MSK neoplasm differentials
Terms
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- Lytic lesion with ossified matrix
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Osteosarcoma
Osteoma
Osteoid osteoma
Osteoblastoma
Osteofibrous dysplasia - Amorphous mineralization in a lytic bone lesion
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Infarct
Amyloid
Colloid ca met - Ground glass mineralization in a lytic bone lesion
- Fibrous dysplasia
- Lytic bone lesions with trabeculae
-
Thin-
GCT, ABC
Thick-
CMF, desmoplastic fibroma
Striated - hemangioma - Lytic bone lesions with elongated shape
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Fibrous dysplasia
Lymphoma
Ewing
Angiosarcoma
Chondrosarcoma
Osteomyelitis
Brodie abscess - Lytic bone lesions in the epiphysis
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Subchondr cyst /ganglion
Chondroblastoma
GCT
Infection
Clear cell chondrosarcoma
Paget's
EG
Mets
Subarticular osteoid osteoma - Lytic bone lesions with patient over 20yo
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GCT, Hemangioma, Enchondroma,
Lipoma, Osteoma
Chondrosarcoma, Osteosarcoma, Plasmacytoma
Fibrous lesions (many) - Diffuse osteosclerosis
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Metabolic-
hypERparathyr
hypOthyroid
hypER vitD
Fluorosis
Neoplastic
Mets
Lymphoma
Blastic myeloma (POEMS)
Osteosarc
Overgrowth w/o tumor
Mastocytosis
Paget's
Myelofibrosis
Sarcoid
TS
Osteopetrosis
Pyknodysostosis - Bone tumor has associated ST mass
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Ewing
MFH / Fibrosarcoma
Chondrosarcoma
Met
MM
Osteosarcoma - Osteomalacia - what bony lesions predispose?
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NOF/FCD
FD
Hemangiopericytoma - Blowout Mets in bone
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Renal
Thyroid
Melanoma
MM - 1° Lytic Lesions of the Spine
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GCT
Osteoblastoma
ABC
Plasmacytoma
EG - Lucent Lesion with Pronounced Surrounding Sclerosis
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Osteoid osteoma
Osteoblastoma
Brodie abscess
Stress Fx - Juxtaarticular Osteoporosis
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RA / JRA
TB
Psoriatic arthritis
Synovial sarcoma - Bone lesion with Fluid-Fluid Levels
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ABC
Telangiectatic osteosarcoma
Chondroblastoma
GCT
MFH
FD - Hemosiderin Deposition around joint
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PVNS
Hemophilia
Chronic hemarthrosis
Synovial Hemangioma - Characteristics of Brodie Abscess
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Subacute pyogenic osteo(staph)
Children, M>F
Metaphysis
Tibia, tarsal bones
Lytic lesion with dense sclerotic rim
Tubular, tortuous extending to physis
Periosteal rx, STS
MR: T2WI: high SI gran. tissue surrounded by low SI sclerosis
DDx: osteoid osteoma -
Characteristics of osteoid osteoma
(kinds, imaging char, patients, ddx) -
Cortical (70-80%): long bones, lucent, dense surr sclerosis
Cancellous (25%): intramedullary, fem. neck, post. elements, tubular bones, less sclerosis, can be subarticular
Subperiosteal (rare): juxtacort., ST mass eroding cortex, little sclerosis
Age 10-35 years, M:F = 2-3:1
Nocturnal pain
MR - lots of BM edema
Angio- dense blush
Ddx- DDx : Brodie abscess, stress fx, enostosis - Enchondroma
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Lytic, <3cm centric metadiaph lesion w chondroid matrix
MRI: foci of signal void (Ca2+), ↑T2 , no sig. enhance
60% tubular bones, 25-45% long bones (malig. degen. in 15-20%), NOT skull (not formed by enchondral ossif.)
Age 15-40, M:F = 1:1
Pain without fracture ïƒ consider malignancy
DDx: bone infarct (serpentine border, more sclerotic, no endosteal scalloping), chondrosarc., juxtacortical chondroma, epidermoid inclusion cyst, UBC, FD - Glomus Tumor
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Hamartoma - elements of neuromyoarterial apparatus
4th-5th decade
Soft tissues: tips of digits, subungual; rarely in bone
Pain :
--Love test: precise localiz of pain w/ pencil tip
--Hildreth test: pain resolves w proximal arm tourniquet
MRI: ↑T2 SI, enhancement
DDx: epidermoid inclusion cyst, enchondroma, chronic osteomyelitis, sarcoid, met, osteoid osteoma, subungual melanoma - Cortical Desmoid
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Periosteal new bone + subperiosteal cortical defect along posteromedial & superior aspect MFC (medial ridge of linea aspera) at attachment of adductor magnus aponeurosis
“Pulling†lesion
“Leave me alone†lesion (Bx could resemble osteosarcoma)
Age 3-17 (pk 14-16), M:F=3:1
DDx: stress Fx, osteoid osteoma, NOF/fibroxanthoma - Myositis Ossificans
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Benign ossifying ST mass
80% intramuscular
Hx of trauma in 75%
Adolescents, young adults; M>F
Hemorrhage, myonecrosis
“Zonal†sign, +/- periost Rx
Regresses in a few months
DDx: parosteal osteosarcoma, synovial sarcoma, osteochondroma, tumoral calcinosis, other sarcomas - Multiple lytic lesions
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(FEEMHI):
fibrous dysplasia
enchondromas
EG
mets, myeloma
HPT
infection - Rib lesions
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(FAME):
fibrous dysplasia
ABC
mets, myeloma
enchondroma, EG -
Lytic epiphyseal lesion
(also apophyseal, carpal and tarsal bones, patella): -
- Chondroblastoma, clear cell chondrosarc, CA (mets/myel)
- ABC (young patient)
- Geode (if DJD present)
- GCT (if epiphyses closed)
- Infection
- EG (if <30yo)
age>40 – add mets and myeloma and remove chondroblastoma - Lytic lesion in posterior elements of spine
- (OAT): osteoblastoma, ABC, TB
- Exclude these lytic lesions if age>30
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(CANES):
chondroblastoma
ABC
NOF
EG
SBC - Lesions that have no pain or periostitis
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(FENS):
fibrous dysplasia
enchondroma
NOF
SBC - Bony sequestrum
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(FILE):
fibrosarcoma
infection
lymphoma
EG
osteoid osteoma (mimic) - Geodes
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(CARD):
CPPD
AVN
RA
DJD
trauma - Sclerotic lesion age 20-40:
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chondroblastoma, ABC, NOF, EG, SBC, FD, infection, HPT (healing brown tumor), osteoid osteoma, giant bone island
age>40 - mets - Endosteal scalloping:
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fibrous dysplasia
enchondroma
cartilaginous tumor - Wide zone of transition (permeative):
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mets + myeloma
reticulum cell sarcoma
Ewing’s
infection
EG - Malignant transformation of bony lesions:
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FD – fibrosarcoma, OSA, MFH
Paget’s – OSA
osteo w draining sinus – SCC
RTX– OSA, chondrosarcoma, MFH
bone infarct– fibrosarc, MFH
Ollier’s – chondrosarcoma
Maffucci’s – chondrosarcoma
osteochondroma- chondrosarc - Mets to bone
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PBKTL
P – mostly blastic
B – mixed,
K – purely lytic
TL – mostly lytic - Lytic lesion in ilium
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FD, ABC, SBC
hemophilia
mets, plasmacytoma, Ewing’s,
chondrosarcoma, lymphoma - Lytic sacrum lesion
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met
chordoma (sacrum, clivus, vertebrae, expansile lytic lesion w large ST component and variable Ca++)
plasmacytoma
chondrosarcoma
GCT