Enneking’s 4 questions:
What is the anatomic location involved?
What effect does the lesion have on the surrounding bone?
What (if any) is the response of the bone to the lesion?
What are the unique characteristics of the tumor?
Characteristics of the lesion:
1. geographic – slow bone destruction
– well-defined with encasing rim of reactive bone = benign latent lesion
– well-defined with no sclerotic margin = benign active lesion
– ill-defined margins = benign aggressive lesion
2. moth-eaten – intermediate growth rate with no clear margination of bony lesion
3. permeative – aggressive lesion with such rapid growth that it invades bone before the bone is resorbed
4. periosteal reaction – occurs with more aggressive tumors & infection
– Codman’s triangle
– onionskin appearance
– interrupted Codman’s triangle or lamellation or speculated sunburst à sig. growth/aggressiveness