Saturday, May 29, 2010

Metaphyseal Lesions

The differential diagnosis for metaphyseal lesions includes:
  • Metastases:
  • Osteomyelitis: In children. May cross an open physis, but this isn't typical.
  • Enchondroma: Expansile lesion with chondroid matrix. When in the digits, it's a predominantly lucent lesion.
  • Non-ossifying fibroma (shown above): "An eccentric, well-defined, lucent lesion in the metaphysis of a tubular bone a short distance from the physis in a child or adolescent is almost diagnostic of a fibrous cortical defect or non-ossifying fibroma." (Resnick)
  • Aneurysmal bone cyst: Eccentric, multicystic, septated, expansile lesion with sclerotic margins and periosteal reaction. Age: 10-30 years
  • Unicameral bone cyst: Centrally located, expansile lesion with sclerotic margin and no periosteal reaction. Age: 10-20 years
  • Chondromyxoid fibroma: Benign bone tumor most often seen in young patients, and usually found in the long tubular bones, especially the tibia and femur near the knee joint.

  • Giant cell tumor: Originates on the metaphyseal side of growth plate and extends to the epiphysis in adults. Stays in the metaphysis when it occurs in kids.
  • Chondrosarcoma:
  • Cortical/periosteal desmoid:
  • Desmoplastic fibroma:
  • Lipoma:
  • Osteoblastoma: Tends to involve the metaphysis and proximal diaphysis.
  • Osteosarcoma: 90% occur in metaphyses

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