Permeative Bone Lesion: Differential Diagnosis #9
While not highly common, a permeative bone lesion is an important finding to note on any study which includes osseous structures. When any bone lesion is encountered, especially a lucent or lytic one, it is important to note the margin, which is also called the zone of transition. If the zone can be easily traced with a pencil, it is called narrow. If it is difficult to make out where abnormal bone ends and normal bone begins, the zone is called wide. The term permeative implies a lesion with a wide zone of transition and multiple small lytic areas within it. This appearance is considered aggressive until proven otherwise. Common permeative lesions can be recalled by the word POLLEN:
As the table above shows, all these entities need medical and/or surgical management.
References:
| Disease | Notes | |
| P | Permative | Had to make the mnemonic work... |
| O | Osteomyelitis | Most common: Staph |
| L | Langerhans Cell Histiocytosis | Spectrum: EG (isolated, benign); Hand-Schuller-Christian (systemic, manageable); Letterer-Siwe (poor px) |
| L | Leukemia/Lymphoma | |
| E | Ewing's Sarcoma | A small round blue cell / PNET tumor; called Askin when in chest wall |
| N | Neuroblastoma mets | Primary typically in adrenal, but can be anywhere |
As the table above shows, all these entities need medical and/or surgical management.
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| Ewing sarcome in distal femur Source: Radiopaedia |
References:
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