15 types of tumors that occur on the ribs, have you seen them all?

1.

Osteochondroma is the most common bone tumor with typical imaging manifestations.

2.

According to the WHO (2002 edition) classification standard, it is divided into giant cell tumor of bone and malignant tumor in giant cell tumor of bone, which are WHO grade I and III respectively.

3.

It is a relatively common benign bone tumor.

4.

It is customary to be divided into two categories: benign and malignant (invasive).

5.

Plasmacytoma, also known as plasmacytoma, is a malignant tumor originating from the reticulocytes of the bone marrow

6.

Derived from primitive mesenchymal cells, the cells have the ability to differentiate into histiocytes, fibroblasts and intermediate cells in multiple directions, and the cellular components are complex, resulting in very diverse imaging manifestations, which are basically classified into the following four categories: 1.

7.

Osteosarcoma is a common malignant bone tumor with a predilection age of 10 to 20 years old.

8.

It can be divided into primary and secondary.

9.
Bone Island

It is the most common rib lesion on CT.
The lesion is manifested as an area of ​​increased bone density with a clear boundary in the rib body
.
Pathologically, the bone island is a limited variation of bone growth in the cancellous bone, so the shape of the ribs generally has no obvious change; there is no obvious change in the dynamic observation of the lesions
.

10.
Fibrous dysplasia

It is a disease in which normal bone tissue is replaced by abnormally proliferating fibrous tissue; microscopically, there are mainly active hyperplasia, fibrous tissue and osteoid tissue, in different lesions or different areas of the same lesion, due to the different proportions of the two, the corresponding Plain X-ray and CT findings are also different
.
Therefore, the ground-glass-like changes in the lesions are the characteristics of the lesions (predominant fibrous tissue hyperplasia is more common); sometimes ivory-like density changes may be present (probably due to the predominance of osteoid tissue hyperplasia)
.

11.
Rib metastatic tumor

Mainly hematogenous transfer
.
Hematogenous metastasis is mainly of the vertebral venous type, because anatomically, the pelvic, thoracic, and limb veins have extensive communication with the vertebral venous plexus
.
Since there is no venous valve in the venous network, the blood flow is slow, stagnation and reverse flow can occur
.
Any factor that causes the increase of thoracic and intra-abdominal pressure can cause the tumor thrombus to retrograde into the venous plexus along the veins
.
Therefore, tumor emboli can directly transfer to bones without passing through the liver and lungs, especially the spine, ribs, pelvis and skull; the most common primary tumors in clinic are breast cancer, prostate cancer and lung cancer, among which bone metastasis of lung cancer accounts for the rib metastasis.
to 68.
6%
.
Multiple lesions are the main features of metastatic tumors, mainly osteolytic destruction, and there are also ivory-like osteogenic metastases
.

12.
Rib hemangioma

Tumor-like hyperplasia of vascular tissue interspersed between trabecular bone can be divided into cavernous hemangioma and capillary hemangioma, the former is composed of a large number of thin-walled blood vessels and blood sinuses, commonly found in the skull and spine; the latter is composed of extreme dilation.
Hyperplasia of small capillaries, mostly in the metaphysis of long bones and flat bones
.
CT manifestations are clearly demarcated areas of expansive bone destruction with radial spicules or bony septa, which must be differentiated from fibrous dysplasia and ossifying fibroma.
The latter two have a relatively younger age of onset, but The lesions of fibrous dysplasia of bone are relatively large, some of which have blurred edges and mild swelling, and loofah or spider web-like bone patterns can be seen in some lesions
.
Ossifying fibroma is unilocular or multilocular destruction, with obvious expansion and clear sclerotic borders; while rib hemangioma is often incomplete, with obvious enhancement on enhanced scan
.

13.
Rib chondrosarcoma

Occurred in older patients, CT showed localized bone destruction of the ribs, which may be accompanied by characteristic round, arc-shaped or nodular cartilage calcification.
Necrosis and cystic degeneration
.
Chondrosarcoma without calcification should be differentiated from metastases, lymphoma, and myeloma.
The latter three are usually multi-bone and multifocal infiltration.
The differential diagnosis of a single lesion depends on pathological biopsy
.

14.
Rib fibrosarcoma

It is more common in the elderly and can be divided into central and peripheral types.
The former originates from the medullary cavity, which is more common; the latter originates from the non-osteogenic layer of the periosteum, which is rare
.
CT findings of central fibrosarcoma of the rib are osteolytic destruction of the rib, which can form a soft tissue mass, and calcification and necrosis can be seen in the mass
.
The CT manifestations of fibrosarcoma around the ribs are soft tissue masses around the ribs, calcifications and necrosis areas can be seen in the masses, and the adjacent rib cortex is moth-eaten bone destruction
.

15.
Ewing's tumor

It is a highly malignant tumor originating from small round cells in the bone marrow, and it is the second largest malignant bone tumor after osteosarcoma among primary malignant bone tumors in adolescents.
The pelvis and ribs are more common
.
CT showed rib worm-eaten, osteolytic bone destruction, laminar, onion skin-like, radial needle-like periosteal reaction and soft tissue mass.
Soft tissue mass was often larger than the extent of bone destruction
.
Some rib Ewing's tumors may be mainly sclerosis, with increased density of the medullary cavity, or osteolysis and sclerosis co-exist
.
Therefore, rib Ewing's tumor should be differentiated from other lytic and osteogenic tumors
.
Patients with younger age, extensive bone destruction, lamellar onion-like periosteal reaction, larger soft tissue mass, early distant metastasis and symptoms similar to bone infection are helpful for the diagnosis of Ewing's tumor
.

Summarize:

1.
History of malignant tumor: first consider metastases

2.
Multiple lesions: metastases, myeloma, bone fibers
.

3.
Lesion site: the junction of the front end of the rib and the costal cartilage: cartilage tumor
.
Behind the ribs: giant cell tumor and bone fibers
.

4.
Intralesional soap bubble-like: giant cell tumor of bone
.

5.
Scope of lesions: lesions longer than 200px are mostly fibrous dysplasia, and can even reach the full length of ribs
.

7.
High expansion: giant cell tumor and fibrous dysplasia of bone
.

8.
Calcified sequestrum with sand grains: tuberculosis
.

9.
The annular calcification in the lesion indicates cartilage tumor; the ground glass-like changes in the lesion indicate fibrous dysplasia

10, verrucous process: osteochondroma
.