Podcast
Questions and Answers
What imaging findings would favor a diagnosis of telangiectatic osteosarcoma over an aneurysmal bone cyst (ABC)?
What imaging findings would favor a diagnosis of telangiectatic osteosarcoma over an aneurysmal bone cyst (ABC)?
- Eccentric location of the lesion within the bone.
- Thick nodular septations and a surrounding soft tissue component. (correct)
- Fluid-fluid levels seen on CT or MRI.
- Expansile remodeling of the bone.
Which of the following characteristics is NOT typically associated with telangiectatic osteosarcoma?
Which of the following characteristics is NOT typically associated with telangiectatic osteosarcoma?
- Large hemorrhagic spaces within the tumor.
- Fluid-fluid levels on imaging.
- Expansile remodeling of the bone. (correct)
- Cortical destruction.
What is a key differentiating factor between telangiectatic osteosarcoma and aneurysmal bone cyst (ABC) regarding their clinical significance?
What is a key differentiating factor between telangiectatic osteosarcoma and aneurysmal bone cyst (ABC) regarding their clinical significance?
- Telangiectatic osteosarcoma and ABC require identical treatment approaches.
- The prognosis and treatment differ substantially between the two entities. (correct)
- Both have similar prognoses and treatment strategies.
- Telangiectatic osteosarcoma is benign, while ABC is malignant.
A radiologist observes fluid-fluid levels within a bone lesion. Which additional imaging finding would be most suggestive of telangiectatic osteosarcoma rather than an aneurysmal bone cyst?
A radiologist observes fluid-fluid levels within a bone lesion. Which additional imaging finding would be most suggestive of telangiectatic osteosarcoma rather than an aneurysmal bone cyst?
Which imaging modality is most helpful in visualizing the soft tissue component associated with telangiectatic osteosarcoma?
Which imaging modality is most helpful in visualizing the soft tissue component associated with telangiectatic osteosarcoma?
What is the significance of identifying periosteal reaction in the context of osseous lesions?
What is the significance of identifying periosteal reaction in the context of osseous lesions?
Which of the following patterns of periosteal reaction is generally considered most aggressive?
Which of the following patterns of periosteal reaction is generally considered most aggressive?
What type of periosteal reaction is characterized by spicules of new bone radiating from the bone surface?
What type of periosteal reaction is characterized by spicules of new bone radiating from the bone surface?
A patient's radiograph shows a 'sunburst' pattern of periosteal reaction. Which of the following diagnoses is most likely?
A patient's radiograph shows a 'sunburst' pattern of periosteal reaction. Which of the following diagnoses is most likely?
Which of the following periosteal reaction patterns is LEAST likely to be associated with a benign, slow-growing process?
Which of the following periosteal reaction patterns is LEAST likely to be associated with a benign, slow-growing process?
Which of the following conditions is LEAST likely to present with a spiculated (sunburst) periosteal reaction?
Which of the following conditions is LEAST likely to present with a spiculated (sunburst) periosteal reaction?
What is the most important feature of an osteochondroma that confirms its benign nature on imaging?
What is the most important feature of an osteochondroma that confirms its benign nature on imaging?
What is the primary concern regarding the cartilage cap of an osteochondroma in adults?
What is the primary concern regarding the cartilage cap of an osteochondroma in adults?
What cartilage cap thickness in an adult osteochondroma is generally considered suspicious for malignant transformation?
What cartilage cap thickness in an adult osteochondroma is generally considered suspicious for malignant transformation?
At what cartilage cap thickness might resection of an osteochondroma be considered?
At what cartilage cap thickness might resection of an osteochondroma be considered?
What is the significance of finding fluid-fluid levels on imaging of a bone lesion?
What is the significance of finding fluid-fluid levels on imaging of a bone lesion?
Which of the following patterns of periosteal reaction is most suggestive of chronic osteomyelitis?
Which of the following patterns of periosteal reaction is most suggestive of chronic osteomyelitis?
What underlying feature is common to both osteochondromas and normal bone?
What underlying feature is common to both osteochondromas and normal bone?
What characteristic of an osteochondroma cap is most indicative of potential malignancy?
What characteristic of an osteochondroma cap is most indicative of potential malignancy?
Which of the following patterns of periosteal reaction is least likely to be caused by osteomyelitis?
Which of the following patterns of periosteal reaction is least likely to be caused by osteomyelitis?
Which of the following is the most appropriate next step when a solitary osteochondroma lesion transforms into chondrosarcoma?
Which of the following is the most appropriate next step when a solitary osteochondroma lesion transforms into chondrosarcoma?
Which imaging modality is BEST for evaluating the thickness of a cartilage cap in an osteochondroma?
Which imaging modality is BEST for evaluating the thickness of a cartilage cap in an osteochondroma?
Which feature of periosteal reaction suggests a slow, benign process?
Which feature of periosteal reaction suggests a slow, benign process?
When assessing a bone lesion in a child, which pattern of periosteal reaction is MOST concerning for malignancy?
When assessing a bone lesion in a child, which pattern of periosteal reaction is MOST concerning for malignancy?
A patient presents with pain in the distal femur. Imaging reveals a lesion with a thick, solid periosteal reaction. Which of the following conditions is MOST likely?
A patient presents with pain in the distal femur. Imaging reveals a lesion with a thick, solid periosteal reaction. Which of the following conditions is MOST likely?
Flashcards
Telangiectatic Osteosarcoma
Telangiectatic Osteosarcoma
A rare osteosarcoma variant with large hemorrhagic/necrotic spaces surrounded by sarcomatous tissue. Fluid-filled cavities make up most of the tumor.
Aneurysmal Bone Cysts (ABC)
Aneurysmal Bone Cysts (ABC)
Benign bone lesions with fluid-filled cavities. Fluid-fluid levels also occur in telangiectatic osteosarcoma.
Telangiectatic Osteosarcoma Imaging Features
Telangiectatic Osteosarcoma Imaging Features
Thick nodular septations, soft tissue component, matrix mineralization, and cortical destruction.
Periosteal Reaction
Periosteal Reaction
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Nonaggressive Periosteal Reaction
Nonaggressive Periosteal Reaction
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Aggressive Periosteal Reaction
Aggressive Periosteal Reaction
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Spiculated (Sunburst) Periosteal Reaction
Spiculated (Sunburst) Periosteal Reaction
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Conventional Osteosarcoma
Conventional Osteosarcoma
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Osteochondromas
Osteochondromas
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Osteochondroma Cartilage Cap Thickness
Osteochondroma Cartilage Cap Thickness
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Study Notes
- Telangiectatic osteosarcoma is a rare osteogenic sarcoma variant featuring large hemorrhagic or necrotic spaces surrounded by viable sarcomatous tissue.
- Fluid-filled cavities make up >90% of telangiectatic osteosarcomas.
- Internal fluid–fluid levels are common on CT and MRI in telangiectatic osteosarcoma, but are not specific.
- Aneurysmal bone cysts (ABC) also characteristically show fluid–fluid levels, these are benign tumor-like lesions of bone.
- Accurate diagnosis is crucial because telangiectatic osteosarcoma and ABC have different prognoses and treatments.
- Imaging features favoring telangiectatic osteosarcoma over ABC include thick nodular septations and a surrounding soft tissue component, best seen on contrast-enhanced CT or MRI.
- Matrix mineralization within the lesion and cortical destruction are also indicative of osteosarcoma.
- Cortical destruction indicates aggressive behavior.
- Expansile remodeling is more typical of slow-growing, nonaggressive lesions like ABC.
- Both telangiectatic osteosarcoma and ABC can be eccentrically located.
Periosteal Reaction
- Periosteal reaction occurs in response to various osseous insults.
- Periosteal reaction patterns can be classified as nonaggressive or aggressive in appearance.
- Nonaggressive patterns include thin, thick, solid, thick irregular, and septated types.
- Nonaggressive patterns typically occur with benign, slow processes like healing fractures or osteoid osteoma.
- Aggressive periosteal reactions include laminated (onion skin), spiculated (perpendicular or sunburst), disorganized, and marginal periosteal elevation (Codman triangle).
- Aggressive patterns suggest more aggressive biologic behavior due to primary bone tumors, infection, or metastases.
- Spiculated (sunburst) periosteal reaction exhibits spicules of new bone radiating from the femoral shaft.
- Conventional osteosarcoma is most likely to demonstrate a spiculated (sunburst) type of periosteal reaction.
- Osteomyelitis may show a spiculated pattern, but more commonly is disorganized, thin, or lamellated.
- Eosinophilic granuloma lesions may be associated with a thick or laminated pattern, especially during healing.
- Periosteal reaction with chondroblastoma is typically thick, solid, or laminated in large lesions.
Osteochondromas
- Osteochondromas are osseous excrescences with corticomedullary continuity to the underlying bone and are covered by a cap of orderly hyaline cartilage.
- Cartilage cap thickness under 1.5 cm is generally considered benign in adults, while over 2.5 cm is considered malignant.
- Resection is often recommended if cartilage cap thickness is >1 cm.
- The incidence of a solitary osteochondroma transforming into chondrosarcoma is
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