Pattern of Bone Destruction

• GEOGRAPHIC BONE DESTRUCTION

Cause (a) slow-growing usually benign tumor

: (b)rarely malignant: plasma cell myeloma, metastasis
(c) infection: granulomatous osteomyelitis

well-defined smooth / irregular margin

short zone of transition

• MOTH-EATEN BONE DESTRUCTION

Cause (a) rapidly growing malignant bone tumor

: (b) osteomyelitis

less well defined / demarcated lesional margin

longer zone of transition

mnemonic H LEMMON
:

o Histiocytosis X
o Lymphoma
o Ewing sarcoma
o Metastasis
o Multiple myeloma
o Osteomyelitis
o Neuroblastoma
• PERMEATIVE BONE DESTRUCTION

Cause aggressive bone tumor with rapid growth potential (eg, Ewing sarcoma)
:

poorly demarcated lesion imperceptibly merging with uninvolved bone

long zone of transition

Size, Shape, and Margin of Bone Lesion

Primary malignant tumors are larger than benign tumors

elongated lesion (= greatest diameter of >1.5 times the least diameter): Ewing
sarcoma, histiocytic lymphoma, chondrosarcoma, angiosarcoma

sclerotic margin (= reaction of host tissue to tumor)

Tumor Position in Transverse Plane
• CENTRAL MEDULLARY LESION
o Enchondroma
o Solitary bone cyst
• ECCENTRIC MEDULLARY LESION
o Giant cell tumor
o Osteogenic sarcoma, chondrosarcoma, fibrosarcoma
o Chondromyxoid fibroma
• CORTICAL LESION
o Nonossifying fibroma
o Osteoid osteoma
• PERIOSTEAL / JUXTACORTICAL LESION
o Juxtacortical chondroma / osteosarcoma
o Osteochondroma
o Parosteal osteogenic sarcoma

Tumor Position in Longitudinal Plane

• EPIPHYSEAL LESION
o Chondroblastoma (prior to closure of growth plate)
o Intraosseous ganglion, subchondral cyst
o Giant cell tumor (originating in metaphysis)
o Clear cell chondrosarcoma
o Fibrous dysplasia
o Abscess
mnemonic CAGGIE
:
o Chondroblastoma
o Aneurysmal bone cyst
o Giant cell tumor
o Geode
o Infection
o Eosinophilic granuloma
 [after 40 years of age throw out “CEAâ€‌ and insert
metastases / myeloma]
• METAPHYSEAL LESION
o Nonossifying fibroma (close to growth plate)
o Chondromyxoid fibroma (abutting growth plate)
o Solitary bone cyst
o Osteochondroma
o Brodie abscess
o Osteogenic sarcoma, chondrosarcoma
• DIAPHYSEAL LESION
o Round cell tumor (eg, Ewing sarcoma)
o Nonossifying fibroma
o Solitary bone cyst
o Aneurysmal bone cyst
 o Enchondroma
o Osteoblastoma
o Fibrous dysplasia
mnemonic FEMALE
:
o Fibrous dysplasia
o Eosinophilic granuloma
o Metastasis
o Adamantinoma
o Leukemia, Lymphoma
o Ewing sarcoma

Tumors Localizing to Hematopoietic Marrow

• Metastases
• Plasma cell myeloma
• Ewing sarcoma
• Histiocytic lymphoma