Wise Sayings About Solitary Lucent Lesions

Wise Sayings About Solitary Lucent Lesions

Sometimes, all the logical principles that you have at your disposal don't seem to help very much, and one must fall back on some of the empirical maxims that musculoskeletal radiologists have accumulated over the years. Here are a few of the ones I have used over the years.

1. With a long lesion in a long bone, think of fibrous dysplasia.
2. Simple cyst, enchondroma, and fibrous dysplasia can mimic each other and can be hard to distinguish. Thus, when you think of one of these three entities, also think of the other two.
3. Giant cell tumors nearly always occur near a joint surface.
4. Certain bones in the body can be considered "epiphyseal equivalents" for purposes of differential diagnosis. These include the patella, the calcaneus, and most apophyses. Therefore, for lucent lesions in these areas, one should include the classic epiphyseal entities such as chondroblastoma, giant cell tumors and aneurysmal bone cysts.
5. Lucent lesions of the sternum should be considered malignant until proven otherwise (Helms CA, personal communication, 1983).
6. Keep in mind that the classic descriptions of bone tumors that you spend so much time studying are for untreated lesions. What kind of lesions do radiologists spend most of their time looking at? Treated lesions -- treated with surgery, chemotherapy, cryotherapy and radiation therapy. In surgically treated lesions, besides simple resection of the lesion, one may also see replacement by a metal prosthesis, an allograft, or other forms of bone grafting. In short, you won't see the "classic" appearance of a lesion for very long in a given patient. When the patient first presents to you, you may not even have any history of these prior interventions, so you will just have to remember this phenomenon. Also, any given film that you see of a patient is just one frame out of a long documentary movie about that patient -- movies change. Remember this.