OSTEOLYTIC LESIONS

APPROACH

• AGE 

• Metastatic Neuroblastoma in infant and young child.

• Metastases and multiple myeloma in middle aged and elderly.

• Ewing’s sarcoma and simple bone cyst in children and teens.

CHARACTERSTIC RADIOGRAPHIC APPEARANCE

• CORDUROY Vertebral body – Hemangioma.

• Fallen fragment sign – simple bone cyst.

• Gas in juxta articular lesion – intraosseous ganglion cyst.

• Chondroid matrix with geographic lytic lesion‐enchondroma.

• Vertebra plana – Langerhan cell histiocytosis.

• Cockade sign in calcaneum – intra osseous lipoma.

SOLITARY LYTIC LESIONS(Mnemonic – FOGMACHINES)

• FIBROUS DYSPLASIA

• OSTEOBLASTOMA

• GIANT CELL TUMOR

• METASTASES/ MYELOMA

• CHONDROBLASTOMA

• HYPERPARATHYROIDISM/ BROWN TUMOR/ HEMANGIOMA

• INFECTION

• NON OSSIFYING FIBROMA

• EOSINOPHILIC GRANULOMA/ ENCHONDROMA.

• SOLITARY BONE CYST.

MULTIPLE LYTIC LESIONS

• Calvarial osteomyelitis.

• Sarcoidosis.

• Hand schuller christian disease.

• Metastatic bone disease.

• Lymphoma.

• Multiple myeloma.

• Gaucher’s disease.

• Histiocytosis X.

Giant cell tumor

• Giant cell tumor is a locally aggressive neoplasm

• The sites affected most frequently are the long tubular bones

Giant cell tumor

• Clinical manifestation 

• Earliest manifestations include pain, local swelling, limitation of motion and pathologic fractures 

Imaging feature

• On radiographs, the long and short tubular bones reveal eccentric osteolytic lesions

• With MR imaging, intraosseous fluid levels may be seen.

Giant cell tumor a, b. AP (a) and lateral (b) radiographs of the knee demonstrate an eccentric osteolytic lesion in the proximal tibia. The lesion has a non-sclerotic border and abuts the articular surface of the tibia.

c. Sagittal T1-weighted MR image of the knee demonstrates the low signal intensity mass in the proximal tibia.d. Fat-suppressed T1-weighted MR image after gadolinium adminstration demonstrates enhancement of the mass in the proximal tibia.

Giant cell tumor

osteolytic lesion in the distal radius

soap bubbleexpandabilitySoft tissue swelling

Bone cyst

• Bone cyst is a usually cavitary lesion of bone. 

• Bone cysts may occur after trauma and in osteoarthritis

• These cysts occur most frequently in long tubular bones, especially the metaphysis, and in the bony pelvis 

Imaging feature

• Radiographically, these lesions appear radiolucent and are located centrally, with cortical thinning and mild expansion of the bone 

• CT scanning and MR imaging with contrast enhancement reveal presence of fluid within the lesion 

• Complications of simple bone cysts include complete and incomplete fractures, 

and (rarely) malignant transformation

Bone cystSimple bone cyst. AP radiograph of the shoulder demonstrates a pathologic fracture through the simple bone cyst in the humeral metaphysis.

Note the "fallen fragment" within the bone cyst.

Osteosarcoma

• Osteosarcoma is a malignant neoplasm of bone composed of proliferating tumor cells that in most instances produce osteoid or immature bone 

Clinical feature

• 75% of cases occurring between the ages of 10 and 25 years 

• 86% occur in the long bones with the distal femoral metaphyseal region 

• The next commonest sites are the upper tibia and humerus 

Clinical feature

• The commonest presentation is pain in the affected area or, occasionally, a pathological fracture 

• This tumor metastasises early, particularly to the lungs and other bones 

Imaging feature

• On the radiograph, the tumor may be purely lytic or sclerotic , or a mixture of the two

Imaging feature

• Pure lytic lesions vary from areas of diminished bone density to completely lytic areas with very little reaction from the bone

• They may have a very thin periosteal reaction overlying the lesion with very little evidence of new bone formation

Imaging feature

• The sclerotic osteogenic sarcomas may produce a region of dense sclerosis with loss of the inner cortical margins 

• The periosteal reaction may be laminated or spiculated with so‐called 'sunburst' appearance 

Imaging feature

More often the tumors are both lytic and sclerotic with destruction of the bone and cortex, and extension into the soft tissues

There may be a variable amount of calcification in the soft tissues

a prominent periosteal reaction with a Codman's triangle

• MRI:

• The lytic areas of the tumor show a low signal on T1 and high signal on T2

• The extension in the medullary cavity is very accurately determined by MRI, as is the soft tissue extent 

Osteosarcoma AP(a) and lateral (b)radiographs of thefemur demonstratea large soft tissuemass with anaggressiveperiosteal reactioncreating thesunburstappearance.

Patchyosteosclerosis andosteolysis in thedistal femur

OsteogenicsarcomaOsteolytic sarcomaof the fibular head.There is a smallamount ofcalcification withinthe tumor.

Osteogenic sarcomaOsteoblastic sarcoma in the upper metaphyseal region of the tibia. There is sclerosis, breach of the cortex and sclerotic extension of the tumor into the tissues. The cortical margin is lost

Osteogenic sarcomaRadiograph of a distalfemoral osteogenicsarcoma.On the radiographthere is a mixed scleroticand lytic lesion with alayered periosteal reactionanteriorly and showingcalcification.

Osteogenic sarcomaThe large soft tissue component is well seen on the MR. There is high signal within the lesion and in the medullary cavity