Which of the following conditions does NOT typically manifest as lytic bone lesions?

The condition that does not typically manifest as lytic bone lesions is osteosarcoma. Osteosarcoma is a type of bone cancer that primarily arises in the metaphysis of long bones and is known for producing a dense and aggressive bone formation rather than lytic lesions. The hallmark feature of osteosarcoma is the formation of a characteristic sunburst pattern on X-rays due to bone production around the tumor.

In contrast, conditions such as Paget's disease, multiple myeloma, and hyperparathyroidism are all associated with lytic bone lesions. Paget's disease can lead to areas of bone resorption, causing deformities and lytic lesions within the affected bones. Multiple myeloma, a hematologic malignancy, is well-known for causing multiple lytic bone lesions throughout the skeleton due to the proliferation of malignant plasma cells that disrupt normal bone remodeling. Hyperparathyroidism can also result in bone lysis due to increased osteoclastic activity driven by elevated parathyroid hormone levels, leading to bone resorption. Thus, osteosarcoma stands out as the condition that does not typically present with lytic bone lesions.