E5499. An OsteoCLASS in Bone Tumors: A Systematic Approach for Bone Tumor Evaluation
Authors
Adriana Vargas Figueroa;
University of Puerto Rico: Medical Sciences Campus
Christian Irizarry Cruz;
University of Puerto Rico: Medical Sciences Campus
Valerie Vargas Figueroa;
University of Puerto Rico: Medical Sciences Campus
Gerardo Torres Flores;
University of Puerto Rico: Medical Sciences Campus
Ricardo Vargas Figueroa;
Universidad Central del Caribe
Carlos Perez Morales;
Universidad Central del Caribe
Elizabeth Trullenque Martinez;
San Juan Veterans Hospital; University of Puerto Rico: Medical Sciences Campus
Background
Although primary malignant bone tumors are not common and comprise approximately 0.2% of malignancies in total, it is important to readily differentiate radiographically benign versus malignant entities to guide the physician towards the most appropriate management. There have been many cases where benign diagnoses have been mistaken for malignant pathologies and led up to unnecessary surgeries. It is imperative to follow a systematic approach when evaluating a bone lesion to eventually reach the correct diagnosis. Certain features are known to be associated with malignancy, including the presence of a periosteal reaction, cortical destruction, and a soft tissue component. In this pictorial review, we will provide a systematic approach to evaluate bone lesions including the patient’s age, lesion multiplicity, the location of the lesion, and its imaging characteristics. Afterwards, multiple examples will be provided using different imaging modalities including radiographs, CT, and MRI to appropriately differentiate the most common benign and malignant bone tumors.
Educational Goals / Teaching Points
The purpose of this educational exhibit is to provide a systematic approach to evaluate bone lesions as well as review and differentiate the most common benign and malignant osseous tumors using different imaging modalities, including radiography, CT, and MRI. The main goal is to educate the reader to eventually decrease misdiagnosis of benign entities as malignant and further narrow down the differential diagnosis in cases of skepticism.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Most malignant bone tumors show destructive features, which readily aid physicians in their accurate diagnoses. However, many benign bone entities also have features that overlap with those of malignant tumors; therefore, a systematic approach for accurate recognition is crucial to prevent erroneous decisions in terms of surgical and medical management. Using different imaging modalities including radiographs, CT, and MRI, we will provide a systematic approach to evaluate bone lesions and a high yield review of the key features of the most common benign and malignant bone tumors. Some of these characteristic features include: ‘rings and arc’ configuration, Codman triangle, sunburst appearance, endosteal scalloping, amongst many others.
Conclusion
This educational exhibit will highlight the importance of following a systematic approach when evaluating bone tumors radiographically to recognize the most important imaging features of benign and malignant bone tumors. We will present a systematic approach to evaluate bone lesions, a custom diagram of the most common tumor locations as well as key images from multiple imaging modalities. After finalizing this educational exhibit, the reader should be able to recognize the characteristic clinical and imaging features of the most common benign and malignant bone tumors, as well as be able to accurately differentiate the most commonly mistaken entities.
