Bone lesion approach

Question 1

Primary bone lesions are common or rare

Answer 1

Rare

Question 2

Initial approach

Answer 2

Location and age of the patient

Question 3

Which lesions are found in those under 30

Answer 3

Eosinophilic granuloma
Aneurysmal bone cyst
Non - ossifying fibroma 
Chondroblastoma
Simple bone cyst
Infection

Question 4

When over 40 what are the additionla diagnoses to consider?

Answer 4

Infeciton
mets
myeloma
lymphoma

Question 5

Under 30s
describe where 
Ewings
Osteoid osteoma
Osteochondroma
Aneurysmal bone cyst 
enchondroma 
osteosarcoma
Chondroblastoma
Simple bone cyst would exist

Draw these out

Answer 5

.https://portal.e-lfh.org.uk/LearningContent/Launch/313872

Question 6

In the over 30s where are

Metastasis myeloma lymphoma
metastasis myeloma HPT
Enchondroma chondrosarcoma
Giant cell tumour
Geode 

found

Answer 6

https://portal.e-lfh.org.uk/LearningContent/Launch/313872

Question 7

Single vs multiple lesions

if multiple lesions then differentials are

Answer 7

metastases
myeloma
lymphoma

Question 8

What exxample is there of a non malignant lesion behaving as an aggressive lesion?

Answer 8

Langerhans cell histiocytosis

infection

Question 9

What to cover when describing a bone lesion?

Answer 9

Whether the lesion is lytic or sclerotic
The pattern of bone destruction
Matrix mineralisation
The zone of transition (ZT)
The cortical response
Any periosteal reaction
Any soft tissue component

Question 10

Pattern of bone destruction related to what

Answer 10

intensity and degree of aggression of a destructive bone process

Question 11

Geographic pattern relates to what?

Answer 11

slow graoth, single focus
well defined margins
least aggressive

Question 12

Moth eaeten pattern of destruction related to what?

Answer 12

rapidly growing lesions but not fast enough for all the bone to be destroyed.

Can be agressive or non aggressive

Question 13

Osseous lesions description

Answer 13

Immature, cloud like ossification to mature well defined bony masses

Question 14

Osseous - exmaple of benign and malignant

Answer 14

Osteoid osteoma and osteosarcoma

Question 15

Chondral lesions description

Answer 15

Punctate calcification in rings and arcs, c shaped

Question 16

Examples of chondral bone lesions for benign and malignant

Answer 16

benign (endochroma, chondroblastoma, chondromyxoid fibroma) malignant is chondrosarcoma

Question 17

description of fibrous lesion

Answer 17

ground glass due to numerous fine spicules of bone

Question 18

examples of fibrous lesions

Answer 18

benign - fibrous dysplasia and non ossifying fibroma. Malignant is fibrous sarcoma

Question 19

why do lesions get a sclerotic margin?

Answer 19

the host response to the lesion, if the lesion is slow growing enough that sclerosing can happen at the edges

Question 20

Expansion with intact cortex implies

Answer 20

slow growth

Question 21

Scalloping (endosteal) implies

Answer 21

growth of lobules of tumour (especially chondral and fibrous)

Question 22

Trabeculation is frequent in

Answer 22

in simple cysts and GCTs

Question 23

Causes of focal periosteol reaction?

Answer 23

Trauma (fracture), infection, tumour

Question 24

Osteoid osteoma what kind of periosteol reaction?

Answer 24

Solid / cortical thickening

Question 25

Ewings sarcoma type of periosteal reaction

Answer 25

onion skin

Question 26

Osteosarcoma type of preiosteol reaction

Answer 26

spiculated

Question 27

Aneurysmal bone cyst type of periosteal reaction

Answer 27

periosteal buttress

Question 28

Solid cortical thickening is what assocition?

Answer 28

benign

Question 29

How does solid corticol thickening come abour?

Answer 29

end point of another pattern of periosteal reaction such as asoteoi dosteoma, chronic osteomyelitis or trauma

Question 30

Exra osseoous involvement is a dewcription for

Answer 30

malignant features

Question 31

what other modalities are useful to image bone lesions and why

Answer 31

CT - pattern and edge of the calcifications,
MRI - oedema and soft tissue component,
Scintigraphy - mets