1. Interpretation of bone tumors at X-Ray.
Dr/ ABD ALLAH NAZEER. MD.

39. Osteochondroma:
Long bones++
The lesion is composed of cortical and medullary bone protruding from and
continuous with the underlying bone.
The areas of osseous continuity between parent bone and osteochondroma
may be broad, involving a large portion of the bone circumference (dimension
of the lesion base exceeding its length-sessile osteochondroma), or narrow,
with a bulbous tip (pedunculated osteochondroma).
Identifying the characteristic cortical and medullary continuity between lesion
and parent bone on radiographs is dependent on lesion type (sessile or
pedunculated), location, and image projection.
This relationship is usually well delineated in lesions of long bones, particularly
pedunculated osteochondromas, with standard radiographic projections
(although often only on one view) .
However, in osteochondromas of flat bones with complex anatomy (i.e., pelvis,
spine, scapula) and sessile lesions, the continuity and thus the diagnosis may
not be apparent on radiographs alone . Pedunculated lesions usually point
away from the nearest joint owing to the forces of the overlying tendons and
ligaments (although not typically attached to the osteochondroma.

42. X-ray appearance of different exostoses. (a) Solitary exostosis in a femur.
(b) Multiple exostoses in the knee joint, antero-posterior view. (c) Multiple
exostoses in the knee joint, lateral view. (d) Multiple exostoses in the
upper hip and trochanter (arrows indicate the exostoses sites).

43. Osteochondroma of scapula.

45. Osteoid osteoma.

46. Typical osteoid osteoma in the femur.
Notice the extensive cortical broadening.

48. Osteoblastoma in a child.

49. Osteoblastoma of the distal radius.

50. Osteoblastoma of the
right pubic ramus.

52. Unicameral bone cyst.

53. Unicameral bone cyst.

54. Unicameral bone cyst with fracture and fallen fragment sign.

56. Aneurysmal bone cyst - Proximal tibia.

57. Aneurysmal bone cyst - Distal tibia.

58. Aneurysmal bone cyst.

60. Giant cell tumour.

61. Giant cell tumor of the distal ulna.

62. Giant cell tumor of the distal radius.

64. Cortical fibrous defects and non-ossifying fibromas in children and young adults:

65. Cortical fibrous defect.

67. Non-ossifying fibroma.

68. Non-Ossifying Fibroma (Fibroxanthoma).

69. Fibrous Dysplasia
• Long lesion in a long bone
(often occurs in proximal femur).
• Expansion and bone deformity
• Lytic but becomes ground-glass
in appearance as the matrix
calcifies, and then becomes
sclerotic.
• Asymptomatic, but can fracture
• No periosteal reaction
• May be single or multiple
lesion in different locations.

71. Fibrous dysplasia (polyostotic form).

72. Fibrous dysplasia: various presentations with or without sclerotic margin,
with ground glass appearance, with calcifications or ossifications.

73. Fibrous dysplasia

74. Fibrous dysplasia with Coxa vara of proximal femur.

75. Enchondroma
• Most commonly seen in the phalanges
• Asymptomatic but commonly fractures
• Well-defined with narrow zone of transition
• Lobulated
• Can become slightly expansile
• Causes endosteal scalloping and cortical thinning
• Ollier's Disease = Multiple enchondromas
• Maffuci's Syndrome = Multiple enchondromas
with soft tissue hemangiomas
• Contain calcified chondroid matrix (irregular,
speckled) when located away from phalanges.

77. Enchondroma - Proximal humerus.

78. Plain X-Ray: Enchondroma of Proximal Phalanx.

79. A child with Ollier’s disease: a non-hereditary, sporadic,
skeletal disorder characterized by multiple enchondromas

80. Ollier’s disease

81. Mafucci’s syndrome. Plain radiograph of the left hand. Note multiple
enchondromas and soft-tissue hemangiomas with intralesional phleboliths.

82. Maffuci's syndrome.

84. Chondromyxoid fibroma - Proximal tibia.

85. Chondromyxoid fibroma.

88. Chondroblastoma.

89. Chondroblastoma.

91. Secondary synovial chondromatosis.

92. Synovial chondromatosis – Shoulder.

93. Chordoma:
• Uncommon malignant tumours: 40% of all sacral tumors
• Location
• 50% occur in sacrum,
• • • 40% of all sacral tumors
• Most common in 4th or 5th sacral segment
• 35% at skull base around clivus (Benign tumors but may locally
invade and compress)
• 15% in remainder of spine: Cervical spine most common
• Occurs between the ages of 30-70 with a 2:1 male: female ratio
• Imaging Findings
• Large presacral mass (>10cm) with displacement of the rectum
and/or Bladder
• Solid tumor with cystic areas in 50%
• Destroys multiple sacral and coccygeal segments
• Sequestered bone fragments are common
• Sclerotic rim in 50%
• May have amorphous calcifications, especially peripherally
• May cross the sacroiliac joint

95. Sacral chordoma.

96. Chordoma of skull base.

98. Brown tumor.

99. Brown tumor at the femur diaphysis.

101. Adamantinoma of the proximal tibia.

102. Adamantinoma Tibia.

105. Skull and femur hemangioma.

106. Computerized tomography demonstrates lesions with osseous spicules in keeping with hemangiomas
involved with left frontal bone, supraorbital wall, sphenoid sinus and ethmoid. The central portion of
this lesion revealed subtle striated trabeculations and retained a thin sclerotic rim of peripheral bone
condensation, and the boundary was clear. Both the inner and the outer tables of the skull were eroded

107. Hemangioma of the Long Bones

108. Intraosseous Hemangioma of the Nasal Septum.

110. Eosinophilic granuloma – Humerus.

111. Various presentations of eosinophilic granuloma.

112. Monostotic and polyostotic eosinophilic
granuloma in the skull.
Eosinophilic granuloma in the skull.

114. Ewing sarcoma.

115. Ewing sarcoma arising from the right iliac bone.

116. Ewing sarcoma of femur. Frontal radiograph and lateral radiographs of the femur demonstrate mottled,
osteolytic lesion (blue circle) with poorly marginated edges in the diaphysis of the bone. There is
sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white arrows).

117. Ewing sarcoma

119. (a) X-ray anteroposterior and lateral views of proximal tibia and knee joint showing diaphyseal
osteosarcoma of tibia with sclerosis (arrow), cortical destruction on posteromedial side (arrow
heads) and new bone formation in the soft tissues (b) x-ray distal end of femur (anteroposterior
and lateral views) showing sclerosis/radio-opacity in sclerosing osteosarcoma.

120. X-ray of knee joint anteroposterior views showing surface osteosarcoma: (a)
parosteal (b) periosteal. See the under lying cortex is visibly intact in ‘a’ and lifting
of periosteum in ‘b’ (red arrow). However, both are on the surface of the bone

121. Telangiectatic type of osteosarcoma of the proximal tibia: (a) X-ray anteroposterior
and lateral views showing lysis and expansion (b) MRI showing fluid levels.

122. Osteosarcoma.

123. Parosteal Osteosarcoma.

125. Chondrosarcoma of the iliac bone and proximal humerus.

126. Chondrosarcoma of the distal femur and proximal humerus.

128. Chondrosarcoma.

135. Typical x-ray appearance of
osteolytic bone metastases.
Typical x-ray appearance of
osteoblastic bone metastases.

140. Anteroposterior radiograph of the lower legs demonstrates a permeative, lytic lesion in the metadiaphysis of
the left tibia. Note the aggressive periosteal reaction with Codman triangles and soft-tissue extension/swelling.
Soft-tissue involvement is easy to appreciate when the left leg is compared with the normal right leg.

141. Burkitt's lymphoma of the humerus.

142. 62-year-old patient with lymphoma and low back pain. Anteroposterior (A) and profile (B) X-rays
showing a diffuse increase in bone density, with erosion on the left side of the L4 vertebral body (arrow).

144. The skull x-ray lateral and AP view reveals multiple oil droplet like punched out lytic defects throughout bony
calvarium. The appearance is highly suggestive of, but not completely diagnostic for, multiple myeloma.

145. Multiple myeloma.

146. Multiple Myeloma/Plasmacytoma.

150. Thank You.