However, we can further define the location of the lesion by noting its relationship to the physis. The favored locations are listed in the figure below. Very few lesions tend to arise in the epiphysis. Chondroblastoma is one of the very few tumors that arise here before the physis closes. Osteomyelitis can also arise in the epiphysis.
Several entities can spread across the physis.
Osteomyelitis is a classic example of this. Although the dogma for years has been that malignancies such as osteosarcoma and Ewing's tumor rarely cross the physis, more recent experience with MRI has shown this to be untrue. After the plate closes, the physis ceases to be an anatomic barrier to disease, and a variety of lesions can be seen involving the epiphyseal area, such as giant cell tumor, enchondroma or aneurysmal bone cyst. This is the fastest growing area of a bone, and also the most likely area for a primary neoplasm to arise. This is especially true in the distal femur and proximal tibia, which are the fastest growing metaphyseal areas in the skeleton.