Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 6368

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

 Table of Contents    
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 25  |  Issue : 3  |  Page : 322-324
Mimics of bone tumors


Department of Radiodiagnosis, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India

Click here for correspondence address and email

Date of Web Publication24-Jul-2015
 

How to cite this article:
Aswani Y, Anandpara KM, Hira P. Mimics of bone tumors. Indian J Radiol Imaging 2015;25:322-4

How to cite this URL:
Aswani Y, Anandpara KM, Hira P. Mimics of bone tumors. Indian J Radiol Imaging [serial online] 2015 [cited 2019 Oct 21];25:322-4. Available from: http://www.ijri.org/text.asp?2015/25/3/322/161471
Sir,

We read with interest the pictorial essay, "Bone tumor mimickers: A pictorial essay," by Mhuircheartaigh et al. [1] The article discusses about numerous benign processes that mimic the radiographic appearance of bone tumors. We found the article excellent and informative. We would like to contribute by adding to the list of differentials a few other benign pathologies simulating a neoplasm, which are discussed below and in the table that follows [Table 1].
Table 1: Mimics of bone tumors (other than in Ref.[1] and those discussed above)


Click here to view


  • Congenital unilateral agenesis of vertebral body pedicle [2]
    • Unilateral absence of a pedicle on the frontal view may not always represent an osteolytic metastasis (winking owl sign); a unilateral, congenitally absent pedicle has a similar radiologic appearance. Contralateral enlargement of the pedicle surrounded by a sclerotic margin, however, is seen only in the latter [Figure 1]. This expansion is compensation to weight-bearing stresses
      Figure 1: Congenital unilateral agenesis of vertebral body pedicle. Radiograph lumbosacral spine depicts absence of pedicle of L4 vertebra. There is compensatory enlargement and sclerosis of the contralateral pedicle

      Click here to view
      .
  • Osteopoikilosis [3]
    • It is a hereditary benign condition with symmetric distribution of radiopaque densities around the joints. This appearance can mimic an osteoblastic metastasis, especially when osteopoikilosis is present diffusely throughout the pelvis rather than just around the joints. A uniform size and symmetric juxta-articular distribution are, however, characteristic of osteopoikilosis [Figure 2].
      Figure 2: Osteopoikilosis. Radiograph pelvis reveals multiple small sclerotic densities situated predominantly around the joints. Distribution around the joints, rather than diffusely, is typical of osteopoikilosis

      Click here to view
  • Epidermal inclusion cyst [5]
    • Ectopic rests of surface epidermal cells in dermis especially due to trauma may cause focal proliferation which may erode into the adjacent bone [Figure 3]. More frequent in terminal phalanges, these lytic bony lesions may mimic neoplastic process. Epidermal inclusion cyst has a low signal both on T1 and T2 images due to increased lipid content; low T2 signal, however, may be seen due to crystalline cholesterol or keratin. There is distinct absence of contrast enhancement.
      Figure 3: Epidermal inclusion cyst. The radiograph shows lytic lesions in the middle phalanx of the third finger with adjacent soft tissue swelling. The lesion was an epidermal inclusion cyst on histopathology

      Click here to view
  • Paget's disease [2]
    • Radiologic appearance varies as per the stage of the disease. However, the general features include changes in bone density, coarsening of trabeculae, cortical thickening, bone expansion, subarticular disease, and pathological fractures [Figure 4]. Highly aggressive lesions may show periosteal reaction. Paget's disease mimics both the osteolytic as well as osteoblastic malignancies. The neoplasm, however, shows lack of cortical expansion; there is rather cortical disruption. Subarticular involvement is characteristic of Paget's disease.
      Figure 4: Paget's disease. The radiograph reveals cortical thickening and bone expansion of tibia with subarticular extension. The femur, patella, and fibula appear uninvolved. The mottled opacities within the tibia represent cotton wool appearance. Also noted is a pathologic transverse fracture in the mid-diaphysis of tibia

      Click here to view
  • Bulbous ischiopubic synchondrosis [4]
    • The junction of ischium and pubis may undergo considerable enlargement. This bulbous expansion may be unilateral [Figure 5] or bilateral. It is usually an asymptomatic variant, but may be confused with a neoplasm, especially in symptomatic individuals. Lack of marrow and adjacent soft tissue edema on MRI helps distinguish this normal growth variant and a neoplasm.
      Figure 5: Bulbous ischiopubic synchondrosis. Radiograph pelvis depicts unilateral bulbous enlargement of ischiopubic articulation

      Click here to view
  • Bone infarction [6]
    • A bone infarction is a diametaphyseal process in a long bone that has serpiginous sclerotic border. This sclerotic border has a low signal on MRI (due to reactive new bone formation) with central high signal (of yellow marrow). Such an appearance is not always seen. It is often difficult to distinguish bone infarction from enchondroma [Figure 6]. The latter causes endosteal scalloping and lacks a sclerotic border.
      Figure 6: Bone infarction. The radiograph shows two infarcts, one in metaphysis and the other in proximal diaphysis. The margins of the lesion are minimally sclerotic with areas of localized internal sclerosis. The overlying cortex is uninvolved

      Click here to view


We conclude by once again commending the authors for an excellent article on an important topic.

 
   References Top

1.
Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: A pictorial essay. Indian J Radiol Imaging 2014;24:225-36.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Yochum TR, Rowe LJ. Tumors and tumor-like processes. In: Yochum TR, Rowe LJ, editors. Essentials of Skeletal Radiology. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1137-372.  Back to cited text no. 2
    
3.
Helms CA. "Don't Touch" lesions. In: Helms CA, editor. Fundamentals of Skeletal Radiology. 3 rd ed. Philadelphia: Elsevier Saunders; 2005. p. 55-77.  Back to cited text no. 3
    
4.
Guebert GR, Rowe LJ, Yochum TR, Thompson JR, Maola CJ. Congenital anomalies and normal skeletal variants. In: Yochum TR, Rowe LJ, editors. Essentials of Skeletal Radiology. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 257-404.  Back to cited text no. 4
    
5.
Vanhoenacker FM, Eyselbergs M, Van Hul E, Van Dyck P, De Schepper AM. Pseudotumoural soft tissue lesions of the hand and wrist: A pictorial review. Insights Imaging 2011;2:319-33.  Back to cited text no. 5
    
6.
Helms CA. Benign lytic lesions. In: Helms CA, editor. Fundamentals of Skeletal Radiology. 3 rd ed. Philadelphia: Elsevier Saunders; 2005. p. 7-31.  Back to cited text no. 6
    

Top
Correspondence Address:
Yashant Aswani
Department of Radiodiagnosis, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.161471

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1607    
    Printed17    
    Emailed0    
    PDF Downloaded306    
    Comments [Add]    

Recommend this journal