A panoramic radiograph shows well-defined bone destruction appearing "punched out." This is consistent with which condition?

The appearance of well-defined bone destruction that is described as "punched out" on a panoramic radiograph is most consistent with multiple myeloma. This type of lesion is characterized by the presence of osteolytic lesions, which are areas where bone density is lost due to the proliferation of abnormal plasma cells.

In multiple myeloma, these lesions can occur in various locations throughout the skeleton and are often particularly pronounced in the skull, spine, and pelvis. The classic radiographic finding of these lesions is that they are well-defined, which distinguishes them from other conditions that may cause bone changes. The term "punched out" refers to the round, sharply circumscribed defects that can be easily identified on the radiograph.

Understanding this radiographic appearance is crucial for diagnosis since other conditions may present with different bony lesions or patterns of destruction. In the context of the listed conditions, multiple myeloma is the only one that typically presents with this specific pattern of bone involvement.