Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO THE EDITOR
Year
: 2015  |  Volume : 25  |  Issue : 3  |  Page : 322--324

Mimics of bone tumors


Yashant Aswani, Karan Manoj Anandpara, Priya Hira 
 Department of Radiodiagnosis, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Yashant Aswani
Department of Radiodiagnosis, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra
India




How to cite this article:
Aswani Y, Anandpara KM, Hira P. Mimics of bone tumors.Indian J Radiol Imaging 2015;25:322-324


How to cite this URL:
Aswani Y, Anandpara KM, Hira P. Mimics of bone tumors. Indian J Radiol Imaging [serial online] 2015 [cited 2019 Nov 20 ];25:322-324
Available from: http://www.ijri.org/text.asp?2015/25/3/322/161471


Full Text

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}

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}.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}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}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}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}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}

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

References

1Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: A pictorial essay. Indian J Radiol Imaging 2014;24:225-36.
2Yochum 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.
3Helms CA. "Don't Touch" lesions. In: Helms CA, editor. Fundamentals of Skeletal Radiology. 3 rd ed. Philadelphia: Elsevier Saunders; 2005. p. 55-77.
4Guebert 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.
5Vanhoenacker 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.
6Helms CA. Benign lytic lesions. In: Helms CA, editor. Fundamentals of Skeletal Radiology. 3 rd ed. Philadelphia: Elsevier Saunders; 2005. p. 7-31.