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Aggressive lesions tend to grow (more/less) rapidly than less aggressive lesions
Lytic or blastic?
Lytic
Created by osteoclasts.
Charcterized by the presence of less bone.
Lytic lesions is created by what? What characterizes it?
Lytic or Blastic?
Blastic
Created by osteoblast.
Characterized by less bone.
Blastic lesions are created by what? What is it characterized by?
Wide or narrow zone of transition?
Wide
It’s an osteogenic sarcoma.
Wide or narrow zone of transition?
Narrow
It’s a benign unicamal cyst
Zone of transition?
It’s a trick. Only applies to X-rays.
Everything seems narrow in MRI and CT.
Bone loss in one area
Bone more or less resembles a continent and has a narrow zone of transition
Characteristic of geographic zone of distruction
Pattern of destruction?
Geographic
Multiple lytic areas
Wider zone of transition, more aggressive lesion
Characterization of moth eaten pattern of destruction?
Pattern of destruction?
Moth eaten
Many tiny holes, perhaps pin size
Wide zone of transition
Characterization of permeative patten of destruction
Pattern of destruction?
Permeative
Physiological stress; metatarsal fracture
What causes periostitis? Give an example.
Periostitis
(fusiform shape bone callus sign here)
Thick and uniform
What characterizes periostitis?
Periostitis: Sunburst pattern
Occuring here in osteosarcoma
Any periostitis that is not thick with a smooth surface is associated with a more aggressive lesion until proven otherwise
What is the general rule of periostitis?
Periostitis: Hair on end
Periostitis: Onion skin
Occurs when the lesions rapid growth is intermittidly interrupted
What causes periostitis: onion skin?
Moth eaten pattern and wide zone of transition
What is seen in periostitis: onion skin?
Periostitis with Codman’s Triangle
A rapidly expanding lesion effectively lifts the periostium from the bone’s surface
What happens in a periostitis lesion with Codman’s triangle?
What’s seen here? Should it be considered aggressive until proven otherwise?
Soft tissue involvement; yes
Note it has a wide zone of transition
Even if it looks less aggressive, a lesion is considered aggressive if the patient is over 40
Use common sense when applying it. If a patient has OA and it’s next to an OA joint, it’s likely a geode or cyst without needing further action.
What is the over 40 rule?
Benign lesions with edge characteristics ranging from well defined to poorly defined
Lodwick Radiographic Tumor Staging: Grade 1A, 1B, and 1C
Low-grade malignant lesions with invasive features; applies particularly to lesions demonstrating total penetration of the cortex
Lodwick Radiographic Tumor Staging: Grade 2
High-grade malignant lesions with invasive, permeative, and destructive features
Lodwick Radiographic Tumor Staging: Grade 3
Radiographically benign lesions that do not require further investigation or treatment
Sundaram et al: Group 1
Lesions with a high likelihood of being benign but that should be confirmed as benign by means of clinical or radiographic follow-up examination
Sundaram et al: Group 2
Benign lesions that require surgical resection because of aggressive behavior or a risk of pathologic fracture
Sundaram et al: Group 3
Aggressive-appearing lesions that should be considered malignant but on which a biopsy should be performed to confirm the diagnosis and histologic grade
Sundaram et al: Group 4