Intraosseous lipomas originating from simple bone cysts
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SCIENTIFIC ARTICLE
Intraosseous lipomas originating from simple bone cysts Bernhard J. Tins 1 & Yaron J. Berkowitz 2 & Praveen Konala 3 & Mark Davies 4 & Victor N. Cassar-Pullicino 1 & Radhesh Lalam 1 & Paul Cool 1 Received: 27 February 2020 / Revised: 22 September 2020 / Accepted: 23 September 2020 # ISS 2020
Abstract Purpose Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishable from intraosseous lipomas. Materials and methods The pathology and PACS databases at 2 specialist orthopedic hospitals were retrospectively interrogated for all cases of intraosseous lipomas or SBCs with cross-sectional imaging follow-up for SBCs and precursor or follow-up imaging for intraosseous lipomas, in the time period from August 2007 to December 2016. For intraosseous lipoma cases, these were only included if change in imaging appearances was observed. Results There was no case of change in the appearance in intraosseous lipomas. Six cases of SBC with cross-sectional imaging follow-up were identified in one participating hospital and none in the other. The 6 cases were comprised of 4 male and 2 female patients. Two were located in the proximal humerus, one in the proximal tibia, and 3 in the os calcis. All cases demonstrated filling in of the cystic lesion with fat from the periphery, in 2 cases complete filling in, and in 4 cases partial fatty conversion. Conclusion SBCs can heal with fatty conversion of the cystic cavity, with partly cystic remnants. It is proposed that at least part of the so-called intraosseous lipomas are healed simple bone cysts. Keywords Simple bone cyst . Intraosseous lipoma . Progression . Transformation . Precursor lesion
Introduction Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. These may be asymptomatic and incidental but sometimes are associated with pain [1, 2]. The presence of fat is seen as reassuring and indicating a benign lesion [1]. The nature or origin of these lesions is neither clearly understood nor accepted. Partly involuted lipomas, liposclerosing myxofibromatous tumor, bone infarcts, and simple bone cysts have all been discussed as possible * Bernhard J. Tins [email protected] 1
Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AQ, UK
2
John Radcliffe Hospital Oxford, Oxford, UK
3
Central Manchester University Hospitals, Manchester, UK
4
Royal Orthopaedic Hospital, Birmingham, UK
precursors [1–3]. In the calcaneus in particular, a connection between simple bone cysts and fatty lesions has been described [3, 4]. However, this has never been proven for simple bone cysts in general. In fact, the exact opposite has also been proposed that fatty lesions are precursors of bo
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