Common features of solitary intraosseous lesions
Peak age (years) | Location | Centrality | Density | Margin | Expansile a | Periosteal Reaction b | Notes | |
|---|---|---|---|---|---|---|---|---|
| Generally well-defined predominantly lytic lesions | ||||||||
| Simple bone cyst | 5–20 | Met±Dia | Central | Lucent | Well+Scl | −/+ | − | Unilocular. ‘Fallen fragment’ if fractured |
| Aneurysmal bone cyst | 5–30 | Met | Eccentric | Lucent | Well+Scl | ++ | − | Expansile, bubbly . May occur 2° to another lesion |
| Giant cell tumour | 20 – 50 | Met+Epi | Eccentric | Lucent | Well/Poor | + | − | Nonsclerotic margin, often abuts articular surface |
| NOF/FCD | 5–25 | Met | Cortical | Lucent | Well+Scl | −/+ | − | NOF >3 cm; FCD <3 cm. Sclerose after healing |
| Benign fibrous histiocytoma | 25 – 40 | Met/Dia | Eccentric | Lucent | Well±Scl | −/+ | − | Rare; similar to NOF but in older patients + any location |
| Chondromyxoid fibroma | 10–30 | Met | Eccentric | Lucent | Well±Scl | + | − | Rare; can mimic NOF, ABC and BFH |
| Osteoid osteoma | 10–30 | Dia /Met | Cortical | Lucent±Ost | Scl | – | Solid | Lucent nidus <2 cm + surrounding sclerosis |
| Osteoblastoma | 10–30 | Dia/Met | Eccentric | Lucent±Ost | Well±Scl | + | Solid | Lucent nidus >2 cm ; spine > flat bones>long bones>talus |
| Chondroblastoma | 5–20 | Epi | Eccentric | Lucent±Chon | Well+Scl | − | −/Solid | Classically epiphyseal ; also in apophyses, patella, tarsals |
| Intraosseous lipoma | >20 | Met | Any | Lucent±Scl | Well±Scl | −/+ | − | Lucent ± central sclerosis . Calcaneus >prox femur>other |
| Fibrous dysplasia | >3 | Dia | Central | Ground glass | Well±Scl | + | − | Variable density. Commonest in long bones, ribs, skull |
| LSMFT | >20 | Met | Central | Lucent ±Scl | Well+Scl | −/+ | − | Intertrochanteric region of femur |
| Adamantinoma | 10–35 | Dia | Cortical | Lucent ±Scl | Well+Scl | + | − | Anterior cortex of tibial diaphysis |
| Osteofibrous dysplasia | <10 | Dia | Cortical | Lucent±Scl | Well±Scl | + | − | Similar to adamantinoma but in younger age group |
| Desmoplastic fibroma | 10–50 | Met/Dia | Central | Lucent | Well | + | − | Rare. Lytic + pseudotrabeculations |
| Haemophilic pseudotumour | >10 | Any | Any | Lucent | Well±Scl | ++ | − | Male ± signs of haemophilia ± pseudotrabeculations |
| Brown tumour | >40 | Any | Any | Lucent | Well | + | − | Look for other features of hyperparathyroidism |
| Generally well-defined sclerotic/mixed lesions | ||||||||
| Bone island | >20 | Any | Any | Scl | Well | − | − | Round/oval ± spicules, uniformly dense, <2 cm |
| Bone infarct | Any | Any | Central | Scl +Lucent | Well+Scl | – | − | Serpiginous sclerosis , can mimic enchondroma |
| Enchondroma | >10 | Met/Dia | Central | Lucent/Chon | Well | −/+ | − | Lytic in phalanges, chondroid calc in larger bones |
| Chondrosarcoma | >30 | Met | Central | Lucent/Chon | Poor/Well | −/+ | − | Can mimic enchondroma, chondroblastoma or GCT |
| Haemangioma | >10 | Met | Any | Lucent±Scl | Well | −/+ | −/Spic | Spine > skull > other. Appearance depends on site |
| Paget’s disease | >40 | All | All | Lucent/Scl | Well | − | − | Appearance depends on stage and location; |
| Aggressive lesions in children and adolescents | ||||||||
| Osteomyelitis | Any | Met/Epi | Any | Lucent | Poor | − | Lam | If chronic: sclerosis ± sequestrum ± cloaca |
| Brodie’s abscess | 0–20 | Met/Epi | Any | Lucent | Scl | − | Solid | Discrete lucency + surrounding sclerosis |
| Eosinophilic granuloma | 0–30 | Any | Any | Lucent | Poor/Well | − | Lam | Variable site/appearance, usually aggressive |
| Ewing sarcoma | 5–20 | Dia | Central | Mixed | Poor | − | Lam | Often subtle, ± noncalcified soft tissue mass |
| Osteosarcoma | 10–25 | Met | Any | Ost | Poor | − | Spic | ± Characteristic osteoid matrix in soft tissue mass |
| Aggressive lesions in adults | ||||||||
| Metastasis | >40 | Any | Any | Lucent/Scl | Poor/Well | −/+ | −/Spic if sclerotic | Usually multiple, variable appearance; |
| Plasmacytoma | >40 | Any | Central | Lucent | Well | ++ | − | Axial and proximal appendicular skeleton |
| Bone lymphoma | >30 | Any | Central | Mixed | Poor | − | Lam | Large soft tissue mass + only subtle bone changes . 2°>1° |
| Chordoma | >30 | N/A | Central | Lucent+ Scl | Well±Scl | ++ | − | Lytic + foci of calcification. Sacrum > clivus > vertebrae |
| Fibrosarcoma and UPS | >20 | Met/Dia | Any | Lucent | Poor | − | Any | Nonspecific. Can arise from Paget’s, infarct and others |
| HP/HE/angiosarcoma | >20 | Any | Any | Lucent | Poor | + | − | Rare. A regional cluster of lytic lesions is suggestive |
