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Presented by Edward McCarthy, M.D. and prepared by Walter Klein, M.D.
Case 1: A 35-year-old woman had mild low back pain.
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1. Question
Week 173: Case 1
A 35-year-old woman had mild low back pain. A CT scan demonstrated a well-defined radiodense lesion in the body of a lumbar vertebraimages/klein/022304case1fig1.jpg
images/klein/022304case1fig2.jpg
images/klein/022304case1fig3.jpgCorrect
Answer: Bone island (enostosis)
Histology: Radiologically the lesion is uniformly radiodense and extremely well-marginated. Bone islands are known to occur in the vertebral body. This is an example of a giant bone island. Histologically, the specimen shows dense compact bone identical to cortical bone.
Discussion: The lesion is not an osteoid osteoma because no nidus tissue is present. There is no evidence of increased cellularity with seams of woven bone and osteoclast-like giant cells as is seen in osteoid osteoma. The lesion is not metastatic carcinoma. Although metastatic carcinomas can produce extreme radiodensities in bone, epithelial cells will be evident between the spicules of the dense compact bone. The lesion is not an osteosarcoma because no malignant cells are present. Although osteosarcomas can be extremely radiodense, malignant cells with nuclear pleomorphism are evident between the dense trabeculae.
Incorrect
Answer: Bone island (enostosis)
Histology: Radiologically the lesion is uniformly radiodense and extremely well-marginated. Bone islands are known to occur in the vertebral body. This is an example of a giant bone island. Histologically, the specimen shows dense compact bone identical to cortical bone.
Discussion: The lesion is not an osteoid osteoma because no nidus tissue is present. There is no evidence of increased cellularity with seams of woven bone and osteoclast-like giant cells as is seen in osteoid osteoma. The lesion is not metastatic carcinoma. Although metastatic carcinomas can produce extreme radiodensities in bone, epithelial cells will be evident between the spicules of the dense compact bone. The lesion is not an osteosarcoma because no malignant cells are present. Although osteosarcomas can be extremely radiodense, malignant cells with nuclear pleomorphism are evident between the dense trabeculae.
