Weekly Case

Title : Case 684

Age / Sex : 42 / F

Chief complaint : Incidental findings on APCT

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 윤영철 Young Cheol Yoon, 삼성서울병원 Samsung medical center Seoul hospital



Tuberous sclerosis complex


Multifocal sclerotic bone lesions in spine and pelvic bone.

Multiple AMLs in both kidneys.

Differential Diagnosis:

Osteoblastic metastasis, osteopoikilosis, POEM syndrome, and mastocytosis


Sclerotic bone lesions(SBL) were the third most common imaging finding in these patients after brain tubers and renal angiomyolipomas in tuberous sclerosis complex (TSC). If more than four SBLs were detected in a CT scan of any main body region, the differential-diagnosis of TSC has to be considered. Radiologically, the SBLs in TSC closely resemble bone islands (enostoses), foci of dense, compact bone within the medullary cavity of bones.

The differential diagnosis of sclerotic bone lesions includes osteoblastic metastasis, osteopoikilosis, POEM syndrome, and mastocytosis.

Several primary malignancies characteristically produce osteoblastic metastases, including carcinomas of the prostate gland, breast, and pancreas; mucinous adenocarcinoma of the gastrointestinal tract; transitional cell carcinoma; carcinoid tumor; lymphoma; medulloblastoma; and neuroblastoma. Of these malignancies, carcinomas of the prostate gland and breast most frequently result in osteoblastic metastases.

Osteopoikilosis is a disorder of endochondral ossification involving the secondary spongiosa. Multiple enostoses are laid down at the ends of short tubular bones; in the tarsal, carpal, and pelvic bones; and in the meta-epiphyseal regions of long bone.

Mastocytosis is an unusual systemic disease, with there is an abnormal proliferation and accumulation of mast cells. Bone lesions in mastocytosis may be lytic, blastic or mixed. Diffuse skeletal involvement is most frequent. Typically the radiographic pattern is an axial skeleton sclerosis and of the distal part of the long bones.


Nilo A. Avila , Andrew J. Dwyer, Antoinette Rabel, Thomas Darling, Chien-Hui Hong, Joel Moss. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis. Radiology: Volume 254: Number 3—March 2010

Susanne Brakemeier, Lars Vogt, Lisa C. Adams et al. Sclerotic bone lesions as a potential imaging biomarker for the diagnosis of tuberous sclerosis Complex. Scientific reports 2018) 8:953

Lauren L. Ihde, Deborah M. Forrester,  Christopher J. Gottsegen et al. Sclerosing Bone Dysplasias: Review and Differentiation from Other Causes of Osteosclerosis. RadioGraphics 2011; 31:1865–1882

M.F. Ramos Solis, C. Gómez de la Heras, J. A. Luque Ordoñez et al. CT findings in systemic mastocytosis. ECR 2013/ C-0104

Correct Answer
Total applicants 30 Correct answers 23
Name Institution
윤유성 순천향대 부천병원, 전문의
김대영 전문의
김기욱 전문의
이규정 국군대전병원, 전문의
이혜란 전문의
김동언 서울아산병원, 전문의
강건우 전문의
여현정 전문의
임윤진 단국대학교병원, 전공의
김동수 전공의
이동규 경인지방병무청, 전문의
이승보 서울아산병원, 전문의
문경일 전남대학교병원, 전공의
이현규 전문의
백승진 분당차병원, 전공의
김동찬 단국대학교 병원, 전공의
조영민 전문의
최형인 군의관, 전문의
김성진 365병원, 전문의
권기언 서울아산병원, 전문의
윤나연 전공의
심상우 서울아산병원, 전문의
김형민 연세의대 강남세브란스병원, 전문의
Semi-Correct Answer
Total applicants 30 Semi-Correct answers 4
이진영 전문의
전인환 전문의
조신영 전문의
강지희 전문의