 Hello everyone, welcome to the case review session of bone tumors. Let's review this case. In the case of a 22-year-old male who presented with an increasingly sinful proximal right to delusion associated with the soft tissue mass. So this is the AP and lateral radiograph of the right knee joint of the patient and we will evaluate this bone tumor on the basis of following points. First is age of the patient. As we can see age of the patient is 22 years. Second is whether the lesion is single or multiple. As we can see the lesion is involving proximal tibia and it is single. Next is the skeleton location. So it is involving the appendicular skeleton and it is involving long bone. What is the site of long bone involvement? As we can see it is involving epithelial and metaphyal lesion of the tibia but it is also extending into diaphysis. And it is involving metabolic cavity. It is predominantly central in location. Next is pattern of growth and bone destruction. So as we can see it is having formative pattern of bone destruction that is why it is known of transition. Next is type of periostal reaction. As we can see the lesion is having aggressive pattern of periostal reaction. Next is matrix mineralization. The lesion is having offshore cloud like matrix in the tumor. Next is soft tissue involvement. As we can see the lesion is having soft tissue involvement outside the bone. So this is the case of an ill-defined lytic pleurotic lesion centrally located in the proximal tibia with offshore matrix mineralization and soft tissue involvement. So this is the case of osteosarcoma and specifically a case of conventional osteosarcoma. Osteosarcoma are most common primary malignant bone tumor in young adults and adolescent age group. It commonly affects 10-25 years of age range with a 2-1 male predominant. The simple swelling of the lower limb is a common presenting symptom. Metaphysis of the distal femur, proximal tibia and proximal humerus are the most common sites of involvement. 50% of cases are pleurotic, 25% are purely lytic and 25% are mixed lesions. Osteosarcoma can present with cannonball metastasis in the lung with ossification in the metastatic tissue. And these lesions can cause spontaneous pneumothorax in the chest. Let's review this case. This is the case of a 21-year-old female who presented with swelling in the distal femur for two months. This is the AP and lateral radiograph of this patient and we will evaluate the bone tumor on the basis of following the heading. First is age of the patient. As we know age of the patient is 21 years. She is a young female. However, the pices are closed and she is a skeletally mature patient. Next is whether the lesion is single or multiple. As you can see, the lesion is single and it is involving the distal femur. A skeletal location. It is a perpendicular skeletal in location and it is involving long bone. What is the site of long bone involvement? As you can see, the lesion is involving epiphygel and metaphygel region of distal femur. The lesion is eccentric, expands site and it is reaching up to the subarticular region. Next is pattern of growth and bone destruction. As we can see, the lesion is having geographic tumor-thetan pattern of bone destruction with narrow zone of transition. Next is the type of periosteal reactions. As we can see, there is mild periosteal buttressing and periosteal reaction is predominantly non-aggressive type. Pattern of matrix mineralization. As we can see, there is no obvious conduit or auspicious matrix mineralization in the tumor. Next is the soft tissue involvement. As we can see, there is slight soft tissue involvement in the periosteal region because of the cortical region. So, this is the case of a well-defined dietic lesion eccentricly located in the distal femur epiphysis with sub-condrel and metaphygel extension and associated focal bridge of the cortex. So, radiographically, this is giant cell tumor or osteoplastoma, but there are certain differentiates which we need to consider. These differentiates are chondroblastoma, enlargement bone cysts and round tumor of hyperparathyroidism. So, why it is not chondroblastoma? Because chondroblastoma generally affect skeletally immature patients with non-fused epiphysis and the lesions are phenomenally epiphyzer in location. Chondroblastoma bone cysts generally have so bubble matrix and ABC also affects in their age group. Next is round tumor of hyperparathyroidism. In this patient, we are not seeing any other radiographic signs of hyperparathyroidism. So, this is not a round tumor. This patient was a histopathologically proven GCT and she was treated with venosomal for four months and this drug led to ossification of the tumor matrix. And this was followed by cementing of the lesions. So, giant cell tumor predominantly affects age group of 20 to 40 years. The most common locations are distal femur and distal radius. The lesions are eccentric and expand sign. The lesions are predominantly metaphyseal and epiphyseal in location extending into the subarticular region. The lesions can cause thinning of the cortex. They have phenomenally geographic pattern of bone destruction and internal septations can be seen which is predominantly because of ABC transformation of the GCT. So, this was all about giant cell tumor or osteoplastoma. This is the case of a three-year-old female who presented with an increasingly facing forearm of tissue mass lesion and a recent onset of no-grade tumor. This is the dental radiograph of the serum of the patient and you will review this swelling on the basis of following criteria. First is age of the patient. So, age of the patient is three years and she is a young child. So, there is a lesion single or multiple. So, as you can see the lesion is single. And it is involving anus. Skeletal location is appendicular skeleton and is involving long bones. Sight of long bone involvement as you can see the lesion is involving diaphysis of anus. And it is involving the medullary cavity so the predominancy central with expansion. Pattern of growth and bone destruction as you can see the lesion is having formative pattern of bone destruction with wide donor transition. Talking about the types of periosteal reactions as you can see this is aggressive. In nature, the periosteal reaction is aggressive and it is of onion skin and cord man endothelium. Pattern of matrix mineralization is difficult to comment upon as there is aggressive onion skin type of periosteal reaction and there is no obvious or share circum-diad matrix within the tumor. Proficient involvement as you can see this lesion is having proficial involvement within the forearm percussion. So this is the case of a large indefined destructive diaphyseal intra medullary lesion with permeative pattern of bone destruction and periosteal reaction of onion skin type. So this is the case of hidden sarcoma. Hidden sarcoma are classified as a round cell tumor along with multiple myeloma and non-hutchkin lymphoma of bone. Localized pain with swelling at the site of the lesion is a common symptom. It may mimic infection, systemic signs of slight fever, secondary anemia, leukocytosis and increased ESR are common. It is the only primary malignant bone tumor with symptoms, sandalating and infection. The long tuberous bones of the lower extremities are most commonly affected. A nominate bone is the most common flat bone affected and it is the most common primary malignant bone tumor to metastasize to bones. This is the case of a 10 year old male who presented with swelling in the digital forearm for 5 months. This is the radiograph of the digital forearm and wrist of the patient and this part is under plaster cut. And we will review this swelling again under following subheadings. First is age of the patient. So as we know age of the patient is 10 years. So this is the x-ray of a young child. Again the lesion is either single or multiple as we can see the lesion is single. It is involving distal end of radius. Next is skeletal location. So as we can see this is involving appendicular skeleton and it is involving long bones. Next is the site of long bone involvement. As we can see the lesion is involving epiphyzer and metaphyzer lesion of the distal radius. And this lesion is expansile in nature. Pattern of growth and bone destruction. So this lesion is having geographic pattern of bone destruction with narrow zone of transition. Types of periostal reaction. So the periostal reaction is of non-aggressive type. Pattern of matrix mineralization. So there is no obvious cartilaginous or austere matrix. But there is typical toe bubble internal appearance. There is no obvious soft tissue involvement. So this is the case of a well defined expansile lytic lesion located in the distal radial epiphysis and metaphysis with toe bubble appearance. So this is the case of aneurysmal bone cyst. The differential diagnosis will include giant cell tumor. But giant cell tumors are generally seen in middle age group when the epiphysis is closed. Aneurysmal bone cyst involves 75% of the cases present between the ages of 5 and 20 years. In long bones ABCs generally involve metaphysis and diaphysis. Whereas in spine it involves neural arch and it gives an appearance of inflated spine. The lesions generally have geographic pattern of bone destruction. They are eccentric, expansile. They have very thin basal cortex and they have light internal septation. They give an appearance of blown out or finger in the balloon sign. Spinal lesions in the neural arch must be differentiated from osteoblastoma. Osteoblastomas generally have auspicious matrix whereas ABCs have toe bubble appearance. MRI demonstrates a classic fluid fluid level. So this was all about aneurysmal bone cyst. I hope you have enjoyed the video. Thank you. This is the case of a 45 year old female who is presented with swelling in the region of lytic lymphosis for two months. This is the frontal radiograph of the pelvis of the patient covering both hip joints. And we will review this swelling on the basis of warrants of headings. First is age of the patient. So as we know age of the patient is 45 years and she is the middle aged female. Second is whether the lesion is single or multiple. So as we can see the lesion is single. Third is the skeletal locations. So as we can see the lesion is involving the skeletal skeleton. It is involving less in the tremor. Side of long bone involvement is not applicable in this case. Pattern of growth and bone destruction. So as you can see the lesion is having more theta and pattern of bone destruction with wide zone of transition. Very austere reaction is of aggressive type. Pattern of matrix mineralization. As you can see the lesion is having a small focus of calcification with internal suffocation. And there is a definitive suffocation involvement. So this is the case of ill-defined expansile lytic lesion located in the left pubic remi with internal calcification and thymine septum. So this is the case of conrosarcoma. The differential diagnosis will include metastasis, giant cell tumor, plasma cytoma and ground tumor of hyperparathyral. Metastasis can be excluded on the basis of absence of other lesions in the skeleton and absence of some bone primary. Giant cell tumor can be kept as a differential in this case. Plasma cytoma will also present as a solid free austere lytic lesion. However it will not have a foci of internal calcification. Ground tumor of hyperparathyralism can also be excluded on the basis of absence of other skeleton features of hyperparathyralism. This is the CT of the same patient showing expansile lytic lesion involving left pubic remi with thinned out cortex. This is MRI of the same patient showing the lesion is appearing very hyper intense on the deteriorated sequence and it is having extensive force contrast enhancement. So conrosarcoma represents the third most common primary melignin bone tumor following myeloma and austere sarcoma. It affects 40 to 60 years of age with 2 to 1 male predominance. It can be primary or below or it can be secondary because of degeneration in the osteocondroma or uncontrollable. The closer the lesion to the axial skeleton the higher the potential for melignin degeneration. Travgnosis is good with 90% survival after a knee surgery. So this was all about conrosarcoma. I hope you have enjoyed the video. Thank you.