-
Orthopaedics & Traumatology, Surgery &... Feb 2015Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which... (Review)
Review
Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.
Topics: Adolescent; Biopsy; Bone Cysts; Bone Cysts, Aneurysmal; Child; Female; Fractures, Spontaneous; Humans; Magnetic Resonance Imaging; Male; Prognosis; Risk Factors; Treatment Outcome; Young Adult
PubMed: 25579825
DOI: 10.1016/j.otsr.2014.06.031 -
International Journal of... 2017Causes of lytic bone lesions include benign, malignant, and infectious processes. Lytic lesions due to tuberculosis (TB) may closely mimic those due to tumors such as...
Causes of lytic bone lesions include benign, malignant, and infectious processes. Lytic lesions due to tuberculosis (TB) may closely mimic those due to tumors such as bone cyst, osteoblastoma, osteosarcoma, and metastatic bone disease radiologically. Histopathology and culture help in definitive diagnosis and prompt management. We describe an immunocompetent patient with isolated lytic bone lesion in the distal part of ulna due to TB to make the readers aware of such unusual presentations of TB.
Topics: Adult; Female; Humans; Mycobacterium; Osteolysis; Tomography, X-Ray Computed; Tuberculosis
PubMed: 28559524
DOI: 10.4103/ijmy.ijmy_62_17 -
Clinical Imaging Feb 2020The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article... (Review)
Review
The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement. Further assessment with magnetic resonance (MR) imaging including diffusion weighted imaging (DWI) aids in soft tissue characterization. We present cases of large solitary lytic skull vault lesions in adults, emphasizing on salient and atypical imaging features, with pathological correlation for better understanding of the disease processes that underlie the imaging features.
Topics: Adult; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Skull; Skull Neoplasms; Tomography, X-Ray Computed
PubMed: 31816540
DOI: 10.1016/j.clinimag.2019.10.011 -
Skeletal Radiology 1982The radiographic features of 42 purely lytic osteosarcomas are presented. Purely lytic osteosarcoma is identified as a lytic lesion of bone with no demonstrable osteoid...
The radiographic features of 42 purely lytic osteosarcomas are presented. Purely lytic osteosarcoma is identified as a lytic lesion of bone with no demonstrable osteoid matrix by conventional radiographic modalities. Purely lytic osteosarcoma represented 13.7% of a group of 305 osteosarcomas. The most common presentation was that of a lytic ill-defined lesion with a moderate to large extraosseous mass component. Nine lesions presented with benign radiographic features. The differential diagnosis is outlined. The need for awareness of this type of presentation of osteosarcoma is stressed.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Bone Resorption; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteolysis; Osteoradionecrosis; Osteosarcoma; Soft Tissue Neoplasms; Tomography, X-Ray Computed
PubMed: 6961529
DOI: 10.1007/BF00367373 -
Archives of Orthopaedic and Trauma... 1991A correlation is demonstrated between chronic hemodialysis using cuprophane membranes (mean duration: 13 years) and pathological fractures (n = 7 in 6 patients) after... (Review)
Review
A correlation is demonstrated between chronic hemodialysis using cuprophane membranes (mean duration: 13 years) and pathological fractures (n = 7 in 6 patients) after lytic bone deposits of beta 2-microglobulin amyloid (n = 13 patients). The characteristic symptom complex includes painful impingement syndrome of the shoulder, carpal tunnel syndrome, painful hip and recurrent knee effusions. The first steps of the clinical diagnostic procedure are to demonstrate lytic defects in skeletal radiographs and to verify the presence of beta 2m by biopsy or puncture. Due to reduced regeneration capacity in amyloid bone lesions the resulting surgical therapy should aim at total joint replacement or augmented osteo synthesis. Definitive operative treatment should be aspired even in the absence of manifest fractures, as the natural course of the disease is characterized by progression of the bone destruction and a continuous pain syndrome.
Topics: Amyloid; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Kidney Failure, Chronic; Osteolysis; Renal Dialysis; Time Factors; beta 2-Microglobulin
PubMed: 2015141
DOI: 10.1007/BF00393881 -
Insights Into Imaging Oct 2018Lytic lesions of the skull include a wide range of diseases, ranging from benign conditions such as arachnoid granulations or vascular lacunae, to aggressive malignant... (Review)
Review
Lytic lesions of the skull include a wide range of diseases, ranging from benign conditions such as arachnoid granulations or vascular lacunae, to aggressive malignant lesions such as lymphomas or metastases. An early and correct characterisation of the nature of the lesion is, therefore, crucial, in order to achieve a fast and appropriate treatment option. In this review, we present the radiological appearance of the most frequent lytic lesions of the skull, describing findings from different imaging modalities (plain X-rays, CT and MRI), with particular attention to diagnostic clues and differential diagnoses. TEACHING POINTS: • Osteolytic skull lesions may be challenging to diagnose. • Association of different imaging techniques may aid image interpretation. • Clinical information and extensive knowledge of possible differential diagnoses is essential. • Some osteolytic tumours, although benign, may present as locally aggressive lesions. • Malignant lesions require accurate staging, followed by variable treatment approaches.
PubMed: 30232766
DOI: 10.1007/s13244-018-0653-y -
BMJ Case Reports Dec 2011The authors describe a rare case of metastatic bronchogenic adenocarcinoma in a 55-year-old man presenting with concomittant solitary lytic skull lesion and ischaemic... (Review)
Review
The authors describe a rare case of metastatic bronchogenic adenocarcinoma in a 55-year-old man presenting with concomittant solitary lytic skull lesion and ischaemic stroke. Metastatic bronchogenic carcinoma is known to present as lytic skull lesions. Primary brain tumours are also known to cause ischaemic brain injury. An underlying stroke risk may be exagerated by cranial tumour surgery. Patients with brain tumours are well known to be predisposed to an increased risk of developing thromboembolic disease. It is unusual to see metastatic bronchogenic adenocarcinoma presenting as ischaemic stroke with a background of concomittant cerebral metastasis. The aetio-pathogenesis of this rare occurrence is discussed with a review of literature.
Topics: Adenocarcinoma; Brain Ischemia; Carcinoma, Bronchogenic; Humans; Lung Neoplasms; Male; Middle Aged; Skull Neoplasms; Stroke
PubMed: 22669998
DOI: 10.1136/bcr.11.2011.5092 -
Polish Journal of Radiology 2017The sternum is an uncommon site for neoplastic involvement and metastases are far commoner than primary neoplasms. Of the primary tumours, malignant lesions are more... (Review)
Review
The sternum is an uncommon site for neoplastic involvement and metastases are far commoner than primary neoplasms. Of the primary tumours, malignant lesions are more frequent than the benign lesions. Early diagnosis and treatment is prudent in such neoplasms not only to halt disease progression but also to prevent circulatory compromise resulting from the mass effect on the mediastinum. Sound knowledge of neoplasms affecting the sternum and their imaging appearance is essential to arrive at an early diagnosis and also to obviate biopsy in cases with classical imaging findings. Neoplastic involvement of the sternum is extremely unusual and should be considered malignant unless proven otherwise. Imaging may help in arriving at the diagnosis of these lesions, together with other factors such as patient's age, type of lesion (lytic/sclerotic or mixed), matrix mineralization, multiplicity and involvement of other sites.
PubMed: 29662571
DOI: 10.12659/PJR.901226 -
Indian Journal of Orthopaedics Oct 2009Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type. The skeletal manifestations are usually osteolytic lesions whose...
Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type. The skeletal manifestations are usually osteolytic lesions whose differential diagnosis includes primary and secondary bone tumor. This tumor is characterized by the presence of abnormal paraprotein 8 in blood and urine. However, one to five per cent of the cases do not have any protein. Hence they are termed nonsecretory. It often poses a diagnostic dilemma when it is presented to orthopedic surgeons with no clear features of the disease. Our case report exemplifies such a diagnostic dilemma. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or lytic lesion.
PubMed: 19838394
DOI: 10.4103/0019-5413.55979