Grade II. A 54-year-old woman. One larger ill-defined lytic bone tumor is observed (solid arrow). Distal to this lesion are several round/oval smaller lytic lesions of varying size (dashed arrows). This is a moth-eaten pattern of bone destruction, i.e., Lodwick growth grade II is assigned. Note that if the larger lesion is considered the dominant (geographic) lesion, the overall resulting growth grade is still II—due to the width of the moth-eaten margin distally. This patient had multiple myeloma