Differential diagnosis of focal and diffuse neoplastic diseases of bone marrow in MRI

Metastatic carcinoma in a 14th–19th century skeleton from Constância (Portugal)

“…The aggressiveness of the tumour may create a distinct pattern in the bone ranging from purely osteolytic or osteoblastic forms, to those with a mixed response, which are more typical (Steinbock, 1976;Aufderheide & Rodríguez-Martín, 1998;Ortner, 2003;. When bone reaction is extensive, several layers of new bone are produced creating a radiant alignment of tumour tissue called 'sunburst' (Steinbock, 1976;Aufderheide & Rodríguez-Martín, 1998;Ortner, 2003;Nö bauer & Uffmann, 2005;. In all cases, lesions may increase in size, but it is almost always a single lesion and rarely metastasises to other bones (Steinbock, 1976;Ortner, 2003).…”

“…In all cases, lesions may increase in size, but it is almost always a single lesion and rarely metastasises to other bones (Steinbock, 1976;Ortner, 2003). With a high incidence in younger adults, especially males, this primary tumour is more frequent in the long bones, particularly in the distal portion of the femur and in the upper ends of the humerus and tibia (Steinbock, 1976;Nö bauer & Uffmann, 2005). The age and the acute spreading of bone lesions, predominantly at the axial skeleton and skull, observed in the female skeleton, are incompatible with a case of osteosarcoma.…”

“…Neither gross inspection nor radiological analysis of the skeleton showed a pattern of lesions consistent with this description. The skeletal distribution of Ewing's sarcoma shows a predilection for the metaphyseal portion of long bones, especially in the lower extremities (25% in the femur) (Nö bauer & Uffmann, 2005). Nevertheless, lesions can also be found in the hip bones, vertebrae and ribs (Steinbock, 1976;Ortner, 2003).…”

“…Bone metastases are particularly frequent in individuals above 50, and can affect several bone elements, amongst them the skull, the vertebrae, the pelvis, the ribs, the sternum, and the metaphyseal portions of the humerus and the femur (Steinbock, 1976;Waldron, 1996;Mundy, 1997;Aufderheide & Rodríguez-Martín, 1998;Ortner, 2003;Nö bauer & Uffmann, 2005;Resnick & Kransdorf, 2005). Metastatic lesions distal to the elbow and knee are rare (Steinbock, 1976;Waldron, 1996;Thillaud, 1996;Campanacci, 1999;Ortner, 2003;Resnick & Kransdorf, 2005).…”

“…Metastatic lesions distal to the elbow and knee are rare (Steinbock, 1976;Waldron, 1996;Thillaud, 1996;Campanacci, 1999;Ortner, 2003;Resnick & Kransdorf, 2005). Tumour cells commonly metastasise to the most vascularised parts of the skeleton due to haematological spread (Thillaud, 1996;Mundy, 1997;Smith, 2002;Nö bauer & Uffmann, 2005). The metastases may reach the skeleton by direct invasion from the primary tumours or from a secondary site, such as a lymph node.…”