• Jun-Ku Lee, Young Woo Kwon, Jae Chan Shim, Yun Kyung Kang, Weon Min Cho, Jong Woong Park, and Soo-Hong Han.
• Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang.
• Medicine (Baltimore). 2021 Jul 16; 100 (28): e26445e26445.

RationaleSeveral diseases feature tumors, or tumor-mimicking lesions, that further invade the bone and surrounding joints of the wrist region. Here, we describe 3 rare cases of multiple destructed carpal bones and adjacent joints in different disease entities confirmed via pathologic diagnosis.Patient ConcernsAll 3 cases were examined between January 2016 and December 2019. Three patients presented with similar clinical manifestations and radiographic features, with multiple osteolytic lesions in the carpal bones and metacarpal bone base.DiagnosesThe 3 cases were diagnosed as diffuse type tenosynovial giant cell tumor, calcifying aponeurotic fibroma, and rheumatoid arthritis.InterventionsSeparate, experienced radiologist and pathologist took part in the interpretation and compartmentalization of radiographs and pathological findings, respectively. Even magnetic resonance imaging could not achieve a diagnosis; surgical excision was therefore required, with subsequent pathological assessment for treatment and final diagnosis.Outcomesfunctional outcomes also differed among patients, poorest in rheumatoid arthritis patient.LessonsWe report 3 rare disease entities, presenting with multifocal osteolytic lesions in the wrist. They all presented with similar clinical manifestations, and the final diagnoses were made via pathological evaluation. Compared with tenosynovial giant cell tumor and calcifying aponeurotic fibroma, rheumatoid arthritis had the poorest outcome.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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