This document discusses bone tumors of the pelvis based on a study of 3,398 cases from a bone tumor institute in Italy between 1900-2012. It finds that the most common tumors were primary malignant tumors (40.7%), followed by bone metastases (24.9%), benign tumors (25.4%), and systemic tumors (9.0%). For benign tumors, the most frequent diagnoses were osteochondroma and bone cysts. Examples of specific benign and malignant bone tumors are also presented along with imaging findings.

1. Bone tumors of the pelvis
Daniel Vanel
Istituto Ortopedico Rizzoli. Bologna (Italia)

2. RIZZOLI TUMORS
3.398 cases of Bone Tumors of pelvis (Istituto ortopedica RIZZOLI 1900/2012)
Systemic Tumors
306 (9.0%)
Bone Metastasis
846 (24.9%)
Benign Tumors
864 (25.4%)
Primary
Malignant Tumors
1.382 (40.7%)

3. BENIGN TUMORS
Total BENIGN tumors : 864 (25.4%)
46%
54%
Average: 27 - Median: 23 - Range: 0-79
30
25
20
% 15
10
5
0
0-9
10-19
20-29
30-39
40-49
age
50-59
60-69
70-79

4. BENIGN TUMORS
Total BENIGN tumors : 864 cases (25.4%)

5. BENIGN TUMORS
Case 1: 20 year old man; pain
DESMOID FIBROMA
non calcified and low signal on T2
è fibrous tissue

6. BENIGN TUMORS
Case 2: 18 year old man; pain
ANEURISMAL BONE CYST
fluid fluid levels
è embolisation
After embolisation

7. BENIGN TUMORS
Case 3: 17 year old man; pain
OSTEOID OSTEOMA
small nidus, huge inflammatory reaction.
è Radio frequency treatment

8. BENIGN TUMORS
Case 4: 31 year old woman.Thoracic pain
T1
FSE T2 fs
T1 gd

9. BENIGN TUMORS
Case 4: 31 year old woman.Thoracic pain
?
1. metastasis
2. normal variant (red marrow)
3. angioma
4. other

10. BENIGN TUMORS
Case 4: 31 year old woman.Thoracic pain
?
1. biopsy
2. follow up
3. ignore

11. BENIGN TUMORS
Case 4: 31 year old woman.Thoracic pain
1. metastasis
2. normal variant (red marrow)
3. angioma
4. other

12. BENIGN TUMORS
Case 4: 31 year old woman.Thoracic pain
1. biopsy
2. follow up
3. ignore

13. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
Yamaguchi
et
al
Skeletal Radiol 2008.

14. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
Skeletal Radiol 2008.
100 spines (cadavers)
26 BNCT / 20 patients (M:F 2:1)
· same location as chordoma

15. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)

16. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
SIMILARITIES between BNCT and chordoma
Location: bone
Immuno: +
CK18 and vimentin, S-100 protein,
EMA, CAM5.2,
AE1/AE3, brachyury
MRI :
hypoT1 et hyperT2

17. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
DIFFERENCES between BNCT and chordoma
BNCT
Chordoma
Growth
minimal; sclerosis
Slow but aggressive
Sft tissues
Histologiy
Thick bone trabeculae
myxoïd component
Rx and CT
sclerotic
normal cortex and soft tissues
Lytic
Soft tissues invaded
MRI
no cm uptake
Uptake after injection

18. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
BNCT and Chordoma

19. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.

20. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
T1

21. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
T1
After biopsy

22. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.

23. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.

24. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.

25. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.

26. BENIGN TUMORS
Benign notochordal cell tumor (BNCT)
29 year old man, pain for 9 months.
BNCT invading the soft tissues !
BNCT a still moving entity!

27. HEMOPATHIES
Total systemic bone tumors : 306 cases (9%)
41%
59%
Average: 48 - Median: 49 - Range: 1-84
20
18
16
14
12
% 10
8
6
4
2
0
0-9
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
age

28. HEMOPATHIES
Total systemic bone tumors : 306 cases (9%)
17
Myeloma
140
Hodgkin Lymphoma
149
Non Hodgkin Lymphoma
0
25
50
75
100
125
150

29. HEMOPATHIES
LLC

30. HEMOPATHIES
B cell high grade LYMPHOMA

31. HEMOPATHIES
MYELOMA

32. HEMOPATHIES
MYELOMA
62 year old woman

33. HEMOPATHIES
MYELOMA
69 year old man
T1FSE

34. MALIGNANT TUMORS
METASTASES
Total metastasis bone tumors : 846 cases (24.9%)
Including 11 cases from neuroblastoma
41%
59%
Average 57 - Median: 59 - Range: 1-88
30
25
20
% 15
10
5
0
0-9
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
age

35. MALIGNANT TUMORS
METASTASES
Lytic or sclerotic
PROSTATE
BREAST

36. MALIGNANT TUMORS
THYROID
METASTASES

37. MALIGNANT TUMORS
PRIMARY TUMORS
Total primary tumors : 1.382 cases (40.7%)
40%
60%
Average: 38 - Median: 35 - Range: 2-87
25
20
15
%
10
5
0
0-9
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
age

38. MALIGNANT TUMORS
PRIMARY TUMORS
Total primary tumors : 1.382 cases
Adults : CHONDROSARCOMA
Children : EWING

39. MALIGNANT TUMORS
PRIMARY TUMORS
Surgical classification

40. MALIGNANT TUMORS
PRIMARY TUMORS
60 year old man, pain
CHONDROSARCOMA

41. MALIGNANT TUMORS
PRIMARY TUMORS
60 year old man, pain

42. MALIGNANT TUMORS
PRIMARY TUMORS
60 year old man, pain

43. MALIGNANT TUMORS
PRIMARY TUMORS
60 year old man, pain

44. MALIGNANT TUMORS
PRIMARY TUMORS
CHONDROSARCOMA
normal SI and acetabulum

45. MALIGNANT TUMORS
PRIMARY TUMORS
Missed CHONDROSARCOMA
Prothesis.

46. MALIGNANT TUMORS
PRIMARY TUMORS
OSTEOSARCOMA
( zone I II, SI)
è surgery
radiotherapy
well at 5 years

47. MALIGNANT TUMORS
PRIMARY TUMORS
OSTEOSARCOMA
( zone I II, SI)
è surgery
radiotherapy
well at 5 years

48. MALIGNANT TUMORS
PRIMARY TUMORS
OSTEOSARCOMA

49. MALIGNANT TUMORS
PRIMARY TUMORS
CHONDROSARCOMA
Zone I and nerve

50. MALIGNANT TUMORS
PRIMARY TUMORS
EWING
Pregnant
Zone I, ½ sacrum, ½ zone II

51. MALIGNANT TUMORS
PRIMARY TUMORS
EWING
Pregnant
Zone I, ½ sacrum, ½ zone II

52. MALIGNANT TUMORS
PRIMARY TUMORS
EWING
Pregnant
Zone I, ½ sacrum, ½ zone II
15 years follow up

53. MALIGNANT TUMORS
PRIMARY TUMORS
CHONDROSARCOMA
70 year old man

54. MALIGNANT TUMORS
PRIMARY TUMORS
10 years follow up
CHONDROSARCOMA
70 year old man

55. Gilles Missenard

56. Bone tumors of the pelvis
KEY POINTS
Ÿ BNCT
Ÿ Frequent metastases
Ÿ Local staging for primary malignant tumors: CT , MRI