Benign Lucent Bone lesions Flashcards
Enumerate FEGNOMASHIC
Fibrous dysplasia, Enchondroma, Eosinophilic granuloma, Giant cell tumor, Nonossifying fibroma, Osteoblastoma, Metastatic disease and Myeloma, Aneurysmal Bone Cyst, Solitary bone cyst, Hyperparathyroidism (Brown tumors), Hemangiomas, Infection, Chondroblastoma, Chondromyxoid fibroma
fibrous dysplasia can be seen at what age
any age
discriminator for fibrous dysplasia
no periosteal reaction
2 discriminator for enchondroma
calcification present (except in phalanges), painless (no periostitis)
discriminator for eosinophilic granuloma
younger than 30
4 discriminator for giant cell tumor
- closed physes,
- abuts the articular surface (in long bones),
- well defined with a nonsclerotic margin (in long bones),
- eccentric
2 discriminator for nonossifying fibroma
younger than age 30, painless (no periostitis)
discriminator for osteoblastoma
mentioned when ABC is mentioned (especially in the posterior elements of the spine)
discriminator for metastatic diseases and myeloma
older than age 40
2 discriminator for aneurysmal bone cyst
expansile, younger than age 30
2 discriminator for solitary bone cyst
central, younger than age 30
2 discriminator for hyperparathyroidism (brown tumor)
must have other evidence of HPT, rare, may be multiple
discriminator for infection
always mention
2 discriminator for chondroblastoma
younger than age 30, epipiphyseal
discriminator for chondromyxoid fibroma
no calcified matrix
most common form of fibrous dysplasia
monostotic
4 predilection of fibrous dysplasia
PPRS
- pelvis,
- proximal femur,
- ribs and
- skull
typical appearance of fibrous dysplasia in the ribs
expansile, lytic appearance in posterior ribs, sclerotic appearance in the anterior ribs
classic description of fibrous dysplasia
ground glass or smoky matrix
lesion that resembles fibrous dysplasia in the tibia
adamantinoma
it is a malignant tumor that radiographically and histologically resembles fibrous dysplasia
adamantinoma
adamantinoma is common in what 2 parts of the body
tibia and jaw
polyostotic fibrous dysplasia occassionally occurs in association with cafe au lait spots on the skin and precocious puberty
McCune Albright syndrome
McCune Albright syndrome is commonly unilateral or bilateral
unilateral, affecting 1/2 of the body
multiple lesions of fibrous dysplasia in the jaw is called
cherubism
true or false: jaw lesions in cherubisms regress in adulthood
true
most common benign lytic lesion in the phalanges. invariably contain calcified chondroid matrix except when in the phalanges of the hands and feet
echondromas
how to differentiate bone infarct from enchondroma
infarct usually has a well-defined, densely sclerotic serpiginous border, enchondroma does not. enchondroma often causes mild endosteal scalloping
multiple enchondromas has been termed
Ollier disease
presence of multiple enchondromas associated with soft tissue hemangiomas is known as
Maffucci syndrome
true or false: Maffucci syndrome carries a high risk of malignant degeneration than Ollier disease
true
typical appearance of enchondroma other than in the phalanges
stippled punctate calcification typical of chondroid matrix
also known as langerhans cell histiocytosis; is the most common and least severe form of LCH, with the other forms being Letterer-Siwe disease and Hand-Schuller-Christian disease
Eosinophilic granuloma
eosinophilic granuloma is commonly of what type
monostotic
bony sequestrum is typical of osteomyelitis, but can also be seen in what benign lesion especially in young patients
eosinophilic granuloma
aside from osteomyelitis and EG, bony sequestrum can also be seen in (3)
lymphoma, fibrosarcoma, osteoid osteoma may simulate sequestrum if it shows calcification
FLO
uncommon tumor found almost exclusively in adults in the ends of long bones and in flat bones
Giant cell tumor
giant cell tumor must be at what part of the bone
epiphyseal and abut the articular surface
very helpful finding in GCT; not applicable to flat bones, such as pelvis and calcaneus
sharply defined zone of transition (border) that is not sclerotic
3 locations where giant cell tumors often occur
sacrum, pelvis and calcaneus
also called fibroxanthoma, is probably the most common bone lesion encountered by radiologists
non-ossifying fibroma
benign, asymptomatic lesions that typically occur in the metaphysis of a long bone, emanating from the cortex
non ossifying fibroma
classic appearance of NOF
sclerotic border, scalloped and slightly expansile
true or false: NOFs routinely “heal” with sclerosis and eventually disappear, usually around ages of 20 to 30 years
true
NOFs may appear hot on a radionuclide bone scan because there is
osteoblastic activity
true or false: NOFs can occasionally get quite large, therefore, growth or change in size should not alter the diagnosis
true
NOFs are most commonly seen in what part
knee
two appearance of osteoblastoma
looks like large osteoid osteoma and are often called giant osteoid osteomas, primarily sclerotic lesions due to reactive bone formation and do not resemble bubbly lucent lesions; simulates ABCs, often having a soap bubble appearance
common location of osteoblastomas
posterior elements of vertebral bodies
appearance of calcifications in osteoblastomas
speckled calcifications
metastatic disease should be considered for any lytic lesion-benign or aggressive in appearance- in a patient of what age
more than 40 years of age
diffuse permeative process in the skeleton
myeloma
bubbly, lytic bone lesions of myeloma are more correctly called
plasmacytomas
in general, lytic expansile metastatic diseases tend to come from
thyroid and renal tumors
metastatic lesion that is said to always be lytic is
renal cell carcinoma
characteristic appearance of plasmacytoma involving vertebral body on CT and MRI
“mini-brain”
common location for plasmacytoma aside from the vertebral body
ilium
aneurysmal bone cysts virtually always presents as (2)
expansile; also fluid-fluid levels
secondary ABCs have been said to occur with
giant cell tumors, osteosarcomas and many other lesions
said to be pathognomonic for a unicameral bone cyst
fallen fragment sign
only lesion in FEGNOMASHIC that is always central in location
solitary/unicameral bone cyst
2/3 to 3/4 of these lesions occur in the proximal humerus and proximal femur
solitary/unicameral bone cyst
solitary bone cyst pattern of growth
begin at the physeal plate in long bones and grow into the shaft of the bone
PP-S
common location of solitary bone cyst in the calcaneus
inferior surface of the calcaneus
pathognomonic finding for HPT
subperiosteal bone resorption
4 common location of HPT
- radial aspect of the middle phalanges,
- medial aspect of proximal tibia,
- distal clavicles and
- sacroiliac joints
also known as cystic angiomatosis or cystic lymphangiomatosis
hemangiomas
massive osteolysis or disappearing bone disease
Gorham disease
focus of devitalized bone that does not have a blood supply and will not be effectively treated with parenteral medication
sequestrum
abscess collection in the proximal humerus
Brodie’s abscess
rare lesions but are among the easiest lesions for radiologists to deal with because they occur in the epiphyses
chondroblastomas
3 differential diagnosis of a lytic lesion in the epiphysis of a patient less than 30 years of age are:
infection,chondroblastoma, GCT
four disease process that presents with subchondral cyst or geode
- degenerative joint disease,
- RA,
- calcium pyrophosphate dihydrate crystal disposition disease or pseudogout and
- avascular necrosis
basically resembles NOFs but can occur at any age
chondromyxoid fibroma
5 lesions in patients younger than 30 years of age
E-SCAN
EG, ABC, NOF, chondroblastoma, solitary bone cyst
4 lesions that have no pain or periostitis
FENS
fibrous dysplasia,
enchondroma,
NOF,
solitary bone cyst
4 epiphyseal lesions
IG-CG
- infection,
- GCT,
- chondroblastoma,
- Geode
5 differential for rib lesions
(FAMEE)
- fibrous dysplasia,
- ABC,
- metastatic disease and myeloma,
- enchondroma and
- EG
7 multiple lesions
FEEMHHI
- fibrous dysplasia,
- EG,
- enchondroma,
- metastatic disease and myeloma,
- HPT,
- hemangiomas,
- infection
difference between epiphyses and apophyses
epiphyses contribute to the length of bone, whereas apophyses serve as tendon and ligament attachment sites
sclerotic focus identified in a 20 to 40 year old patient, especially if asymptomatic, incidental finding, the following lesions should be considered (6):
AB-SC-EN
- NOF,
- EG,
- ABC,
- solitary
- bone cyst and
- chondroblastoma