BENIGN CYSTIC

BONE LESIONS
(FEGNOMASHIC)
JESSICA MAE M. NARIO, MD
LEVEL 1
 FEGNOMASHIC
O Fibrous dysplasia
O Enchondroma, Eosinic Granuloma (EG)
O Giant Cell Tumor (GCT)
O Nonossifying fibroma (NOF)
O Osteoblastoma
O Mets, Myeloma
O Aneurysmal Bone Cyst (ABC)
O Solitray Bone Cyst
O Hyperparathyroidism (Brown Tumor)
O Infection
O Chondroblastoma, Chondromyxoid Fibroma (CMF)
DISCRIMINATIVE FEATURES
O ECCENTRIC O CENTRALLY
O GCT O SBC

O MUST BE <30 O AGE >40

O EG O METASTASIS
O ABC O MYELOMA
O NOF
O GEODE
O SBC
O INFECTION
O CHONDROBLASTOMA
DISCRIMINATING FACTORS
O EPIPHYSEAL O MULTIPLE
O CHONDROBLASTOMA O FD
O GCT O EG
O METS
O GEODE
O MYELOMA
O INFECTION
O ENCHONDROMA
O HYPERPARATHYROI
DISM
O INFECTION
DISCRIMINATING FACTORS
O EXCLUDE IF WITH O CA++
PERIOSTITIS O ENCHONDROMA
O GCT O EOSINOPHILIC
GRANULOMA
O METS (BREAST)
 NONOSSIFYING FIBROMA
O TYPICAL XRAY
O Eccentric well-defined lytic lesion with sclerotic lobulated margin.
O The natural course is a sclerotic filling over time.
O CLINICAL
O Found as incidental finding or presents with a fracture.
O Asymptomatic and exhibit no periostitis, unless there is an
antecedent history of trauma.
O AGE
O < 30 years old
O FAVORITE LOCATION
O Usually located around the knee in diaphysis or meta/diaphysis
and does not occur in hands, feet, spine and flat bones.
O DIFFERENTIAL DIAGNOSIS
O These lesions are so characteristic that no differential diagnosis
should be entertained
 OSTEOBLASTOMA
O TYPICAL XRAY
O lytic lesions with associated reactive sclerosis and varying
amounts of ossifications
O CLINICAL
O Pain is the most common presenting symptom
O AGE
O 80% of patients are between 10 and 30 years old
O FAVORITE LOCATION
O Spine (40% of cases; usually posterior elements)
O Long Bones (30%; Most arise from diaphysis or metaphysis;
Epiphyseal lesions are rare but may occur more often in the
tubular bones of the hands or feet)
O DIFFERENTIAL DIAGNOSIS
O expansile lytic lesion of the posterior elements of the spine :
osteoblastoma, ABC, and tuberculosis.
 METASTASIS
O TYPICAL XRAY
O Usually multifocal, occasionally solitary
O Most metastases are osteolytic.
O Sclerotic metastases are osteoblastic.
O CLINICAL
O Most common osteolytic metastases: kidney, lung, colon and
melanoma.
O Most common osteosclerotic metastases: prostate and breast.
O AGE
O Must be more than 40 years old
O FAVORITE LOCATION
O predilection for hematopoietic marrow sites: spine, pelvis, ribs,
cranium and proximal long bones: femur, humerus.
 MULTIPLE MYELOMA
O TYPICAL XRAY
O multiple lytic 'punched out' lesions.
O AGE
O over 40 years old
O FAVORITE LOCATION
O The most common location is in the axial skeleton
(spine, skull, pelvis and ribs) and in the diaphysis of
long bones (femur and humerus).
O DIFFERENTIAL DIAGNOSIS
O multiple lesions: metastases.
O solitary lesion: chondrotumor, GCT and lymphoma.
HYPERPARATHYROIDISM
(BROWN TUMORS)
O TYPICAL XRAY
O can have almost any appearance, from a purely lytic lesion to a
sclerotic process.
O Subperiosteal bone resorption is pathognomonic.
O Borders are usually sharp, though non-sclerotic
O CLINICAL
O Hyperparathyroidism typically presents in a patient with renal
disease, which leads to secondary HPT.
O AGE
O Not seen before the age of 30
O FAVORITE LOCATION
O Phalanges (particularly in the radial aspect of the middle
phalanges), distal clavicles (resorption), medial aspect of
the proximal tibias, and sacroiliac joints.
 INFECTION
O TYPICAL XRAY
O protean radiographic appearance
O might or might not be expansile, have a sclerotic or
nonsclerotic border, or have associated periostitis
O If a bony sequestrum is present, osteomyelitis
should be strongly considered
O CLINICAL
O AGE
O Any age
O FAVORITE LOCATION
O Has no typical location
 CHONDROMYXOID
FIBROMA
O TYPICAL XRAY
O Resemble NOFs.
O CLINICAL
O can present with pain
O AGE
O FAVORITE LOCATION
O DIFFERENTIAL DIAGNOSIS
SUMMARY
SUMMARY
SUMMARY
SUMMARY