Codman's Triangle,Radial Periosteal Reaction And Their Relationship With The Benign And Malignant Bone Lesions

Objective To analyze the significance of Codman's triangle and radial periosteal reaction in the differential diagnosis between the benign and malignant bone diseases.Materials and Methods Review the cases of pathologically proved bone diseases which had the periosteal reaction,and divided these cases into two groups of the malignant and benign with 85 cases and 812 cases respectively.In the malignant group with periosteal reaction,there were 54 cases of osteosarcomas,12 cases of chondrosarcomas,5 cases of metastatic tumors,4 cases of Ewing's sarcomas,2 cases of primitive neuroectodermal tumors(PNET),2 cases of lymphomas and 2 cases of squamous cell carcinoma of the gums,1 case of neuroendocrine tumor,1 case of poorly classified small round cell malignant tumor,1case of malignant meningioma and 1 case of acinar soft tissue sarcoma.In benign group the periosteal reaction there were 725 cases of fracture,67 cases of osteomyelitis,6 cases osteoid of osteoma,5 cases of Langerhans histiocytosis,3 cases of osteoblastoma,2 case of skull meningioma,1 case of fibrous dysplasia of bone,1 case of bone tuberculosis,1 case of bone hemangioma,and 1 case of subperiosteal hematoma.The occurrence rate of Codman's triangle and radial periosteal reaction were analyzed in the benign and malignant groups respectively.Results In the group of malignant lesions there are 43 cases of Codman's triangle and 30 cases of radial periosteal reaction,of which 4 cases have both signs.In the group of benign lesions there are 6 cases of Codman's triangle and 4 cases of radial periosteal reaction.In the group of malignant lesions with periosteal reaction,the occurrence of Codman's triangle is50.6%(43/85),which included 33 cases of osteosarcoma,5 cases of chondrosarcoma,2 cases of Ewing sarcoma,1 case of primitive neuroectodermal tumor(PNET),1 case of metastatic tumor and 1 case of small round cell malignant tumor that is difficult to be classified.In the group of benign lesions with periosteal reaction,the occurrence of Codman's triangle is0.7%(6/812),which included 1 case of acute osteomyelitis,1 case of subperiosteal hematoma,1 case of bone tuberculosis,1 case of fibrous dysplasia of bone,1 case of dental cyst combined with chronic suppurative inflammation and 1 case of osteoblastoma.For the incidence of Codman's triangle,there was a significant difference between the group of benign and malignant(X2=360.6,P<0.01).In the group of malignant lesions with periosteal reaction,the occurrence of radial periosteal reaction is 35.3%(30/85),which included 19 cases of osteosarcoma,3 cases of chondrosarcoma,3 cases of Ewing sarcoma,1 case of neuroendocrine tumors,1 case of primitive neuroectodermal tumors(PNET),1 case of lymphomas,1 case of malignant meningiomas and 1 case of metastatic tumor.In the group of benign lesions with periosteal reaction,the occurrence of radial periosteal reaction is only0.5%(4/812),which included 2 case of skull meningioma and 1 cranial hemangioma,1osteomyelitis.For the incidence of radial periosteal reaction,there was a significant difference between the group of benign and malignant(X2=246.1,P<0.01).Conclusion Codman's triangle and radial periosteal reaction are not absolute malignant signs.Although they are more common in malignant tumors,they can also be found in a few benign lesions.