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Musculoskeletal #3 – Long case

Axial CT abdomen bone window

Axial CT abdomen soft tissue window

Where is the lesion?

Left iliac bone

What are the radiological characteristics/findings?

Large lytic lesion with wide zone of transition, cortical destruction, and large soft tissue component.
No specific matrix.

What is the differential diagnosis of an aggressive iliac bone lesion?

* Metastasis
* Plasmacytoma: solitary plasma cell tumor expansile lytic lesion with bone destruction and soft tissue component. Usually shows low signal intensity on T2 with variable post contrast enhancement. 
* Chondrosarcoma: malignant cartilage tumor destructive lytic lesion with intralesional rings and arcs calcification (chondroid matrix). High signal intensity on T2. 

What is the most likely diagnosis?

Plasmacytoma

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