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"How do we know whether a lytic lesion is benign or malignant?"
A family member got her x-ray done, in which it was specified "features are suggestive of abnormal sclerotic and lytic lesion." We are too worried if it could be cancer.
I'm sorry to hear that someone in your family is having health concerns. It is true that a lytic lesion found on x-ray can indicate a malignancy. There are several cancers that classically do have a lytic appearance on x-ray, including multiple myeloma, Ewing's sarcoma, or giant cell tumor. However, there is an even longer list of the many conditions that also appear to be lytic on x-rays and are not cancer (including bone cysts, hemangioma, vertebral abnormalities). In order to determine what is causing this finding, your family member's physician will need to review the x-rays with a radiologist and put this in the context of your family members age, health history, symptoms, findings on clinical exam, and additional findings on the x-ray. Which bone or bones have this abnormal appearance is actually very relevant, as lytic lesions in vertebrae have a very different list of diagnostic possibilities than a lytic lesion in a hipbone, for example. If your family member does not have a primary physician, this would be the time to get one. However, it sounds like someone ordered this x-ray, so hopefully she can follow up with that physician to determine if any further testing or referrals are needed.
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