J Korean Radiol Soc.  1990 Aug;26(4):776-782. 10.3348/jkrs.1990.26.4.776.

A lamellar nodular periosteal reaction occuring in osteomyelitis: useful finding for differentiation from malignant bone tumor

• Park SY
• Lee JM
• Kim JH
• Cha IH
• Chung KB
• Suh WH

• KMID: 2359493
• DOI: http://doi.org/10.3348/jkrs.1990.26.4.776

Abstract

The first role of radiologist concerning with tumors or tumor like lesions of bone is to differentiate natures of their benignancy or malignancy. It is true that there were much of difficulties ot distinguish osteomyelitis from malignant leisons radiographically. Although there is no single periosteal reaction that is unique for any disease process, we had confirmed a certain periosteal reaction, that is, a lamellar nodular pattern, might aid to diffferentiate osteomyelitis from malignant bone tumor. The thirty patients of acute osteomyelitis in whom the follow-up studies were possible, eithteen patients with osteosarcoma and five patients wit Ewing's sarcoma wereretrospectively evaluated: periosteal reactions in acute osteomyelitis(30 cases) undergo changes in their appearnace that can be categorized: thin solid (18 cases), Codman's triangle(2 cases), no periosteal reaction(10cases) in early phase; lamellated (7 cases) and lamellar nodular patterns(7 cases) in the course of the disease with pronounced reactive osteoblastic change in the medullary cavity: in chronic forms(14 cases), corticalthickening (11 cases), cortical thickening with involucrum(2 cases) and coritcal thickening with sequestrum(1case) were noted. In 18 cases of osteosarcoma were included: thin solid (1 case), lamellated ( 2 cases),sunburst(5 cases), and Codman's triangle(2 cases) ; combined forms(5 cases) i.e., thin solid and lamellated (1case), lamellated and sunburst(2 cases), bunburst, and Codman's triangle(1 case), lamellated, sunburst andCodman's triangle(1 case) ; and no periosteal reaction(3 cases). 5 cases of Ewing's sarcoma showed sunburst(1case), interrupted periosteal reaction (1 case), and no periosteal reaction (3 cases). It is advised when alamellar nodular periosteal reaction appeared with reactive osteoblastic reaction in the host bone, even though their looking might be suggested to aggressiveness of the lesions, it should be considered osteomyelitis rather than malignant bone tumors such as osteosarcoma of Ewing's sarcoma.

MeSH Terms

Follow-Up Studies
Humans
Osteoblasts
Osteomyelitis*
Osteosarcoma
Sarcoma, Ewing