted. Axial (b) T1- and (c) T2-weighted MR images show not only lesion abutment upon the distal fibula but also extensive involvement of the adjacent muscles and neurovascular structures.