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17.2  Neoplasia of  pecific  eeions  275

                              (A)               (C)                 (E)                 (G)





















                              (B)               (D)                 (F)                 (H)






















             Figure 17.2  Proximal humeral osteosarcoma: (A) lateral and (B) craniocaudal radiographs display a subtle
             lesion (white arrows) that may be missed without performing orthogonal views; (C, D) predominant
             osteolytic changes extending throughout the proximal one‐quarter of the humerus are visible; (E, F)
             osteolytic and proliferative changes extend throughout the proximal one half of the humerus; (G) osteolytic
             and osteoproductive changes, irregular osseous production along the cranial aspect of the proximal
             humerus, as well as a smooth periosteal reaction along the caudal aspect of the humerus; and (H)
             pathologic fracture due to osteosarcoma. Note the periosteal reaction, punctate lysis of the cortices and
             patchy, heterogenous, and moth‐eaten appearance to the medullary cavity of the humerus.

             is the one tumor type where tumor cells are most likely to be seen in the CSF. A sample collected
             from the lumbar cistern has been reported to be more likely to be diagnostic than one collected
             from the cerebellomedullary cistern (Thomson et al. 1990).
               Tumors  of  the  spinal  cord  are  categorized  into  intramedullary,  intradural‐extramedullary,  and
             extradural  based  on  their  location  with  respect  to  the  spinal  cord  tissue  itself  and  meninges:
             Intramedullary neoplasms are located within the spinal cord substance and can be primary spinal
             parenchymal tumors or metastatic. Primary tumors are more common in the C6–T2 segment and are
             predominantly of glial cell origin; astrocytoma and ependymoma are the most frequent but other
             types reported include oligodendroglioma, undifferentiated sarcoma, choroid plexus papilloma, and
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