Mistakes in imaging of a bone tumor

Daniel VanelIstituto Ortopedico Rizzoli, Bologna, Italy

1. We are poor

2. The technique is poor

3. It is very difficult

4. We do not know

5. It is new

Why the mistakes ?

1. We are poor

68 year old lady. Treated for uterine cancer seven years ago. Pain for 4 months.

Negative biopsy. Positive PET (SUV : 9) and scintigraphy.

68 year old lady. Treated for uterine cancer seven years ago. Pain for 4 months.

Negative biopsy. Positive PET (SUV : 9) and scintigraphy.

1. Meta

2. Spondylopathy

3. Radio induced sarcoma

4. Stress fracture

68 year old lady. Treated for uterine cancer seven years ago. Pain for 4 months.

Negative biopsy. Positive PET (SUV : 9), and scintigraphy.

?

68 year old lady. Treated for uterine cancer seven years ago. Pain for 4 months.

Negative biopsy. Positive PET (SUV : 9), and scintigraphy.

68 year old lady. Treated for uterine cancer seven years ago. Pain for 4 months.

Negative biopsy. Positive PET (SUV : 9), and scintigraphy.

1. Meta

2. Spondylopathy

3. Radio induced sarcoma

4. Stress fracture

2. The technique is poor

October 2016 31 year old. Ingenier. Pain for two years. Muscle atrophy,

Palpable mass.

October 2016 31 year old. Ingenier. Pain for two years. Muscle atrophy,

Palpable mass.

Osteitis ??

October 2016 31 year old. Ingenier. Pain for two years. Muscle atrophy,

Palpable mass.

Ossifying fibroma ??

2016

October 2016 31 year old. Ingenier. Pain for two years. Muscle atrophy,

Palpable mass.

Osteoid osteoma

October 2016 31 year old. Ingenier. Pain for two years. Muscle atrophy,

Palpable mass.

2017

3. It is very difficult

35 year old physician. Pain for one year.

T1

T2

35 year old physician. Pain for one year.

T2 T2 FS

Needle Biopsy fibrous dysplasia

or low grade osteosarcoma ??

35 year old physician. Pain for one year.

Surgical Biopsy and radio correlation :

LOW GRADE OSTEOSARCOMA

35 year old physician. Pain for one year.

Surgery Specimen

HIGH GRADE OSTEOSARCOMA

35 year old physician. Pain for one year.

From fibrous dysplasia

to low grade osteosarcoma and wide surgery

to high grade osteosarcoma and chemotherapy

4. We do not know

45 year old lady. Had a lymphoma and a breast cancer. Positive PET

Chondroma

45 year old lady. Had a lymphoma and a breast cancer. Positive PET

2 years later.

45 year old lady. Had a lymphoma and a breast cancer. Positive PET

2 years later.

45 year old lady. Had a lymphoma and a breast cancer. Positive PET

Osteosarcoma

2 years later.

45 year old lady. Had a lymphoma and a breast cancer. Positive PET

CHONDROMA or CHONDROSARCOMA ?

• 3% of patients having an MR of the knee have

cartilaginous nodules

• Few will get a chondrosarcoma.

• The chondrosarcoma starts from the chondroma.

Walden MJ, Murphey MD. Incidental enchondromas of the knee.

Am J Roentgenol 2008

We are not reliable.

CHONDROMA or CHONDROSARCOMA ?

Cartilage nodules,

with fat medullary marrow in between.

CHONDROMA or CHONDROSARCOMA ?

Chondroma

CHONDROMA or CHONDROSARCOMA ?

5. It is new

34 year old woman. Slowly growing mass..

Parosteal osteoliposarcoma

34 year old woman. Slowly growing mass..

9 year old boy. Pain for six months

9 year old boy. Pain for six months

Histology : Bone forming lesion. No malignancy

MDM2 CDK4 partially positive

We do not know : osteosarcoma or fracture?

Bone resection

Follow up

We are not perfect….

and things are moving ...

Medicine is an art, and not always a science