FIGURE 2B. Low grade DCIS vs. atypical ductal hyperplasia; . They are typically located on or around the genitals and anus. The characteristic lesion of BB leprosy is an annular plaque with a well-demarcated 'punched-out' inner margin and a sloping outer margin, giving a 'swiss cheese' appearance (Figures 4A, 4B). 1996 Oct;39(4):860-2. doi: 10.1097/00006123-199610000-00045. CT. Whole-body low dose (WBLD) CT is more accurate than a skeletal survey with a sensitivity of ~70% and specificity of ~90% with a dose 1-2x that of a skeletal survey 12 . Differential by Location: Location in Bone. The differential diagnosis (see Chapter 2.3) includes . (if present they are normal ductal cells and are not complex), almost always a microscopic lesion: Mucinous carcinoma: Mucin in contact with stroma, neoplastic cells floating in mucin . A systematic examination of the lesion based on the history will help with diagnosis and ensure that serious conditions such as melanoma can be ruled out. Differential Diagnosis. Radiographs showed multiple punched-out radiolucent lesions and a CT scan revealed a malignancy in the maxillary sinus. Bilateral yellow-white punched out chorioretinal lesions (size 50 to 200 μm) with variable pigmented fibrotic scars in posterior pole and periphery often clustered nasal to disc . "punched-out" lesions, and a detailed change of the trabecular bone in the area [28,29]. Most common presentation: multiple lytic 'punched out' lesions. For more information, click on the link if you see this icon Diabetic neuropathies are the most common chronic complications of diabetes, with an estimated lifetime prevalence exceeding 50% in people with diabetes. Presumed Ocular Histoplasmosis Syndrome: peripapillary pigment ring, punched out lesions in retinal periphery. A child with clustered vesiculopustules and punched-out erosions. 3.1 Bone tumors and their mimics. . Lesions may appear as single or disseminated, painful red bumps or white vesicles. (if present they are normal ductal cells and are not complex), almost always a microscopic lesion: Mucinous carcinoma: Mucin in contact with stroma, neoplastic cells floating in mucin . Vasculitis of the small dermal vessels manifests as palpable purpura, vesicobullous lesions, and superficial ulcers with regular borders. 90% of the time there are multiple lesions. If the diagnosis is uncertain, particularly if symptoms are not typical, then the clinician may want to discuss the signs and symptoms with a specialist to decide whether a referral is . Those that can be scrapped off with tongue blade . Bone lesions are the most common radiographic manifestation of LCH (Figure 1), occurring in 80% of patients. The diagnosis of POHS is made based upon the identification of classic fundus findings. Differential Diagnoses. The differential diagnosis includes primary bone tumors, sarcoma (especially in area of previous radiation), Paget's . Slow-growing masses (duration of months to years) are usually benign. In addition, the lesion may cross the midline of the mandible. Langerhans cell histiocytosis (LCH) is a neoplastic proliferation of Langerhans cells. Description of Skin Lesions. 2 Impeding patholytic fractures may be best . The disorders that most frequently come to mind are metastatic carcinoma or multiple myeloma. View/Print Figure. 90% of the time there are multiple lesions. Birdshot chorioretinopathy: should have typical oval retinal lesions and vitritis; Occasionally, the infection occurs later in life and in an adult may manifest as a pharyngotonsillitis. Differential diagnosis: The distribution of lesions is often diagnostic for herpes zoster. It is essential to take a thorough medical history and to examine the patient carefully, looking for local and systemic clues to the diagnosis. Bone marrow aspiration and biospy required for diagnosis and staging • Lymphoma • Ewings. Often with vitritis. The differential diagnosis of calvarial lesions is important to decide whether biopsy, surgical intervention or conservative treatment is required for further management [1, 2 . . Particularly for lytic lesions, there is a concern whether an underlying primary tumor or a metastatic deposit is present. . Melanoma. . . Patients presenting with a lesion in the oral cavity should undergo a detailed medial and dental history and examination. Diagnosis is clinical. The differential diagnosis for these findings includes multiple myeloma, plasmacytoma, osteomyelitis, tuberculosis, leukemia, and lymphoma. Patients presenting with a lesion in the oral cavity should undergo a detailed medial and dental history and examination. Commonly in back, ribs, extremities, often worse with movement hs1085@ms9.hinet.net A chronic leg ulcer is defined as full thickness skin loss for > 3 months. Herpetiform ulceration - tends to be found in slightly older patients, with a female predominance. 2 Shi-Pai Road, Taipei 11217, Taiwan. Multiple lesions in Young Patient: EG Fibrous dysplasia Leukemia . Among various forms of neuropathy, diabetic peripheral neuropathy (DPN) is the most common and has the strongest evidence base regarding therapeutic approaches. View/Print Figure. Radiographic evaluation of vertebral body lesions has three goals: (1) to identify lesions, (2) characterize lesions and generate a differential diagnosis, and (3) assess for associated complications (in particular cord compression) and treatment response. Diagnosis • Other viral illnesses to be ruled out or separated • Course, time of year, location of lesions, contact with known infected individual Differential Diagnosis • Hand-foot-and-mouth disease • Varicella • Acute herpetic gingivostomatitis 47. After several days, " punched-out " lesions may appear that later ulcerate. Lesions of the distal phalanx often pose a radiological dilemma as the differential diagnosis is potentially broad. Lesions may occur on any area of the oral mucosa. • Multiple myeloma presents as the classic "punched out" lytic lesions on radiographs. The patient had marked pitting edema in the right lower leg. Comparing with HSV infection Herpangina HSV infections 1. occurs in epidemic 2. A solitary presentation is referred to as plasmacytoma. and increased kyphosis. This often occurs within femur or tibia and typically demonstrates patchy sclerosis with demineralisation . Disease . Multiple myeloma may also occur in the mandible, with or without the typical "punched-out" lesions. pemphigus vulgaris . Lesions to consider in the differential diagnosis include dermatofibroma, superficial spreading and nodular melanoma, squamous cell carcinoma, syphilitic chancre, and nevomelanocytic nevi. There are crops of small, round, punched-out lesions that have raised edges on her forehead and upper chest. Punched-out lesions in the skull a rising f rom cholangio carcinoma ha s not been previously reported. There are intensely painful, punched-out ulcers, which are often bilateral, with a yellow-white base and red borders. And the prognosis is poor. . Often, patients with vasculitis will have systemic symptoms. Diffuse skull osteopenia is less frequently encountered. Download presentation. Vasculitis of the muscular arteries presents as painful red nodules, punched-out irregularly shaped ulcers, or gangrene 51 (Figure 4). Fig. Although it is most frequently monoostotic, it can be polyostotic in 25-34% of patients. The differential diagnosis of lesions affecting the inner and/or outer table, or the diploic space . Description: Cutaneous melanoma is the most malignant tumor of skin structures, and its incidence is on the rise. Multiple myeloma and metastatic carcinoma should be included in the differential diagnosis for any patient older than 40 years with a new bone tumor. Both eyes showed 'punched-out' chorioretinal lesions dotting the peripapillary retina and macula. There is also bone destruction and pathologic fractures of both third toes and the distal right 5th toe (black arrows). Differential diagnosis; Oral lesions; Treatment; Management; Download chapter PDF Premalignant Lesions. Histologically, a series of granulomatous oral disorders should be considered. Differential Diagnosis. Fig. Kormano M. Differential Diagnosis in . 8. . The histopathological and immunohistochemical reports led to the final diagnosis of multiple myeloma, which was supported by . In some cases, there may be no . The most common location is in the axial skeleton (spine, skull, pelvis and ribs) and in the diaphysis of long bones (femur and humerus). Lesions in BL are multiple and there is an increased tendency for symmetry. The patient had marked pitting edema in the right lower leg. infection, fracture, and bleeding are seen in extensive punched-out bone involvement. Slides: 58. The images clearly demonstrate the radiographic finding of multiple "punched out" lesions. One step in the formation of a differential diagnosis is to describe the lesion's presentation, does it appear radiolucent, radiopaque, or does it have characteristics of both radiolucency and radiopacity? The ulcers may be aphthous or, alternatively, deep and round with a punched-out appearance. Diagnosis of oral ulcerative lesions might be quite challenging. Lytic skull lesions have a relatively wide differential that can be narrowed, by considering if there are more than one lesion and whether the mandible is involved.. Mucous Membrane Disorder - Differential Diagnosis Algorithm Erosions/Ulcers/Blisters - Primary Dermatologic Diseases • Aphthous Stomatitis (recurrent, punched out ulcers, often preceded by trauma/emotional stress) • Herpetic gingivostomatitis • Pemphigus vulgaris • Bullous pemphigoid • Erythema multiforme • Stevens-Johnson Syndrome • Toxic epidermal necrolysis - Systemic Disease . Low grade DCIS vs. atypical ductal hyperplasia; . The lesion is centered in the anterior skull base at the orbital plate of the right frontal bone and lesser sphenoid wing and shows a striking mass effect upon the orbital contents (C) and in the floor of the anterior cranial fossa (D) . Oral soft tissue lesions: A guide to differential diagnosis Part II: Surface alterations Nikolaos G. Nikitakis DDS, PhD, Assistant Professor and Program . Differential diagnosis can range from classic infectious disease of childhood (e.g. 49.37). This American Diabetes Association clinical compendium summarizes the latest . Differential diagnosis of Oral White Lesions DEPARTMENT OF ORAL MEDICINE & RADIOLOGY Dentistry Explorer. Plain radiography depicts these tumors as well-circumscribed, punched-out lesions with a sclerotic rim, especially in those arising in the finger. . A "punched out" gingival margin is often characteristic. Thus, radiologists should include Susac's syndrome in the differential diagnosis when punched-out high-signal-intensity lesions are present within the central fibers of the corpus callosum on T2-weighted images. . Occasionally, inflammatory markers may be raised. Pathology Causes. Chronic wounds can be caused by a multitude of different diseases. A patient with atrophie blanche-like lesions will lack a history or physical exam finding of punched-out ulcers. The differential diagnosis includes brown tumors of hyperparathyroidism, which can appear radiologically and histologically identical to giant cell reparative cysts. . Affiliation 1 Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, No. FIGURE 2B. Bone marrow aspiration and biospy required for diagnosis and staging • Lymphoma • Ewings. ): ¯ Lesions abutting the lateral ventricles ¯ Lesions with diameter greater than 0.6 cm ¯ Lesions present in the posterior fossa . Differential Diagnosis. The radiographic appearance of lytic lesions are characteristically 'punched-out' areas - circular or ovoid radiolucent areas without surrounding sclerosis. The lytic, punched-out lesions, as well as expansile rib lesions, are typical of myeloma. Myopic degeneration: lacquer cracks, choroidal neovascular membrane. Symptomatic hypertrophic pacchionian granulation mimicking bone tumor: case report Neurosurgery. The radiographic appearance of lytic lesions are characteristically 'punched-out' areas - circular or ovoid radiolucent areas without surrounding sclerosis. These may coalesce into larger osteolytic segments [2, 9]. The differential diagnosis further includes specific ocular inflammatory conditions, including Fuchs heterochromic iridocyclitis characterized by unilateral anterior uveitis with diagnostic corneal and iris changes; the "white dot syndromes" which are characterized by round white lesions involving choroid and/or retina and pars planitis . Recurrence is common. . or suddenly worse. . 24: Uncountable lytic "punched out" lesions on the lateral skull radiograph, typical. Multiple "punched out", well circumscribed, round or ovoid translucencies, absent central trabecullae. . or suddenly worse. An actinic keratosis is a thick, scaly, or crusty skin patch that's typically less than 2 centimeters (cm), or about the size of a pencil eraser. The history should include the onset and duration of the lesion, change in size, history of trauma to the site, the presence of associated skin lesions, associated pain or bleeding, systemic signs and symptoms (e.g., fatigue, weight loss), use of over-the-counter and . Approximately 10% of patients with multiple myeloma show a form of amyloidosis . The differential diagnosis includes primary bone tumors, sarcoma (especially in area of previous radiation), Paget's . Punch biopsy - a small deep hole is punched out of the lesion, with a small cylindrical sample of tissue removed Advantages = quicker procedure, obtains a full-thickness sample, good cosmetic outcome; disadvantages . Swelling may be one of the common symptoms associated with oral lesions, which indicates nothing more than expansile process that can result from a variety causes. Differential Diagnosis: . White lesions of the oral mucosa may be conveniently divided into two groups: 1. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. Differential by Location: Location in Bone. AP radiograph demonstrates multiple punched-out lytic lesions throughout the phalanges sparing the . The bony cortex may be thinned, expanded, or destroyed. Multiple myeloma must be included in the differential diagnosis of any lytic bone lesion, whether well-defined or ill-defined in age > 40. Multiple Sclerosis: Imaging •Abnormal MRI scans are found in: ¯ 90% of patients with definite diagnosis of MS ¯ 70% of patients with diagnosis of probable MS ¯ 30%-50% of patients with possible MS •3 criteria for the MRI diagnosis of MS (Fazekas et al. lytic skeletal metastases; multiple myeloma; epidermoid - scalloped border with a sclerotic rim; eosinophilic granuloma- Langerhans cell histiocytosis; hemangioma; Paget disease (osteolytic phase) The differential diagnosis of lesions located in the genital and perineal area includes acanthosis nigricans, benign familial pemphigus, and impetigo. Talia Vertinsky, Mahesh V. Jayaraman, Huy M. Do. . In patients with multiple myeloma, imaging typically reveals diffuse lytic, 'punched-out' lesions within single or multiple vertebrae (Fig. There is associated labial swelling, intense pain and dysuria and sometimes, large tender inguinal lymph nodes. This case suggests the need to include hypertrophic pacchionian granulation in the differential diagnosis of punched-out lesions. Usually no increased uptake on bone scan. 201 Sec. Sharply punched out cribriform spaces, microacini or bulbous papillae . 3 Differential Diagnosis. The differential diagnosis of these lesions requires a multidisciplinary approach to diagnosis. It appears on parts of the body that receive a . Other reports describe sarcoidosis ulcerative lesions as punched-out ulcers ,48, 49 or . Differential diagnosis of vertebral body . The main differentials to consider for SCC are other forms of skin cancer, such as BCC or melanoma. Aphthosis The diagnosis is essentially clinical and one of exclusion, following appropriate cultures, serologic testing, and biopsies to rule out other conditions. Differential Diagnosis of Multiple Myeloma. Necrotizing ulcerative gingivitis (NUG) is an acute infectious disease of the gingivae. Multiple myeloma must be included in the differential diagnosis of any lytic bone lesion, either well-defined or ill-defined in age > 40. Since the end manifestations of many diseases can produce atrophie blanche-like lesions, excluding these other causes is necessary to diagnosis true atrophie blanche, i.e., livedoid vasculopathy. Differential Diagnosis. Well defined "punched out" lesion: . At times, it can be difficult to determine the correct diagnosis of a leg ulcer. The differential diagnosis included round cell tumors of the bone, especially multiple myeloma and lymphoma. Diagnosis: Multiple myeloma with expansile rib lesions. Complications include viremia, secondary bacterial . The vast majority of lesions are purely lytic, sharply defined/punched out, with endosteal scalloping when abutting the cortex. bony lesions, contemplate round cell tumors of bone, particularly multiple myeloma and lymphoma. Retinitis pigmentosa: usually with pigmentary changes as well; Multifocal choroiditis and panuveitis: should have typical punched-out lesions. Diagnostic Considerations. Radiologically manifests as "punched-out" lytic lesions; Often seen in the skull. Evaluation. Will cause vertebra plana in the spine, usually thoracic Haemangioma. Treatment options include doxycycline . Intraosseous glomus tumors should be included in the differential diagnosis of bone lesions. The remainder of the. There are additional lytic lesions in multiple ribs, the right clavicle, and the thoracic spine. The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential assessment of the skin condition or wound, before implementation of management strategies, is essential for understanding its cause and development. gingiva, typically causing "punched-out" blunting of the papillae, associated with pain, fetid odor and variable constitutional symptoms. The panoramic radiograph is considered a screening imaging exam in dental practice. Disease . These are the presence of peripapillary atrophy or pigmentation, the presence of characteristic "punched-out" chorioretinal atrophic lesions, and the absence of overlying vitreous involvement. Sharply punched out cribriform spaces, microacini or bulbous papillae . Longitudinal ulcers are rare . Multiple lesions in Young Patient: EG Fibrous dysplasia Leukemia . . Due to lytic lesions and osteopenia "Punched-out" lytic lesion on x-ray; Frequently involve spine, as well as ribs, skull, extremities; Bone pain (even in absence of fracture) in ~60%. Diagnosis: Ossifying fibroma (juvenile ossifying fibroma).

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