More responses advocating biopsy. Wide range of opinions, with responses of benign nonaggressive, benign aggressive, and worried about malignancy. Again, this was completely incidental with no attributable symptoms. Would not have known this lesion existed in its current state, if the patient did not break her elbow.
I never planned to ignore this lesion. Wavered between close follow-up versus immediate biopsy. Some made the point that this lesion has proven to grow and no reason to believe it won’t continue to grow on follow-up. If continues to grow on follow-up, I would have wished I biopsied sooner.
I will speak with our orthopedic tumor surgeon and discuss biopsy. I will provide follow-up when available.
Thanks
Drew
Hello-
Looking for opinions on this case. Outside referral. 14 yo female with medial epicondyle avulsion fracture following elbow trauma. Incidental cortical lytic lesion with subsequent studies listed below.
June xray followed by CT performed for the fracture
F/U post-op xray 1 month later
Another f/u xray about 2 months after initial xray
MRI (T1 post-gad fat sat poor b/c of metal)
T1
T2FS
Post
Growing cortically based lytic lesion with peripheral enhancement. Medullary extension and cortical thinning on MRI. To me it’s nonspecific with broad ddx – osteoid osteoma/osteoblastoma given cortical location (but no significant reactive change), LCH?, intracortical fibrous dysplasia or OFD? (I’ve never seen in humerus), malignant/met? (otherwise healthy teenager), infection (odd)?, NOF wouldn’t grow like this in 2 months. My tentative plan is to recommend CT guided biopsy due to growth over 2 months. Any other thoughts or advice?
