Pubic osteolysis. A benign lesion of the pelvis closely mimicking a malignant neoplasm

Pubic osteolysis is now recognized as a distinct diagnostic entity. It is characterized by roentgenographic findings of rapidly progressing destructive changes in the pubic rami, pubis, or pubic symphysis. A soft-tissue mass with calcification may be present. Overlapping roentgenographic and even histopathologic features with chondrosarcoma may lead to erroneous diagnosis and over-treatment. Each of the six new cases of pubic osteolysis in this report involved middle-aged to elderly females. Three out of six cases had no antecedent trauma. The pathologic findings were extensive reparative changes that included metaplastic cartilage, bone formation, and granulation tissue with myxoid and angiomatoid patterns. Four of the six cases were initially diagnosed after biopsy as low-grade malignancies. One of these was treated with a partial pelvectomy. The follow-up period in the cases was from one to 41 months. In all cases, the initial complaints of pain about the pelvis gradually subsided with conservative therapy. Differentiating pubic osteolysis, osteitis pubis, and pubic osteomyelitis should not be difficult; pertinent differential features are discussed.