Clues for Early Malignant Transformation of Premalignant Bone, Soft Tissue Conditions

Background: Bone and soft tissue conditions such as osteochondroma, enchondroma, neurofibroma, and atypical lipomatous tumor carry risk of malignant transformation. In addition, non-neoplastic conditions like chronic osteomyelitis, burn scars, irradiated tissue, bone infarcts, and Paget disease may also undergo sarcomatous change. While most primary malignancies develop sporadically, these precursor conditions provide radiologists with opportunity for early detection. Transformation is often driven by genetic alterations in tumor suppressor genes or proto-oncogenes, leading to uncontrolled cellular proliferation. Since many of these conditions are followed with serial imaging, radiologists are frequently the first to identify suspicious changes. Signs of transformation include new or worsening pain, enlarging lesions, cortical destruction, periosteal reaction, and developing soft tissue components. Recognizing of these features is crucial for timely intervention and improved patient more...