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Flashcards in Bone lesions: Deck (74):
1

Mnemonic to remember B9 lytic bone lesions:

FEGNOMASHIC

2

FEGNOMASHIC stands for:

Fibrous dysplasia Enchondroma (and Eosinophilic granuloma) Giant cell tumour Non ossifying fibroma Osteoblastoma Mets and Myeloma Aneurysmal bone cyst Solitary bone cyst HyperPTH Infection Chondroblastoma (and Chondromyxoid)

3

What are the characteristics for fibrous dysplasia (FD): (3)

  1. No periosteal reaction- not painful.
  2. Never undergoes malignant degeneration
  3. Ground glass (BUZZWORD) lytic lesion with hazy matrix

4

Diagnosis?

 

This lesion is seen in the tibia and the jaw and it resembles FD with malignant potential

Adamantinoma Rx and Hx (histologically) resembles FD

5

Diagnosis?

Polyostotic FD with cafe au lait spots and precocious puberty

Mc Cune Albright syndrome

6

Define Cherubism

This is the presence of multiple lesions of FD in the jaw that has been termed Cherubim.

Puffed out cheek having an angelic look- the jaw lesions regress in adulthood

7

Typical features for enchondroma: (2)

 

What type of Ca++

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  1. cytic/lytic lesion with Ca++ except in phalanges
  2. No periostitis - Painless

 

  • Popcorn calcification

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8

Difference bwn enchondroma in phalanx and elsewhere

phalanx: no calcification

9

Difference bwn enchondroma and bone infarcts: (2)

  1. Enchondroma: Endosteal scalloping whereas no scalloping in the other one
  2. Sclerotic border in bone infarct

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10

Sinister signs of malignancy in enchondroma

  1. Pain in absence of fracture
  2. Rapid size increase

11

What is Ollier disease?

Multiple enchondroma

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12

Maffucci syndrome

Multiple enchondroma and soft tissue haemangioma

13

Ddx for bone sequestra

  1. EG
  2. Osteomyelitis
  3. Lymphoma
  4. Fibrosarcoma

14

What are the 4 typical characteristics of giant cell tumours?

  1. Only in patients with closed epiphyses
  2. The lesion must be epiphyseal and abut the articular surface- not in flat bones.
  3. Eccentrically located
  4. Must have a sharply defined zone of transition (border) that is not sclerotic.

Not in flat bones. BUT can be in spine and SACRUM

15

What are the characteristics for NOF: (2)

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  1. < 30 years old
  2. No periostitis or pain

multiloculated lucent lesion with a sclerotic rim.  They are located eccentrically in the metaphysis, adjacent to the physis

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16

What is NOF associated with? (3)

  1. NF - 5%
  2. FD
  3. Jaffe Campanacci

17

Difference bwn NOF and fibrous cortical defeft

Radiologically and Hx similar-

 

NOF > 2cm and cortical defect < 2cm

18

Diagnosis?

multiple usually unilateral NOFs with cafe au lait spots

Jaffe companacci syndrome

19

Diagnosis?

Same Hx as NOF, but occurs during the 3rd to 5th decade. Looks like GCT on Xray but with well defined sclerotic margin. 1/3 in knee

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Benign fibrous histiocytoma

20

DDx for expansile lytic lesion of the posterior elements of the spine (3)

  1. Osteoblastoma
  2. ABC
  3. TB

21

DDx for lytic expansile met disease (2)

  1. Thyroid and
  2. renal tumour.
  3. Melanoma
  4. Phaeochromocytoma

22

Mini brain sign

plasmocytoma

23

Two different types of ABC

  1.  Primary: no known cause
  2.  Secondary to trauma or other lesions (GCT or Osteosarcoma)

24

Discrominators for ABC

Location?

Age group?

 

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  1.  Must be expansile. thin walled blood filled cystic spaces.
  2. Eccenteric
  3. Younger than 30

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25

Where is the most common location for Solitary bone cysts?

2/3 to 3/4 in proximal humerous and proximal femur

They have to be CENTRAL

26

Fallen fragment sign is seen in....

Solitary bone cyst

27

Discriminators for solitary bone cyst (3) 

  1. Location?
  2. Age group?
  3. Periosteal reaction?

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  1.  MUST be central
  2.  <30 years of age
  3. No periostitis- thin sclerotic border

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28

What are the radiological signs of hyper PTH?

  1. Subperiosteal bone resorption
  2. If physes are open , frayed, ragged appearance
  3. Rugger Jersey spine
  4. Brown tumour
  5. Terminal tuft erosion

29

Pathognomonic feature of hyperPTH?

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Subperiosteal bone resorption

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30

Where is subperisosteal resorption in hyperPTH seen? (4)

  1. Radial aspect of middle phalanx
  2. Distal clavicles
  3. Medial aspect of tibia
  4. SI joints

31

HyperPTH with osteoporosis and osteosclerosis?

Renal dystrophy secondary to hyperPTH

32

What is the significance of sequestrum in osteomyelitis?

if present, surgical debridement should be considered. Abx alone is not useful.

33

Ddx of a lytic lesion in epiphyses of a patient less than 30 years of age: (3)

1. Infection

2. Chondroblastoma

3. Giant cell tumour

34

Discriminators of Chondromyxoid fibroma (2)

 

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  1. Mention when NOF is mentioned
  2. No calcified matrix can present with pain.
  3. NOF painless

Lobulated, geographical and LYTIC lesion

Well-defined lesion with sclerotic rim in a metaphysis

35

Lesions in patients younger than 30 years of age:

  1. EG
  2. ABC
  3. NOF
  4. Chondroblastoma
  5. Solitary bone cyst

36

Lesions that have no pain or periostitis

  1. Fibrous dysplasia
  2. Enchondroma
  3. NOF
  4. Solitary bone cyst

37

Epiphyseal bone lesion (4)

  1. Infection
  2. GCT
  3. Chondroblastoma (picture)
  4. Geode

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38

Multiple lytic lesions

FEEMHI:

  • FD
  • EG
  • Enchondroma
  • Mets  and myeloma
  • HPT/ brown tumour Infection

39

Benign cystic rib lesions

FAME:

  1. FD
  2. ABC
  3. Mets and myeloma
  4. Enchondroma and
  5. EG

40

Sclerotic focus in a 20-40 years old patient as incidental findings

  1. NOF
  2. EG
  3. ABC
  4. Solitary bone cyst
  5. Chondroblastoma

41

malignant epiphyseal tumour....

Clear cell chondrosarcoma

42

FD and soft tissue myxoma in a middle aged woman

Mazabraud

43

Classic features of EG

  1. vertebral plana in a kid ie complete collapse of vertebral body
  2. skull with lucent "beveled edge" lesion
  3. Floating tooth with lytic lesion in alveolar ridge

44

Classic Ddx for vertebral plana

MELT:

  • Mets/myeloma
  • EG
  • Lymphoma
  • TB/Trauma

45

Multiple myeloma causes vertebral body destruction with sparing of ........ elements. Bone scan is often ........

posterior

Negative - skeletal survey is better.

MRI is most sensitive

46

How would MM manifest as ?

Diffuse osteopenia

47

up to 40% of ABC are associated with....

GCT

48

This bone lesion is often not T2 bright

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Chondroblastoma

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49

Name the 3 classic lesions in the calcaneus

1. Solitary bone cyst 

2. Pseudocyst

3. Interosseous lipoma

50

This lesion is most likely in the inter-trochanteric region of the femur.

lytic lesion with sclerotic border. 10% undergo malignant degeneration

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Liposclerosing Myxofibroma

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51

Only benign tumour associated with radiation

Osteochondroma - point away from the joint - BM flows freely into the lesion

52

This is osteochondroma causing joint deformity , most common in ankles and knees

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Trevor disease/ dysplasia Epiphyseal Hemimelica- DEH

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53

? diagnosis

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Osteochondromas

This is part of the growth plate which separates and continues growing independently, usually away from the nearby joint. The medullary cavity is continuous with the parent bone, and hyaline cartilage caps them.

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54

Osseous process that does nothing but can compress the median nerve if the ligament of Struthers smashes it

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Supracondylar spur/ Avian spur.

55

In avian spur the median nerve is compressed if the ligament of....... smashes it

Struthers

 

It can also compress teh brachial artery

56

This vs that:

Osteochondroma vs avian spur

In osteochondroma : Points away from the joint

vs 

Avian spur: points towards the joint

57

lesion in the finger of a kid with saucerisation of the adjacent cortex with sclerotic periosteal reaction

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Periosteal chondroma

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58

When i say looks like NOF in ANTERIOR tibia with anterior bowing , you say.....

Osteofibrous dysplasia

59

Destructive mass in a bone of leukaemia patient

Chloroma (Granulocytic Sarcoma)

60

Features of madelung deformity (11)

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  1. dorsal and radial bowing of the radius
  2. exaggerated palmar (up to 35°)  and ulnar tilt (up to 60°) of the radiocarpal articulation 
  3. failure of ossification of the ulnar side of the distal radial epiphysis
  4. exaggerated radial inclination
  5. decreased carpal angle < 118°; normal from 118° to 139°.
  6. carpal subluxation in a palmar and ulnar direction
  7. lunate is gradually forced to the apex of the V-shaped radio-ulnar-carpal joint
  8. “V-shaped” proximal carpal row = herniated proximal carpal row.
  9. dorsal subluxation of the distal radio-ulnar joint
  10. positive ulnar variance
  11. wedging of the carpus between the radius and ulna

61

What are the associated conditions with Madelung deformity? (9)

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  1. Ollier disease 
  2. achondroplasia 
  3. Turner syndrome: affects wrists and hands with osteopenia, metacarpal bones shortening (especially 4th) and decreased carpal angles, which resemble Madelung deformities (usually bilateral)
  4. Nail-patella syndrome 
  5. Hurler mucopolysaccharidosis 
  6. Madelung dyschondrosteosis
  7. gonadal dysgenesis
  8. diaphyseal aclasis (hereditary multiple exostoses)
  9. Leri-Weill syndrome: an autosomal dominant dyschondrosteosis (a form of mesomelic dwarfism)

 

62

Diagnosis?

Associated with?

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  • Ollier's disease

 

  • There is an increased risk of :
    • chondrosarcoma occurring later in life. The risk has been reported to be up to 25-30% at 40 years. 
    • increased risk of developing gliomas
    • pancreatic and 
    • juvenile granulosa cell tumours of the ovary

 

63

64

Multiple enchondroma and soft tissue haemangioma

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Maffucci syndrome

65

Diagnosis?

Doughnut sign in NM.

lobulated, eccentric radiolucent lesion. geographical bone destruction. Well defined sclero is cutPayPal their message andtic margin. 

 

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Chondromyxoid fibroma- CMF

66

Diagnostic radiox findings of Nail patella syndrome (4)

  1. absent/hypoplastic patellae (with a tendency to recurrent dislocation)
  2. hypoplasia of the radial head or capitellum (leading to subluxation/dislocation)
  3. bilateral posterior iliac horns ("Fong prongs") 
  4. protuberant anterior iliac spines

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67

Nail patella syndrome is associated with 

Renal dysfunction

abnormal gait

68

two most common locations for chondroblastoma

  1. calcaneus
  2. talus

 

Epiphysesis

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69

This is an eccentric spherical lytic lesion with fine sclerotic margin (Chicken wire calcification ) centred within epiphysis which might extend into the diaphysis

Secondary ABC can form with flui fluid level

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Chondroblastoma

70

Diagnosis?

Eccentric lytic expansile intramedullary lesion within Long bone metaphysis. It can extend to growth plates.

CT shows eggshell thin

cortex. 

MRI shows fluid fluid levels

NM can say doughnuts sign- Photo penic Centre with increased peripheral uptake

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Aneurysmal Bone Cyst- ABC

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71

ABC are secondary to which conditions? (6)

  1. chondroblastoma, 
  2.  chondromyxoid fibroma 
  3. fibrous dysplasia, 
  4. osteosarcoma, 
  5. giant cell tumour 
  6. non-ossifying fibroma 

72

Diagnosis?

This lesion extends from the proximal metaphysis into the diaphysis with growth.

Usually presented with pathological fracture. Geographical lucent lesion.

Fallen fragment sign

Simple bone cyst

NM: cold

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73

Diagnosis?

  1. ameloblastoma 
  2. aneurysmal bone cyst
  3. dentigerous cyst
  4. metastasis
  5. unicarmel bone cyst

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ameloblastoma 

 

Lytic unilocular mandibular lesion with expansion has a wide differential, however, the erosion of the adjacent dental roots makes ameloblastoma the most likely diagnosis of the above list. Keratocystic odontogenic tumours (KCOT) can have a similar appearanc

74

Granulocytic sarcoma happens in what group of patients? (2)

  1. Leukaemia
  2. Myeloproliferative disease

These are rarely sclerotic