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INTRODUCTION (1)

“DON’T TOUCH LESIONS” : TUMORS AND PSEUDO-TUMORS BONE NOT TO TOUCH  M. GONGI, W. HARZALLAH, M. OMRI, M. MAATOUK, MA. JELLALI, W. MNARI, A. ZRIG, R. SALEM, M. GOLLI THE 5th PAN ARAB CONGRESS OF RADIOLOGY MUSCULOSKELETAL : MK 13. INTRODUCTION (1) .

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INTRODUCTION (1)

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  1. “DON’T TOUCH LESIONS” : TUMORS AND PSEUDO-TUMORS BONE NOT TO TOUCH M. GONGI, W. HARZALLAH, M. OMRI, M. MAATOUK, MA. JELLALI, W. MNARI, A. ZRIG, R. SALEM, M. GOLLITHE 5th PAN ARAB CONGRESS OF RADIOLOGYMUSCULOSKELETAL : MK 13

  2. INTRODUCTION (1) • “Don’t touch lesions” (DTLs) also called “Leave me alone lesions” are imaging abnormalities, often discovered incidentally, that a radiologist should readily recognize as benign and therefore should not be biopsied or surgically removed.

  3. INTRODUCTION (2) • Many of these lesions are pathognomonic based on their imaging appearance and have a favorable prognosis (stabilization or regression after a period of evolution).

  4. INTRODUCTION (3) • DTLs include the following: fibrous cortical defect (sometimes referred to as non-ossifying fibroma), periosteal desmoids, fibrous dysplasia, enchondroma, bone infarct, subchondral cyst …

  5. Objectives • The aim of this study is to illustrate the imaging aspects of tumors and pseudo-tumors bone called “Don’t touch lesions” (DTLs), also termed “Leave me alone lesions”.

  6. Materials and methods • In this presentation, we report six cases of DTLs collected in the radiology department of FattoumaBourguiba Hospital of Monastir the last five years. • All patients were explored by radiographs and CT.

  7. Results • We founded : - one case of corticaldefect, - two cases ofnon-ossifying fibroma, - one caseof giant enostosis, - one case of exostosis, - one case of enchondroma.

  8. DISCUSSION 1 - Coricaldefect : - Cortical defects typically occur in children (6 – 11 years). Most are found incidentally when a radiograph is made for another purpose. - There is a male predilection by a ratio of 2.

  9. -the lesion is asymptomatic and self limiting, completely healing by adulthood. - Most cortical defects are in the distal ends of long bones (particularly common in the distal femur) and they are small, measuring less than 2 cm in diameter. - Importantly, there is no associated soft tissue mass.

  10. -Radiographs and CT : -osteolyticcortical lesion, - outlined by a thin rim of sclerosis, - no involvement of the underlying medullary cavity, - no periostealreaction, - no cortical disruption.

  11. Coricaldefect : A small cortical osteolytic lesion of the distal tibia, surrounded by a thin dense border. There is no periostealreaction and no cortical disruption.

  12. 2 - Non-ossifyingfibroma: - The non-ossifying fibroma (NOF) is not a real neoformation, but an abnormal development of bone. - In the affected area, normal ossification does not occur during growth, but the area is filled with tissue connective. This is why the fibroid non-ossifying occurs in children. 

  13. - This abnormality tends to heal spontaneously by ossification at the end of growth. - The FNO is most often diagnosed in children (10-15 years), the diameter is > 2 cm.

  14. - Typically, it is localised eccentrically in the distal metaphysis of the femur. - In most cases, the NOF is asymptomatic and is a radiological finding. - On X-Ray imaging, we find an osteolytic lesion with a lobulated appearance. It is separated from the marrow by a sclerotic rim.

  15. Additional diagnostic workup is not indicated in typical cases. • Evolution : - The lesion almost always undergoes spontaneous resolution within a few years. - It knows no malignant transformation.

  16. Non-ossifying-fibroma in a 12-years-old boy : Osteolytic and multilobed lesion in the distal metaphysis of the femur. The lesion is eccentric with sclerotic border and net limit.

  17. 3 - Enchondroma : • It is a benign tumor that appears in the cartilage tissue found inside a bone and develops in the medullary cavity, arising from ectopic rests of hyaline cartilage. • Usually solitary, although it can occur as multiple lesions in syndromes.

  18. In most cases, enchondromas are painless and do not result in any adverse physical symptoms. • When a tumor is unusually large or when multiple tumors are present, however, a person can suffer from a bone fracture or deformity.

  19. It occurs mostly in 2nd to 3rd decade. • Enchondramas are most likely to appear in the small bones of the hands or feet. But, they can potentially affect any area of the body.

  20. Clinical findings • Usually asymptomatic. • May be associated with pain. • Imaging findings -osteolytic and well-defined lesion of the metaphysis. The cortex may be thinned.  - Usually have some internal calcifications.

  21. Enchondroma in smallbones of the hand

  22. 4 - Exostosis : - The exostosis is a cartilaginous tumor, it develops especially in the metaphysis of long bones. - It is a well-differentiated bony overgrowth - The lesion is painless, but may have local complications: fractures (rarely

  23. - Radiographs : - a bony outgrowth with a cartilage cap. - Sometimes, we find scattered popcorn calcifications.

  24. Exostosis of the metaphysis of the lower femur 

  25. - The nature of bone islands, or enostosis, is unclear. - Most bone islands are small, measuring 1 mm to 2 cm in diameter. - The most common sites of involvement are the femur, hand, humerus, pelvis, and ribs. 5 - Giantenostosis:

  26. - Radiographs : Solitary bone island should be considered in patients with a small, sharply demarcated, asymptomatic, sclerotic lesion located within cancellous bone and having spiculated edges.

  27. - Benign solitary bone islands are usually believed to remain stable over time, with no tendency toward growth.

  28. Enostosis of right humerus :Radiography reveals a homogeneously dense, sclerotic lesion in the cancellous bone with distinctive radiating bony streaks creating a feathered or brush-like border.

  29. Conclusion (1) • In bone and joint disease, it is sometimes difficult to distinguish a benign from a malignant bone lesion. Confusion can cause a delay diagnosis or a high number of unnecessary biopsies.

  30. Conclusion (2) • To avoid this, it is necessary to know the typical semiology of certain tumors and tumor like lesions which do not require histological confirmation.

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