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Unknown Musculoskeletal Clinical Cases Part A: Can You Recognize these Entities?

March 01, 2017

Contributors: Ian O'Connor, BS; James C Wittig, MD, FAAOS; Seija Maniskas, MS; Seija Maniskas, MS

Radiolucent lesions of bone represent a broad spectrum of tumors, all of which appear as lytic defects on radiographs but otherwise present variably. Radiography is the first line of diagnosis for radiolucent lesions of bone because they typically present in a nonspecific fashion on CT and MRI. Radiographs reveal the location of the mass in the bone, such as the medullary canal (the location most of the lesions arise), and the position of the mass in relation to the physis. Many radiolucent lesions of bone have a favorite part of the bone, which may be an identifying feature. In addition, radiographs reveal the nature of the margin of the tumor, which can be used to determine if a tumor is aggressive or indolent. All of these features are used to diagnose radiolucent lesions of bone. Clinically, many patients with a radiolucent lesion of bone have pain and swelling; however, some patients, such as those with a nonossifying fibroma or a unicameral bone cyst, are asymptomatic. Many of these tumors only occur within a given age range, which can be used to distinguish one tumor from another. Lesions such as giant cell tumors of bone and aneurysmal bone cysts grow aggressively and destroy bone; other lesions are more indolent; and some lesions, such as nonossifying fibromas, spontaneously resolve. Histolopathologic studies show some similarities between radiolucent lesions of bone but ultimately differentiate one radiolucent tumor from another. Management of radiolucent lesions of bone varies. Bracing and observation is appropriate for some patients, such as those with vertebra plana caused by eosinophilic granuloma. In patients with an aneurysmal bone cyst, which may grow relatively quickly and destroy bone, curettage and bone grafting with possible en bloc resection are recommended.

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