Common features of solitary intraosseous lesions

Common features of solitary intraosseous lesions


Peak age (years)
LocationCentrality DensityMarginExpansile aPeriosteal Reaction bNotes
Generally well-defined predominantly lytic lesions
Simple bone cyst5–20Met±DiaCentralLucentWell+Scl−/+Unilocular. ‘Fallen fragment’ if fractured
Aneurysmal bone cyst5–30MetEccentricLucentWell+Scl++Expansile, bubbly . May occur 2° to another lesion
Giant cell tumour20 – 50Met+EpiEccentricLucentWell/Poor+Nonsclerotic margin, often abuts articular surface
NOF/FCD 5–25MetCorticalLucentWell+Scl−/+NOF >3 cm; FCD <3 cm. Sclerose after healing
Benign fibrous histiocytoma25 – 40Met/DiaEccentricLucentWell±Scl−/+Rare; similar to NOF but in older patients + any location
Chondromyxoid fibroma10–30MetEccentricLucentWell±Scl+Rare; can mimic NOF, ABC and BFH
Osteoid osteoma10–30Dia /MetCorticalLucent±OstSclSolidLucent nidus <2 cm + surrounding sclerosis
Osteoblastoma10–30Dia/MetEccentricLucent±OstWell±Scl+SolidLucent nidus >2 cm spine > flat bones>long bones>talus
Chondroblastoma5–20EpiEccentricLucent±ChonWell+Scl−/SolidClassically epiphyseal ; also in apophyses, patella, tarsals
Intraosseous lipoma>20MetAnyLucent±SclWell±Scl−/+Lucent ± central sclerosis Calcaneus >prox femur>other
Fibrous dysplasia >3DiaCentralGround glassWell±Scl+Variable density. Commonest in long bones, ribs, skull
LSMFT>20MetCentralLucent ±SclWell+Scl−/+Intertrochanteric region of femur
Adamantinoma10–35DiaCorticalLucent ±SclWell+Scl+Anterior cortex of tibial diaphysis
Osteofibrous dysplasia<10DiaCorticalLucent±SclWell±Scl+Similar to adamantinoma but in younger age group
Desmoplastic fibroma10–50Met/DiaCentralLucentWell+Rare. Lytic + pseudotrabeculations
Haemophilic pseudotumour>10AnyAnyLucentWell±Scl++Male ± signs of haemophilia ± pseudotrabeculations
Brown tumour>40AnyAnyLucentWell+Look for other features of hyperparathyroidism
Generally well-defined sclerotic/mixed lesions
Bone island>20AnyAnySclWellRound/oval ± spicules, uniformly dense, <2 cm
Bone infarct AnyAnyCentralScl +LucentWell+SclSerpiginous sclerosis , can mimic enchondroma
Enchondroma >10Met/DiaCentralLucent/ChonWell−/+Lytic in phalanges, chondroid calc in larger bones
Chondrosarcoma >30MetCentralLucent/ChonPoor/Well−/+Can mimic enchondroma, chondroblastoma or GCT
Haemangioma>10MetAnyLucent±SclWell−/+−/SpicSpine > skull > other. Appearance depends on site
Paget’s disease>40AllAllLucent/SclWellAppearance depends on stage and location;
Aggressive lesions in children and adolescents
OsteomyelitisAnyMet/EpiAnyLucentPoorLamIf chronic: sclerosis ± sequestrum ± cloaca
Brodie’s abscess0–20Met/EpiAnyLucentSclSolidDiscrete lucency + surrounding sclerosis
Eosinophilic granuloma0–30AnyAnyLucentPoor/WellLamVariable site/appearance, usually aggressive
Ewing sarcoma5–20DiaCentralMixedPoorLamOften subtle, ± noncalcified soft tissue mass
Osteosarcoma 10–25MetAnyOstPoorSpic± Characteristic osteoid matrix in soft tissue mass
Aggressive lesions in adults
Metastasis>40AnyAnyLucent/SclPoor/Well−/+−/Spic if scleroticUsually multiple, variable appearance;
Plasmacytoma>40AnyCentralLucentWell++Axial and proximal appendicular skeleton
Bone lymphoma>30AnyCentralMixedPoorLamLarge soft tissue mass + only subtle bone changes . 2°>1°
Chordoma>30N/ACentralLucent+ SclWell±Scl++Lytic + foci of calcification. Sacrum clivus > vertebrae
Fibrosarcoma and UPS>20Met/DiaAnyLucentPoorAnyNonspecific. Can arise from Paget’s, infarct and others
HP/HE/angiosarcoma>20AnyAnyLucentPoor+Rare. A regional cluster of lytic lesions is suggestive
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