Lesions of juxtacortical origin (surface lesions of bone)

Abstract

A large variety of tumor and tumor-like conditions have been shown to originate from the surface of bone (Table 1). Most surface lesions are associated with periosteal reaction. The periosteum is a multipotential membrane. Its cellular composition may give rise to a variety of both neoplasms and tumor-like conditions. To avoid misinterpretation, the orthopedist, radiologist, and pathologist should be familiar with the entire spectrum of surface lesions. A better understanding of the natural history and biological behavior at different lesional maturity stages and correlation of the history with the radiographic and pathological findings is essential to establish the correct diagnosis. A history of injury or blunt trauma is very important. A stress fracture may produce a periosteal reaction acd callus that can be difficult to distinguish from osteosarcoma. In this review article, the authors wish to describe and define each term by its anatomy and radiographic features while discussing the entire spectrum of surface lesions. All the illustrative cases in this review article have been proven histologically.

MR findings of avulsive cortical irregularity of the distal femur

“…The exact etiology is not yet known. Some consider it to be identical to fibrous cortical defect [7], while others believe it to be brought on as a result of stress at the attachment of the tendon of the adductor magnus muscle [2] or the medial head of the gastrocnemius muscle [4,6,8,10,11]. Resnick and Greenway reviewed the previous reports and divided them into two categories [9].…”

“…Because avulsive cortical irregularity sometimes simulates malignancy both radiologically and microscopically, authors have warned of the clinical importance of not mistaking it for malignant bone tumor, such as osteosarcoma or fibrosarcoma [6,7,10,11,13]. Avulsive cortical irregularity has been described as being almost always asymptomatic and found incidentally [6,11,12].…”

“…Avulsive cortical irregularity has been described as being almost always asymptomatic and found incidentally [6,11,12]. If the plain radiographic findings are typical of this condition and the patient does not complain of pain, no further examinations are necessary.…”

“…Irregularity of the cortex of the distal femoral metaphysis is a benign condition, referred to as "distal metaphyseal femoral defect" [1], "cortical desmoid" [2], "avulsive cortical irregularity" [3,4], "distal femoral cortical defect" [5], and "cortical irregularity syndrome" [6]. The pathogenesis of this condition is not yet known; some consider it to be identical to fibrous cortical defect [7], while others believe it to be a result of stress at the tendinous attachment of skeletal muscle [l, 2, 4, 6, 8-11].…”

Musculoskeletal case of the day. Giant cell tumor of the sacrum.

“…Giant cell tumors account for approximately 5% of primary bone tumors [1]. Giant cell tumors are discovered most often during the third decade of life, and about 70-80% of patients present between the ages of 20 and 40 years [1 , 2].…”