Metaphyseal and metaphyseal-diaphyseal bone lesions

Non-tumor

• Bone infarct
• Infection
• Paget’s disease

Benign

• Osteoid osteoma
• Osteoblastoma
• Enchondroma
• Chondromyxoid fibroma
• Non-ossifying fibroma (fibrous cortical defect, fibrous histiocytoma of bone)
• Fibrous dysplasia
• Osteofibrous dysplasia (in tibia)
• Unicameral bone cyst
• Histiocytosis X

Malignant

• Osteosarcoma
• Chondrosarcoma
• Non-osteogenic spindle cell sarcoma of bone (MFH of bone, fibrosarcoma of bone)
• Myeloma
• Lymphoma
• Adamantinoma (tibia and, rarely, ulna)
• Metastatic disease

Notes

This is a long list, but it can be shortened and focused on the basis of radiographic analysis.

• Osteoid osteoma, infection, enchondroma, bone infarct and Paget’s disease have typical Xray findings.

• Osteofibrous dysplasia and adamantinoma are typically tibial lesions.

• Non-ossifying fibroma, fibrous cortical defects, and chondromyxoid fibroma are eccentric geographic lesions.

• Fibrous dysplasia is suspected by multiple bone involvement, deformities, and ground glass appearance.

• Osteosarcoma and chondrosarcoma have typical patterns of matrix formation.

• Non-osteogenic spindle cell sarcoma of bone (ie, MFH, fibrosarcoma, leiomyosarcoma of bone) and lymphoma classically demonstrate permeative bony lysis.

• Metastatic disease is suggested by the patient’s age and the presence of multiple lesions.

• Myeloma is generally a highly lytic lesion, often demonstrating diffuse osteopenia.

Other Differential Diagnoses by Anatomic Location

• Polyostotic conditions
• Juxta-articular bone lesions
• Epiphyseal bone lesions
• Epiphyseal-metaphyseal bone lesions
• Diaphyseal bone lesions
• Parosteal bone lesions
• Anterior bone spine
• Posterior bone spine
• Sacrum bone lesions