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Orthopaedics · Bone tumours: bone island
Sample itemAn incidental 7 mm round, dense, homogeneous sclerotic focus is seen in the femoral neck of a pain-free 40-year-old. Its margins radiate like thorns into the surrounding trabeculae, and a technetium bone scan shows no uptake. What is the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Bone island (enostosis)
A bone island is a benign focus of compact bone within cancellous bone, with spiculated margins blending into the trabeculae and little or no isotope uptake. It needs no treatment, though growth on follow-up or uptake should prompt a re-evaluation.
Option by option
A. Bone island (enostosis) (correct)
Correct. A small, painless, spiculated dense focus that is cold on bone scan is an enostosis.
B. Osteoblastic metastasis
An osteoblastic metastasis shows uptake and is usually multiple.
C. Osteoid osteoma
Osteoid osteoma causes night pain, has a lucent nidus and shows intense uptake.
D. Low-grade osteosarcoma
Low-grade osteosarcoma is larger, symptomatic and active on scan.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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