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Reactive, Metabolic, and Tumor-Like Lesions of Bone

  • Chapter
Imaging of Bone Tumors and Tumor-Like Lesions

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Key Points

• Metabolic bone diseases are not included in the WHO classification of bone tumors. Metabolic bone disease conventionally includes osteoporosis, osteomalacia, hyperparathyroidism, and Paget’s disease.

• Osteoporosis is characterized by fractures that in the vertebrae and pelvis could be mistaken for a more sinister disease, such as metastases. Recognizing their patterns on the different imaging modalities would permit the correct diagnosis to be made and prevent the patient from being overstaged and inappropriately investigated. Exuberant callus formation in OI type V should not be mistaken for sarcoma.

• Oncogenic osteomalacia is a rare clinicopathological syndrome characterized by a triad of severe hypophosphatemia, hyperphosphaturia, and osteomalacia secondary to a neoplasm. The condition is challenging to diagnose, as the patient most often presents with symptoms of osteomalacia, and the primary mesenchymal tumor may be small and often asymptomatic. However, correct diagnosis is particularly gratifying as surgical removal of the offending tumor can lead to a dramatic reversal of osteomalacia. Amyloid deposition in patients on long-term hemodialysis can lead to periarticular osteolytic lesions, and these tumor-like osseous lesions are called amyloidomas of the bone. With the increased life span of hemodialysis patients, radiologists are more likely to encounter brown tumors as well as musculoskeletal manifestations of β2-microglobulinassociated amyloidosis, including lytic osseous lesions (amyloidomas) and renal spondyloarthropathy, and these conditions should not be mistaken for primary or secondary bone neoplasms.

• Florid reactive periostitis (FRP) and bizarre parosteal osteochondromatous proliferation (BPOP) represent opposing ends of a spectrum of reactive lesions that mimic sarcoma. BPOP, also called Nora’s lesion, has been defined as a “well-marginated mass of heterotopic mineralization arising from the periosteal aspect of an intact cortex, without medullary changes.” The radiological appearances of these benign entities are often mistaken for more ominous pathologies, most commonly osteogenic osteosarcoma and chondrosarcoma and also osteomyelitis. Familiarity with the entity of FRP will allow radiologists to provide the correct diagnosis and prevent unnecessary antibiotic therapy or aggressive, early surgery. Close clinical and radiological follow-up of FRP usually shows conversion to BPOP.

• SAPHO is an acronym for a syndrome comprising synovitis, acne, pustulosis, hyperostosis, and osteitis. The radiologist plays a central role in the early, accurate, and definitive diagnosis of SAPHO syndrome. Awareness of SAPHO syndrome is important to facilitate differentiation from other entities with similar radiological presentation, but dramatically different progression, treatment, and prognosis. These entities include malignancies such as round cell tumors like lymphoma and Ewing’s sarcoma, metastases, and also osteomyelitis and Paget’s disease.

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Authors and Affiliations

  1. Department of Radiology, KEM Hospital and Seth GS Medical College, Parel, 400 012, Mumbai, Maharashtra, India

    Darshana Sanghvi

  2. Section of Musculoskeletal Radiology, Imaging Institute, Diagnostic Radiology/A21, School of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, 9500 Euclid Ave., 44195, Cleveland, OH, USA

    Murali Sundaram

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  1. Darshana Sanghvi
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Editors and Affiliations

  1. MRI Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    A. Mark Davies

  2. Section of Musculoskeletal Radiology, Imaging Institute, Diagnostic Radiology/A21, School of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, 9500 Euclid Ave., 44195, Cleveland, OH, USA

    Murali Sundaram

  3. Imaging Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    Steven L. J. James

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Sanghvi, D., Sundaram, M. (2009). Reactive, Metabolic, and Tumor-Like Lesions of Bone. In: Davies, A., Sundaram, M., James, S. (eds) Imaging of Bone Tumors and Tumor-Like Lesions. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77984-1_30

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