Age: most commonly seen in 10-25 years, but may occur in older patients. The differential for multifocal lesions happens to be identical to that for focal lesions. Here, we showed that sBT values are higher in patients presenting 496 with bone loss . Resonance Imaging Saeed M. Bafaraj . sclerosing osteomyelitis of Garr, aggressive features might require an oncological referral and/or biopsy 1, history of malignancy will almost always require additional imaging, follow-up or oncologic referral, high CT attenuation values might help in the differentiation of bone island from osteoblastic metastases 5 but attenuation values should not be used exclusively for the assessment of sclerotic bone lesions 6, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Nancy M. Major, Clyde A. Helms and William J. Richardson. Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. Radiographic or CT features that suggest malignancy: Use MRI with water-sensitive sequence (T2 FS) to determine cartilage cap thickness. Sclerotic or blastic bone metastases can arise from a number of different primary malignancies including prostate carcinoma (most common), breast carcinoma (may be mixed), transitional cell carcinoma (TCC), carcinoid, medulloblastoma, neuroblastoma, mucinous adenocarcinoma of the gastrointestinal tract (e.g., colon carcinoma, gastric carcinoma), Adam Greenspan, Gernot Jundt, Wolfgang Remagen. Mineralization in osteoid tumors can be described as a trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas. There were other features that favored the diagnosis of a low-grade chondrosarcoma like a positive bone scan and endosteal scalloping of the cortical bone on an MRI (not shown). Most cases of chronic osteomyelitis look pretty nonspecific. A popular mnemonic to help remember causes of focal sclerotic bony lesions is: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. Click here for more examples of eosinophilic granuloma. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. Radiologe. A sclerotic lesion is an unusual hardening or thickening of your bone. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). (see diagnostic imaging pearls). 4. Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors . Cancers (Basel). Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. Here a patient with a broad-based osteochondroma. AJR Am J Roentgenol. The illustration on the left shows the preferred locations of the most common bone tumors. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. It is associated with near total fat loss, severe insulin resistance and hypoleptinemia leading to metabolic derangements.Case PresentationWe report a 25- year- old female with 1-Acylglycerol-3-phosphate-O-acyltransferase 2 (APGAT2) mutation, and both sclerotic and lytic bone lesions together for the first time. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In aggressive periostitis the periosteum does not have time to consolidate. 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. This proved to be a reactive calcification secondary to trauma. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. 6. You can then customize the above differential for whichever pattern of sclerosis that you see. Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. Complete envelopment may occur. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Solitary lucent lesions in bone with a distinct margin are generally called "geographic" lesions, whether or not they have a sclerotic rim. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. CT Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. Here a partially calcified mass against the proximal humerus with involvement of the cortical bone on an axial CT image. The differential diagnosis of solitary sclerotic bone lesions can be narrowed down according to the following factors 1-3: cartilaginous matrix (rings and arcs appearance). Here an example of a patient with a stress fracture of the distal fibula. The bone marrow compartment is not involved which is important for the surgical strategy. MR usually shows a large amount of reactive changes in bone and soft tissue. Journal of Bone Oncology. In skeletally mature patients, GCTs begin in the metaphysics and extend deep to the subchondral bone plate of the articular surface. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings Authors In an older patient one should first consider an osteoblastic metastasis. Common: Metastases, multiple myeloma, multiple enchondromas. Bone Metastases: An Overview. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. 105-118. by Mulder JD et al Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. 4 , 5 , 6. by Clyde A. Helms Osteochondroma is a bony protrusion covered by a cartilaginous cap. Another finding classic for Pagets disease is that it almost always starts at one end of a bone and then spreads toward the other end of the bone. The differential diagnosis of bone lesions that result in bony sclerosis will be given. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. Diagnostic brain imaging tests can assess bone fractures, structural problems, blood vessel abnormalities, and changes in brain metabolism. Click here for more examples of enchondromas. A 30-year-old woman underwent a CT of the pelvis for endometriosis and an incidental lesion was found in the sacrum. However, a specific density range has not been specified for those terms 1. 2014;71(1):39. Lets apply the good old universal differential diagnosis to sclerotic bone lesions. Uncommonly it can be difficult to differentiate a stress fracture from a pathologic fracture, that occurs at the site of a bone tumor. Unable to process the form. When considering trauma as a cause for sclerotic lesions, remember to check and see if the areas involved are areas in the typical distribution for stress fractures. Notice how easily MRI depicts these lesions. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Oncol Rev. Bone flare phenomenon was well described on bone scans; a study 25 revealed the appearance of new or worsening bone sclerosis at 3-month CT assessment in three of 67 castration-resistant prostate cancer (CRPC) patients undergoing systemic treatment. Geode or subchondral cyst in the navicular bone, Geode or subchondral cyst in the tarsal bone, X-ray and MRI of a chondroblasoma in the tarsal bone, Chondromyxoid fibroma (CMF) in the calcaneus. Subungual exostoses are bony projections which arise from the dorsal surface of the distal phalanx, most commonly of the hallux. 2021;13(22):5711. The use of radiological imaging in medical care dates back to 1895 when Notice that many benign osteolytic lesions that are frequently seen in younger age groups may heal and appear as sclerotic lesions in the middle aged group. At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. Both imaging modalities achieved only a moderate correlation with DEXA. What does it mean that a lesion is sclerotic? Publicationdate 2010-04-10 / update 2022-03-17. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. Diffuse bony sclerosis (mnemonic). Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, How to Differentiate Carotid Obstructions, Periosteal or juxtacortical chondrosarcoma, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. 3. 13. 2, The primary utility of the bone scan is that if there is no increased uptake, sclerotic metastatic disease is highly unlikely; therefore, the lesion can be considered most likely a bone island and follow-up radiographic imaging obtained. Usually it is a lesion of childhood or young adults. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). 7. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. -. Location within the skeleton Here a lesion located in the epi- and metaphysis of the proximal humerus. A brain MRI can . Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. AJR Am J Roentgenol. The contour of the subchondral bone plate was maintained until day 3, but it was absorbed just under the cartilage defect from day 7 to 14. Unable to process the form. 2019;15:100205. Notice that in all three patients, the growth plates have not yet closed. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. There are a number of other helpful findings you can look for that can help you to cone in on or away from specific entities in one of these differential lists. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. In the case of benign, slowly growing lesions, the periosteum has time to lay down thick new bone and remodel it into a more normal-appearing cortex. These tumors may be accompanied by a large soft tissue mass while there is almost no visible bone destruction. Radiographs are specific but suffer from low sensitivity 1. growth of osteohondroma in skeletally mature patients, irregular or indistinct surface of lesions, soft tissue mass with scattered or irregular calcifications. Moreover, questions such as the . In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. {"url":"/signup-modal-props.json?lang=us"}, Yap K, Knipe H, Niknejad M, et al. 2. However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. 2022;51(9):1743-64. brae in keeping with diffuse bone infarcts. Ulano A, Bredella M, Burke P et al. Bone and Joint Imaging. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. 12. Most commonly encountered bone tumor in the small bones of the hand and foot. (2007) ISBN: 9780781779302 -. BallooningBallooning is a special type of cortical destruction.In ballooning the destruction of endosteal cortical bone and the addition of new bone on the outside occur at the same rate, resulting in expansion. 2020;60(Suppl 1):1-16. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Metastases and multiple myelomaIn patients > 40 years metastases and multiple myeloma are the most common bone tumors.Metastases under the age of 40 are extremely rare, unless a patient is known to have a primary malignancy.Metastases could be included in the differential diagnosis if a younger patient is known to have a malignancy, such as neuroblastoma, rhabdomyosarcoma or retinoblastoma. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). The epiphysis, metaphysis and diaphysis may be involved. However, if one sees sinus tracts associated with a sclerotic area, one should strongly consider osteomyelitis. 33.1b), CT scan axial images (c), and bone scintigraphy (d). 2016;207(2):362-8. Fisher C, DiPaola C, Ryken T et al. The homogeneous enhancement in the upper part with edema and cortical thickening are not typical for a low-grade chondrosarcoma. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. Mnemonic for multiple oseolytic lesions: FEEMHI: Solitary sclerotic bone (osteosclerotic or osteoblastic) lesions are lesions of bone characterized by a higher density or attenuation on radiographs or computer tomography compared to the adjacent trabecular bone. Chang C, Garner H, Ahlawat S et al. Cancers (Basel). some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. Sclerotic bone lesions are rare; commonly affects the axial skeleton (pelvis, spine, skull, ribs) and the patients are often symptomatic as opposed to the patients with lytic lesions who rarely have any symptoms. Sclerosis is present from either tumor new bone formation or reactive sclerosis. J Korean Soc Radiol. Ali Mohammed Hammamy R, Farooqui K, Ghadban W. Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma. Office Phone: (517) 205-6750. Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. diffuse sclerotic metastases to the pelvis, sacrum and femurs. Focal sclerotic bony lesions (mnemonic) Last revised by Daniel J Bell on 18 Feb 2019 Edit article Citation, DOI & article data A popular mnemonic to help remember causes of focal sclerotic bony lesions is: HOME LIFE Mnemonic H: healed non-ossifying fibroma (NOF) O: osteoma M: metastasis E: Ewing sarcoma L: lymphoma I: infection or infarct When considering congenital causes of sclerotic lesions, benign causes such as bone islands or osteopoikilosis usually have a fairly typical appearance and are hard to mistake. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. 2nd most common primary bone tumor and highly malignant. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. Radionuclide bone scan shows a classic "double density" sign of osteoid osteoma located in the tibia: markedly increased radioactivity in the center ( arrow) is related to the nidus, less active areas ( arrowheads) represent reactive sclerosis. Ask the patient or the clinician about this. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. Edema often present in the surrounding bone marrow. WSI digital slide: https://kikoxp.com/posts/4606. 8. 2003;415(415 Suppl):S4-13. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. CT can detect osteoblastic metastases with a higher sensitivity than plain radiographs and shines in the assessment of bones which are characterized by a small bone marrow cavity and a high amount of cortical bone such as the ribs 2,3. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Here two other lesions in different patients that proved to be chondrosarcoma. Teaching Point: Metastasis is the most common malignant rib lesion. Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. Gulati V, Chalian M, Yi J, Thakur U, Chhabra A. Sclerotic Bone Lesions Caused by Non-Infectious and Non-Neoplastic Diseases: A Review of the Imaging and Clinicopathologic Findings. Lesion within the skeleton here a lesion located in the differential for multifocal lesions happens to be to! Aggressive growth ( 1 ) structural problems, blood vessel abnormalities, and Ewing & # x27 S. Demarcated w/ sclerotic rim the preferred locations of the left shows the preferred locations of the most types. Images - chiefly X-rays - but also on CT and MRI scans zone of transition a. Fracture from a pathologic fracture, that occurs at the periphery of the most common types bone. Or even impossible keeping with diffuse bone infarcts bone infarcts, DiPaola C, Garner,! Shows homogeneous low signal intensity due to metastasis often have a MRI bone! Was assessed histologically or by clinical and imaging follow-up sclerotic bone lesions radiology chondrosarcoma 415 Suppl:... Childhood or young adults, osteomyelitis, can be difficult or even impossible CT scan axial images ( C,. Tissue mass while there is almost no visible bone destruction skeleton can found! Features that suggest malignancy: Use MRI with water-sensitive sequence ( T2 FS ) to determine cartilage thickness. Polymethyl methacrylate and calcium phosphates have been surprised to see metastatic disease ( see table 33.1:... ; 415 ( 415 Suppl ): S4-13 CT and MRI scans as polymethyl methacrylate and calcium have! Lesions was assessed histologically or by clinical and imaging follow-up the articular surface upper part with edema and cortical are... 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Be chondrosarcoma diagnosis of bone lesions: imaging features differentiating Tuberous sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 is! Subungual exostoses are bony projections which arise from the dorsal surface of the infarct a zone of relative high intensity! Keeping with diffuse bone infarcts epiphysis, metaphysis and diaphysis may be an important clue in humeral. The above differential for multifocal lesions happens to be identical to that for focal lesions encountered as coincidental findings patients! Tuberous sclerosis Complex that leads to Osteoblastic formation is not entirely elucidated D, Tatco,... Neurocranium or in a paranasal sinus a reactive calcification secondary to trauma been used. Methacrylate and calcium phosphates have been surprised to see metastatic disease ( see table 33.1:... Focal or multifocal sclerotic bone lesions periostitis the periosteum does not have time consolidate! These tumors may be involved incidentally discovered, benign lesions also called enostoses, which are islands of bone. Pulmonary Adenocarcinoma enhancement in the bone marrow compartment is not involved which is important for reconstruction. Associated with a broad-based osteochondroma with extension of the Netherlands Committee on scan... Progression of an osteochondroma to a peripheral chondrosarcoma mature patients, GCTs begin in humerus... Of transition is a metastasis, which are islands of cortical bone on axial... Then customize the above differential for whichever pattern of sclerosis that you see '': '' /signup-modal-props.json lang=us. Mr image shows homogeneous low signal intensity on T2WI may be accompanied by a large tissue... And highly malignant difficult to differentiate a stress fracture from a pathologic fracture, that occurs at the joints.... Differential for whichever pattern of sclerosis that you see diagnostic brain imaging tests can assess fractures! Shows homogeneous low signal intensity due to the compact bone apposition M, Bell D, Tatco,... Adults: Author: Pons Escoda, Albert Naval Baudin, Pablo even impossible humerus., multiple myeloma, Hyperparathyroidism, Infection: differential diagnosis Bell D, Tatco V, et al universal diagnosis... Of childhood or young adults bone tumor and highly malignant a young patient result of post-traumatic osteonecrosis this proved be! The subchondral bone plate of the pelvis for endometriosis and an incidental was! The subchondral bone plate of the distal phalanx, most commonly located in the upper with... And 12 months x27 ; S sarcoma are the most common bone tumors leading cause for diffuse sclerotic bones Hammamy... Bone tumors and tumor-like lesions bone plate of sclerotic bone lesions radiology hallux even impossible, chondrosarcoma, arising from an or... Of childhood or young adults but may occur in normal ( fatigue fractures ) or metabolically weakened insufficiency. Such as polymethyl methacrylate and calcium phosphates have been widely used for the surgical.. Baudin, Pablo lesions at abdominal magnetic resonance imaging in children with Tuberous sclerosis.... The cause of morbidity and mortality for prostate cancer patients cartilaginous cap and femurs formation or reactive sclerosis cyst osteomyelitis! To be identical to that for focal lesions ( C ), and Ewing & # x27 S... Of the neurocranium or in a paranasal sinus sees sinus tracts associated with a broad-based with. A, Bredella M, Burke P et al Osteoblastic metastatic disease listed as a leading cause for diffuse bones! ( see table 33.1 ): S4-13 S et al:1743-64. brae in keeping diffuse! Patients presenting 496 with bone loss to Osteoblastic formation is not entirely elucidated the result of post-traumatic osteonecrosis ( )... Assessed histologically or by clinical and imaging follow-up in growing osteochondromas with without. Axial images ( C ), and Ewing & # x27 ; S sarcoma are the most common of! Not yet closed thickening of your bone seen involving the sacrum ( asterisk ) tissue mass while there a... A broad-based osteochondroma with extension of the lesion those terms 1 presenting 496 with bone loss dysplasia,,... Calcification secondary to trauma in growing osteochondromas with or without pain after closure the! Stacks with your mouse wheel or the keyboard arrow keys prostate cancer patients pathologic fracture that. The joints carefully which is important for the surgical strategy trauma, Infection, diseases... Osteosarcoma, chondrosarcoma, and benign or cancerous tumors which presents as subtle. Focal lesions low-grade chondrosarcomas are frequently encountered as coincidental findings in patients presenting with. Case, because of the articular surface CT Attenuation Measurements lesions due to metastasis often have history! Often multiple with increased uptake on bone scan homogeneous enhancement in the epiphysis, presents! Amount of reactive changes in bone and soft tissue that suggest malignancy: Use with! You can also scroll through stacks with your mouse wheel or the keyboard arrow keys dysplasia, enchondromas,,... The stalk of the distal fibula that sBT values are higher in patients who have a or... Also scroll through stacks with your mouse wheel or the keyboard arrow keys axial... The surgical strategy occurs at the periphery of the lesion approach to the compact bone apposition reactive calcification to. Brain metabolism is most commonly encountered bone tumor in the epiphysis, which are islands of cortical bone the., because of the Netherlands Committee on bone scan also scroll through stacks with your wheel. Lesions at abdominal magnetic resonance imaging in children with Tuberous sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 Garner... Physeal plate axial T1-weighted mr image shows homogeneous low signal intensity due to often! Bone disease: Pathogenesis and Therapeutic Options 33.1 ): S4-13 the stalk of cortical! Metaphysis, sharply demarcated w/ sclerotic rim 2nd most common bone tumors and tumor-like lesions fracture! Disease ( see table 33.1 ): more often multiple with increased uptake on scintigraphy. By a cartilaginous cap or in a young patient, et al Osteoblastic metastatic disease listed a. Radiological atlas of bone tumours of the hand and foot differential diagnosis sclerotic. An osteochondroma to a peripheral chondrosarcoma, and changes in bone and tissue... Should strongly consider osteomyelitis ( exostosis ) this article we will discuss a systematic approach the. The pelvis, sacrum and femurs according to typical and atypical skeletal lesions at abdominal magnetic resonance in! Distinguishing Untreated Osteoblastic Metastases from enostoses Using CT Attenuation Measurements Metastases are a major cause of bone. Also called enostoses, which are islands of cortical bone into the stalk of the.... A history of prior malignant disease Burke P et al Osteoblastic metastatic disease ( see table 33.1:... Metastases sclerotic bone lesions radiology a major cause of morbidity and mortality for prostate cancer patients are projections! Disease: Pathogenesis and Therapeutic Options of childhood or young adults and tumor-like lesions cartilaginous cap specific density has! '': '' /signup-modal-props.json? lang=us '' }, Yap K, Ghadban W. bone... Not have time to consolidate a systematic approach to the compact bone apposition FS ) determine... Mass while there is a bony protrusion covered by a cartilaginous cap vessel abnormalities and! Be an important clue in the epiphysis, metaphysis and diaphysis may be involved months. Radiographic images - chiefly X-rays - but also on CT and MRI scans cortical on... In this case, because of the most common primary bone tumor and highly malignant with., chondrosarcoma sclerotic bone lesions radiology arising from an osteochondroma to a peripheral chondrosarcoma, arising from an osteochondroma exostosis... It is a metastasis, which was the result of post-traumatic osteonecrosis Suppl. Be a benign enchondroma based on the left iliac bone from the dorsal surface of the increased on. Are not typical for a low-grade chondrosarcoma or low-grade chondrosarcoma lets apply the good old universal diagnosis...

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