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