ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

LYTIC BONE LESION

Updated on May 17, 2009

LYTIC BONE LESION

When you see lytic  bone lesion think of FOGMACHINE.

 

Most of the lytic lesions are benign conditions with the exception of 'M' (Metastasis and Multiple Myeloma) 

SOLITARY LYTIC BONE LESION

Differential Diagnosis (Mnemonic = FOGMACHINES)

F = Fibrous Dysplasia

O = Osteoblastoma

G = Giant Cell Tumour

M = Metastasis / Myeloma

A = Aneurysmal Bone Cyst

C = Chondroblastoma

H = Hyperparathyroidism(brown tumours)/ Hemangioma

I = Infection

N = Non-ossifying Fibroma

E = Eosinophilic Granuloma / Enchondroma

S = Solitary Bone Cyst

FIBROUS DYSPLASIA

Dysplasia = Abnormal tissue development.

Etiology unknown

Most common between 3-15 years of age.

Deformity of long bone (Most common deformity is varus of the proximal femur-"Shepherd's crook deformity") and bone pain.

Shepherd's crook deformity

Shepherd's crook deformity
Shepherd's crook deformity

Fundamental Abnormality Of Fibrous Dysplasia

The fundamental abnormality is replacement of medullary bone by fibrous tissue.

Characteristic X-ray findings:

1. Endosteal scalloping

2. Cortical thinning

3. Homogenous ground-glass appearance

4. Angular deformity at the level of the lesion.

Fibrous Dysplasia

Fibrous Dysplasia
Fibrous Dysplasia

McCune Albright's Syndrome

1 Polyostotic

2. Sexual precocity

3. Cafe-au-lait spots (Coast of Maine)

4. Almost always in a female

Coast of Maine cafe au-lait spot - The lesion has a rough, irregular border

Coast of Maine cafe au-lait spot - The lesion has a rough, irregular border
Coast of Maine cafe au-lait spot - The lesion has a rough, irregular border

AP view of the left hand demonstrates multiple large expansile "bubbly" lytic lesions

AP view of the left hand demonstrates multiple large expansile "bubbly" lytic lesions
AP view of the left hand demonstrates multiple large expansile "bubbly" lytic lesions

FIBROUS DYSPLASIA - TREATMENT

TREATMENT:

1. Observation -Prevention of deformity and fracture.

2. Pathologic fracture managed by standard methods according to the site of fracture. Suboptimal alignment will not remodel with time and should not be tolerated.

Surgical treatment principles:

1. Recurrent fracture require internal fixation with intramedullary rods and bone graft.

2. Severe angular deformities- treated with closing wedge osteotomies, bone grafting, and internal fixation.

3. Leg length discrepancy- treated with epiphysiodesis of contralateral limb at the appropriate age.

Fibrous dysplasia of both femur treated with internal fixation

Fibrous dysplasia of both  femur treated with internal fixation
Fibrous dysplasia of both femur treated with internal fixation

OSTEOBLASTOMA

Osteoblastoma is a solitary, benign and self-limited tumour that produces osteoid and bone. (Large form of osteoid osteoma; >2cm)

Occurs in the posterior element of spine, the metaphysis or diaphysis of long bones, and rarely in the pelvis.

Characteristic X-ray findings of Osteoblastoma

1. Radio-lucent defect with a central density due to ossification.

2. The lesion is well circumscribed and may have a surrounding sclerosis.

Osteoblastoma of proximal humerus

Osteoblastoma of proximal humerus
Osteoblastoma of proximal humerus

GIANT CELL TUMOUR

Aetiology unknown)

(Probably arise from zone of osteoclastic activity in skeletally immature patients).

Histology:

Multinucleated osteoclastic giant cells intermixed throughout a spindle cell stroma

Characteristic X-Ray finding of Giant Cell Tumour

1. Solitary expansile lytic lesion

2. Location: Metaphyseal and Juxta-articular (adjacent to joint)

3. Multiple septation (soap bubble appearance)

4. No reactive sclerosis

5. No periosteal reaction in absence of fracture

Giant cell tumour of distal radius

Giant cell tumour of distal radius
Giant cell tumour of distal radius

Giant cell tumour of proximal tibia

Giant cell tumour of proximal tibia
Giant cell tumour of proximal tibia

Multiloculated lesion with a very characteristic appearance (honeycomb-like pattern) (left); Pure lytic lesion (right)

Multiloculated lesion with a very characteristic appearance (honeycomb-like pattern) (left); Pure lytic lesion (right)
Multiloculated lesion with a very characteristic appearance (honeycomb-like pattern) (left); Pure lytic lesion (right)

METASTASIS - RENAL CELL CARCINOMA

When you see a patient over age 40 with hematuria and a large 'blow-out' bone lesion, think of kidney cancer.

Since the kidney is comprised of mostly blood vessels, kidney cancer metastases may also have a rich blood supply, and may bleed extensively (even audibly) after a simple biopsy.

Other lytic but non-expansile metastasis include lung and thyroid cancer.

Renal cell carcinoma metastasis to pelvis

Renal cell carcinoma metastasis to pelvis
Renal cell carcinoma metastasis to pelvis

Multiple Myeloma

It is the most common primary bone tumour and is found in the spine, skull, ribs, sternum and pelvis.

It is a malignant tumour of plasma cells that causes widespread osteolytic bone damage.

The average patient age is over 50 years old.

Men are affected twice as often as women.

It tends to involve the entire skeleton.

Characteristic X-Ray Finding of Multiple Myeloma

Multiple myeloma appears on X-rays as decreased bone density with a lot of "punched out" holes in the bone.

Erosion begins intramedullarly and progresses through the cortex.

These destructive lesions are not surrounded by the white rim of bone seen in other types of destructive lesion.

Multiple "punched-out" lesion in the skull

Multiple "punched-out" lesion in the skull
Multiple "punched-out" lesion in the skull

Multiple Myeloma of long bones

Multiple Myeloma of long bones
Multiple Myeloma of long bones

Plasma Cells

The osteolytic lesions are caused by increased osteoclastic resorption that is stimulated by cytokines released by-the plasma cells.

Plasma cells

Plasma cells
Plasma cells

Aneurysmal Bone Cyst

Hallmark is ballooned-out appearance

Eccentric location

Marked cortical thinning and erosion and periosteal elevation.

Buttress of periosteal reaction (to differentiate from simple bone cyst)

Usual containment by a thin shell of periosteum

Lesion rarely penetrates the articular surface or growth plate.

Radiographic differential diagnosis includes:

1. Simple bone cyst

2. Giant cell tumor of bone

3. Telangiectatic osteosarcoma

4. Angiosarcoma.

Anuerysmal bone cyst of proximal femur

Anuerysmal bone cyst of proximal femur
Anuerysmal bone cyst of proximal femur

ANEURYSMAL BONE CYST - SPINE

Posterior elements of the vertebrae are also frequent location of anuerysmal bone cyst.

Chondroblastoma

Chondroblastomas are radiolucent lesions that typically occupy the epiphysis (or apophysis) of long bones.

They tend to be small (< 4 cm) with most exhibiting a sclerotic border.

Plain radiograph of the distal femoral epiphysis in a 12-year-old boy. This image shows a chondroblastoma with a characteristica

Plain radiograph of the distal femoral epiphysis in a 12-year-old boy. This image shows a chondroblastoma with a characteristica
Plain radiograph of the distal femoral epiphysis in a 12-year-old boy. This image shows a chondroblastoma with a characteristica

Plain radiograph of the greater trochanter in a 24-year-old man. Chondroblastomas that occur in the proximal femur are 3 times m

Plain radiograph of the greater trochanter in a 24-year-old man. Chondroblastomas that occur in the proximal femur are 3 times m
Plain radiograph of the greater trochanter in a 24-year-old man. Chondroblastomas that occur in the proximal femur are 3 times m

Hemangioma

Benign lesions characterized by vascular spaces lined with endothelial cells.

50% of osseous hemangiomas are found in the vertebral bodies (thoracic especially) and 20% in the calvarium.

The remaining lesions are found in the tibia, femur and humerus.

The radiological appearance can be quite striking and depends on the location of the lesion.

The lesions are often poorly defined, appearing as a somewhat localized area of abundant, dilated vessels, some of which may be on the surface of the b

Hemangioma of tibia

Hemangioma of tibia
Hemangioma of tibia

Hemangioma of vertebra

Hemangioma of vertebra
Hemangioma of vertebra

HEMANGIOMA SPINE

On CT scan, vertebral body lesions have a "polka dot" pattern as the vessels are seen in cross section.

Calvaria lesions are lytic and resemble radiating wheel spokes.

INFECTION (OSTEOMYELITIS)

IN CHILDREN:

Pathomechanism

1.Trans-physeal vessels closed

2.Primary focus of infection is in metaphysis

Findings

* Sequestration frequent

* Periosteal elevation

* Small single / multiple osteolytic areas in metaphysis

* Extensive periosteal reaction parallel to shaft (after 3-6 weeks)

* Shortening of bone with destruction of epiphyseal cartilage

* Growth stimulation by hyperemia and premature maturation of adjacent epiphysis

NON OSSIFYING FIBROMA

AKA: Nonosteogenic fibroma, fibroxanthoma, xanthogranuloma of bone.

30 to 40% children over two years have one or more lesions.

Most common between 8-20 years of age.

Usually occur in metaphysis of one (75%) or more (25%) of the tubular bones.

Most often occur in lower extremities around knee.

Fewer than 10% occur in upper extremities.

Non-ossifying Fibroma

X Ray Characteristics:

1. Geographic

2. Lytic

3. Multilobulated

4. Metaphyseal

5. Usually intramedullary

6. Eccentric (situated in the periphery of bone)

7. Well-marginated

8. Sclerotic rim

9. Endosteal scalloping

Non-ossifying fibroma of tibia

Non-ossifying fibroma of tibia
Non-ossifying fibroma of tibia

NON OSSIFYING FIBROMA 3

Most lesions heal spontaneously by being replaced with normal bone.

Migrate away from epiphysis with growth of patient.

May undergo pathologic fracture (picture).

Do not undergo malignant transformation

EOSINOPHILIC GRANULOMA

Solitary, non-neoplastic proliferation of histiocytes.

Part of a spectrum of Langerhan's cell histiocytosis, formerly known as histiocytosis X.

Localized lesion in bone or lung and occurs most commonly in children aged 5 to 10.

The skull may have a lesion with sharp, punched out borders (picture).

ENCHONDROMA

Benign cartilaginous tumor.

Develops in the medullary cavity.

Usually solitary (multiple lesions in syndromes).

Arise from ectopic rests of hyaline cartilage.

Occur mostly in 2nd to 3rd decade.

Most common site is small bones of the hands and feet.

Most occur in the proximal phalanx.

Usually asymptomatic and found insidiously.

Rapid growth with pain and swelling should raise suspicion of either a pathologic fracture or, less likely, malignant transformation.

Enchondroma X Ray Finding

X-Ray finding:

Well-defined lytic and slightly expansile lesion (in small bones).

Usually have some internal calcification and endosteal thinning.

Internal calcifications tend to resemble "rings and arcs" of cartilage calcification .

There is an expansile, lucent, well-defined ("geographic") lesion with swirls and rings of chondroid calcification at the

There is an expansile, lucent, well-defined ("geographic") lesion with swirls and rings of chondroid calcification at the
There is an expansile, lucent, well-defined ("geographic") lesion with swirls and rings of chondroid calcification at the

Enchondroma in the distal femur. Note the lesion is geographic with response from surrounding bone. Cartilagenous matrix is pr

Enchondroma in the distal femur.  Note the lesion is geographic with response from surrounding bone.  Cartilagenous matrix is pr
Enchondroma in the distal femur. Note the lesion is geographic with response from surrounding bone. Cartilagenous matrix is pr

Multiple Enchondromatosis (Ollier Disease)

This is nonhereditary disorder which usually presents in childhood.

The affected extremity is shortened (asymmetric dwarfism) and sometimes bowed due to epiphyseal fusion anomalies.

Patients are at risk for development of sarcomas, specifically osteosarcomas and chondrosarcomas. These occur in approximately 25 % of patients.

Multiple enchondromas are present in this radiograph of the left hand in a patient with Ollier disease. Lesions for unknown rea

Multiple enchondromas are present in this radiograph of the left hand in a patient with Ollier disease. Lesions for unknown rea
Multiple enchondromas are present in this radiograph of the left hand in a patient with Ollier disease. Lesions for unknown rea

The left distal femur is widened with an "Erlenmeyer" deformity. The left femur is also shortened relative to the right. The med

The left distal femur is widened with an "Erlenmeyer" deformity. The left femur is also shortened relative to the right. The med
The left distal femur is widened with an "Erlenmeyer" deformity. The left femur is also shortened relative to the right. The med

New The Most Important Thing

MULTIPLE ENCHONDROMATOSIS (MAFUCCI SYNDROME)

Nonhereditary

Even more rare than Ollier's disease

Multiple cavernous hemangiomas of soft tissues, usually in extremities (digits)

Look for phleboliths in hemangioma

The typical appearance of Mafucci syndrome is illustrated by this radiograph.

Multiple enchondromas are encountered along with phleboliths in soft tissue hemangiomas.

MAFUCCI SYNDROME

Growth disturbance of affected bones

Malignant transformation common -75%

Hemangioma may become sarcoma in 5% of cases.

Mafucci syndrome

Mafucci syndrome represents enchondromatosis with soft tissue hemangiomas, usually in the hands and feet.

As with Ollier disease, there is typically a shortening of the long bones.

These patients are at higher risk for sarcomatous transformation of both the vascular and cartilaginous portions of the disease.

Multiple enchondromas are encountered along with phleboliths in soft tissue hemangiomas.

Multiple enchondromas are encountered along with phleboliths in soft tissue hemangiomas.
Multiple enchondromas are encountered along with phleboliths in soft tissue hemangiomas.

MAFUCCI SYNDROME

Intra operative finding of hemangioma

SOLITARY BONE CYST

Pathogenesis - Theories

Focal defect in metaphyseal remodelling causing blockage in interstitial drainage .

This increases the intraosseous pressure leading to focal bone necrosis and accumulation of fluid .

Fluid causes bony destruction due to presence of prostaglandin, oxygen free radicals, interleukin, cytokines and metalloproteinases .

Prostaglandin - stimulate osteoclasts to resorb bone and subsequently leads to more fluid accumulation.

SOLITARY BONE CYST 3

Indication for treatment- To reduce the potential risk of pathological fracture and to alleviate pain

Options:

- Steroid Injection

- Curretage and bone graft

- Injection of fibrosing agents

- Percutaneous autologus bone marrow injection

- Percutaneous demineralized bone matrix injection

Solitary (Unicameral) Bone Cyst

Purely lytic lesion

Metaphyseal , diaphyseal region

Concentric lesion

Septated

Thin cortex

Solitary bone cyst of proximal humerus with fallen leaf sign signifying pathological fracture

Solitary bone cyst of proximal humerus with fallen leaf sign signifying pathological fracture
Solitary bone cyst of proximal humerus with fallen leaf sign signifying pathological fracture

Wise Sayings About Solitary Lucent Lesions

1. With a long lesion in a long bone, think of fibrous dysplasia.

2. Simple cyst, enchondroma, and fibrous dysplasia can mimic each other and can be hard to distinguish. Thus, when you think of one of these three entities, also think of the other two.

3. Giant cell tumors nearly always occur near a joint surface.

4. For lucent lesions in patella, calcaneum, and most apophyses, one should include the classic epiphyseal entities such as chondroblastoma, giant cell tumors and aneurysmal bone cys

Reader Feedback

    0 of 8192 characters used
    Post Comment

    • Meyani profile image

      Meyani 4 years ago

      Thank for sharing Cikgu

    • imagelist lm profile image

      imagelist lm 4 years ago

      Cool lens... Thumbs Up!

    • CyberTech LM profile image

      CyberTech LM 5 years ago

      WOW so cool. I never knew these things, thanks for the information!

    • profile image

      anonymous 5 years ago

      A bone cyst or tumor can actually lead to cancer if not being medicated properly.

    • profile image

      anonymous 5 years ago

      People with these kind of conditions seem to be leading a difficult life because of the need to undergo several surgery to give them a normal life but its an assurance that they will really live a normal life because like those patients who has undergone hip implants such as depuy pinnacle replacement which has received numerous complain leading to countless cases of DePuy Pinnacle Lawsuit.

    • profile image

      anonymous 5 years ago

      Experiencing this kind of pain in their lives serves a great challenge to these people and a test God put if they can overcome this and get the life they once had. DePuy Pinnacle Lawsuit

    • profile image

      hipreplacementlawsuit 6 years ago

      Having these none disorders and fixing them is a painful process, having gone through hip replacement surgery myself and being active in the Hip Replacement Recall, I can empathize with those who are having these serious bone conditions. Thanks for getting the information out there.

    • profile image

      anonymous 6 years ago

      Very informative and at the same time very alarming lens. I've found out that Fosamax side effects are equally harmful. Fosamax is a drug for bone loss.

    • profile image

      rwarxitsrobb 6 years ago

      Pretty interesting stuff man!!

    • profile image

      anonymous 6 years ago

      A very informative hub. You may also like to visit

      Fosamax Fractures

    • profile image

      anonymous 6 years ago

      A lot of information can be found here. Thanks for sharing

      Fosamax Fracture Lawyer

    • profile image

      anonymous 6 years ago

      thank you!!!!

      (btw I think you missed explaining hyperparathyroidism)

    • profile image

      anonymous 6 years ago

      Thanks for sharing, i bookmarked it for further reference.

      Congrats,

      Fosamax Fracture Lawyers

    • profile image

      anonymous 6 years ago

      Information regarding lytic bone lesions is very important, especially to those affected by DePuy Pinnacle Recall since it is not known whether metallosis resulting from these metal-on-metal devices could potentially lead to bone malignancy. Thanks!

    • profile image

      anonymous 6 years ago

      Zimmer knee recall lawyers can help you out. They are the ones who will make sure that your rights are always protected. Seek their valuable help right away.

      Visit:zimmer lawsuit

    • profile image

      anonymous 6 years ago

      Hi,

      Thank you for posting this information as it needs to get out there. FOGMACHINES makes the information easier to understand, it can be a bit daunting especially for older folks like myself with all those medical terms out there. Again Thank you

      Bryan Sartin

      http://www.fosamaxfemurfracturelawyer.com

    • profile image

      anonymous 6 years ago

      Hi,

      Thank you for posting this information as it needs to get out there. FOGMACHINES makes the information easier to understand, it can be a bit daunting especially for older folks like myself with all those medical terms out there. Again Thank you

      Bryan Sartin

      http://www.fosamaxfemurfracturelawyer.com

    • profile image

      anonymous 6 years ago

      I always appreciate stuffs like these. Acronym works for me. It's one way that i can be more familiar with FOGMACHINES.

      Thanks to you KMLIAU! Keep it up.

      Looking forward for more posts,

      Accutane Lawsuits

    • profile image

      anonymous 6 years ago

      Great lens regarding Lytic Bone. Glad I came across this while researching about fractures and bones.

      Fosamax Fracture Lawsuit

    • profile image

      anonymous 6 years ago

      45 days old baby with osteolytic lesions of all the long bones, pathological fracture of tibia- What could be the diagnosis?

    • profile image

      anonymous 6 years ago

      Thanks' posting a nice lens here! I bookmarked this one, and my son will surely read your lens.

      Thanks'

      Fosamax Lawyers

    • profile image

      anonymous 6 years ago

      This has really helped me. Concise and articulate, very impressive. It really does a lot especially for us doing research about bone issues and disorders. Thanks!

      Fosamax Lawsuit

    • profile image

      anonymous 7 years ago

      I feel great satisfaction after reading these article presented with a great beauty in general description +case study

    • profile image

      anonymous 7 years ago

      very interresting as ive got olliers disease

    • profile image

      anonymous 7 years ago

      very interresting as ive got olliers disease

    • profile image

      anonymous 7 years ago

      right to the point

    • profile image

      anonymous 7 years ago

      thanks very simple explanation

    • profile image

      anonymous 7 years ago

      Thx, U help me to know much about bone cyst

    • profile image

      anonymous 7 years ago

      Thank you so much

    • profile image

      anonymous 7 years ago

      great work , thank u so much .... im a medical student and i find reading this really worthwhile ......

    • profile image

      anonymous 8 years ago

      It's good to see comments on here from students that this lens will help.

    • profile image

      anonymous 8 years ago

      Hey I wanted to say thanks! I am a chiropractic student and we are over loaded with radiology. This really is going to help with my hard tissue exam on tumors and tumor-like lesions.

      Thanks!

    • profile image

      anonymous 8 years ago

      Excellent Lens. 5*

      If you get a chance check out my Instant Stress Management lens.

    • profile image

      anonymous 8 years ago

      great site

      thank you

    • profile image

      anonymous 8 years ago

      Hey - this is a great site. I wish I had found earlier (mid-term is in a few hours). But it has been a great review!

      Thanks

    • profile image

      anonymous 8 years ago

      I'm a med student and this was a great help! Thanks!

    • profile image

      anonymous 9 years ago

      Recently having a lot of pain in both legs (inside knee to groin) and hips (SI Joint area). So bad it's hard to walk at times. Old injury from big MVA in 1978 in those areas. X-rays and MRI's show Lytic Lesions. Now what ? Surgery ? What is this surgery called and what does it involve. Help. Ignorance is not bliss.

    • profile image

      anonymous 9 years ago

      WOW! The lens is quiet interesting and it has got lots of information.I hope this can help a lot.

      Feel free to visit my equity loan blog

    • profile image

      anonymous 9 years ago

      This lens is very valuble.Every thing is presentin a precised manner and is so attractive.It can help a lot those who are suffering from such condition.

      Checkout my blog

      garage remodeling blog

    • profile image

      anonymous 9 years ago

      This is very good informative lens, I like you lens very much. It is giving more useful information about lytic bone.

      Check out my lens that focuses on bathroom remodeling,

      thank you very much.

    • profile image

      anonymous 9 years ago

      Quite educative.Clear and concise.

      Keep it up.