Benign Lucent Bone lesions Flashcards by Butch Josef Abuel

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

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fibrous dysplasia can be seen at what age

any age

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discriminator for fibrous dysplasia

no periosteal reaction

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2 discriminator for enchondroma

calcification present (except in phalanges), painless (no periostitis)

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discriminator for eosinophilic granuloma

younger than 30

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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

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2 discriminator for nonossifying fibroma

younger than age 30, painless (no periostitis)

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discriminator for osteoblastoma

mentioned when ABC is mentioned (especially in the posterior elements of the spine)

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discriminator for metastatic diseases and myeloma

older than age 40

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2 discriminator for aneurysmal bone cyst

expansile, younger than age 30

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2 discriminator for solitary bone cyst

central, younger than age 30

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2 discriminator for hyperparathyroidism (brown tumor)

must have other evidence of HPT, rare, may be multiple

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discriminator for infection

always mention

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2 discriminator for chondroblastoma

younger than age 30, epipiphyseal

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discriminator for chondromyxoid fibroma

no calcified matrix

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most common form of fibrous dysplasia

monostotic

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4 predilection of fibrous dysplasia

PPRS

pelvis,
proximal femur,
ribs and
skull

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typical appearance of fibrous dysplasia in the ribs

expansile, lytic appearance in posterior ribs, sclerotic appearance in the anterior ribs

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classic description of fibrous dysplasia

ground glass or smoky matrix

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lesion that resembles fibrous dysplasia in the tibia

adamantinoma

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it is a malignant tumor that radiographically and histologically resembles fibrous dysplasia

adamantinoma

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adamantinoma is common in what 2 parts of the body

tibia and jaw

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polyostotic fibrous dysplasia occassionally occurs in association with cafe au lait spots on the skin and precocious puberty

McCune Albright syndrome

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McCune Albright syndrome is commonly unilateral or bilateral

unilateral, affecting 1/2 of the body

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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