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ی ن وا خ ت سیا ورها م و ت رم ن ج س ن وDr. S.Pezeshki Orthopeadist 1

Dr. S.Pezeshki Orthopeadist 1. رشد آهسته دارند به اعضای مجاور دست اندازی نمی کنند متاستاز نمی دهند ولی بندرت امکان

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Dr. S.PezeshkiOrthopeadist1 1 Benign . 2 malignant tumors ( )3 : ( ) ( ...) 4 : 5 : ( ) 6

Eccentric centricJuxtacortical 7Differential Diagnosis for Epiphyseal Lesions

Chondroblastoma (age 10-25) Giant cell tumor (age 20-40) Clear cell chondrosarcoma (rare)

8Differential Diagnosis for Diaphysial Lesions

Ewing sarcoma (age 5-25) Lymphoma (adult) Fibrous dysplasia (age 5-30) Adamantinoma (consider in the tibia) Histiocytosis (age 5-30)9Differential Diagnosis for Lesions of the SpineOlder than 40 Years Metastases Multiple myeloma Hemiangioma Chordoma (in sacrum)

Younger than 30 Years Vertebral Body Histiocytosis Hemangioma

Posterior Elements Osteoid osteoma Osteoblastoma Aneurysmal bone cyst

10Differential Diagnosis for Multiple Lesions Histiocytosis Enchondroma Osteochondroma Fibrous dysplasia Multiple myeloma Metastases Hemangioma Infection Hyperparathyroidism

11Transition zone narrow transition zone wide transition zone12 13 periostial reaction 14 ==> ground glass ==> ==> 15 (extracompartmental) 16 Isotope Scintigraphy 99 TC 99m 1- = 2- blood pooling3- 3 = 17

18 ( ) (ectopic ossification)

19 ! ( ) !(super scan)

20CT scan

21 22MRI

23 MRI skip lesion ( ) ( )

24 ( )

25 ESR ( 100) . : ( ) 26

27If hole must be made in bone during biopsy, defect should be round to minimize stress concentration, which otherwise could lead to pathological fracture27poorly performed biopsies

28Excisional biopsy

29Low-grade chondrosarcoma in 50-year-old woman who had progressive right knee pain. A, Anteroposterior radiograph of the right knee shows expansile lesion in proximal fibula. Lesion appears to contain calcification suggesting cartilaginous lesion. B, Coronal T1-weighted MRI shows that lesion remains entirely within cortex. C, Primary resection was done without biopsy. This treatment strategy allowed for wide margins without contamination of common peroneal nerve (arrow). D, Lesion proved to be low-grade chondrosarcoma. E, Radiograph after primary resection of 29 : ( ) ( ). : stress fracture myositis ossificant( Heterotopic new bone)30

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32Enneking System for Staging Benign and Malignant Musculoskeletal Tumors BENIGN 1. Latent(inactive encapsulated) 2. Active (encapsulated but growing ) 3. Aggressive( cortical distraction and soft tissue mass may be seen , 5% chance of metastasis) some time malignant

33Stage 1 lesions are intracapsular, usually asymptomatic, and frequently incidental findings. Radiographic features include a well-defined margin with a thick rim of reactive bone. There is no cortical destruction or expansion. These lesions do not require treatment because they do not compromise the strength of the bone and usually resolve spontaneouslyStage 2 lesions also are intracapsular, but are actively growing and can cause symptoms or lead to pathological fracture. They have well-defined margins on radiographs but may expand and thin the cortex. Usually they have only a thin rim of reactive bone. Treatment usually consists of extended curettage. Stage 3 lesions are extracapsular. Their aggressive nature is apparent clinically and radiographically. They usually have broken through the reactive bone and possibly the cortex. MRI may show a soft-tissue mass, and metastases may be present in 5% of patients with these lesions. Treatment consists of extended curettage and marginal or even wide resection, and local recurrences are common33MALIGNANT

34 35

25 36 )nidus ( 37

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41This 17-year-old girl complained of left thigh pain for several months. A and B, Anteroposterior and lateral views of left hip show small radiolucent lesion with thick sclerotic rim of reactive bone. C, CT clearly shows nidus and confirms diagnosis. D, A radiofrequency ablation probe placed into nidus under CT guidance. 41Bone Island Bone islands, also called enostoses, are benign lesions of cancellous bone. They usually are asymptomatic and are discovered incidentally. Almost any bone can be involved. It is unclear whether they represent a developmental abnormality or neoplastic process.42Most remain quiescent. They are of interest primarily because other, more aggressive, lesions are occasionally in the differential diagnosis for patients with bone islands43Osteopoikilosis Is a rare condition consisting of multiple small bone islands throughout the skeleton. Autosomal dominant and sporadic forms of the syndrome have been identified.44Bone islands usually can be diagnosed by plain radiographs. They typically are small, round or oval areas of homogeneous increased density within the cancellous bone 45

46osteoblastoma