Bone tumors and their mimics

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Benign[1]

Name Presentation Radiograph Findings/Location Clinical Importance
Chondroblastoma Bone or joint pain in adolescent Epiphysis of long bones, may cross growth plate Growth disturbance, arthritis
Enchondroma Soft tissue mass in hands or feet of adolescent; seen in Ollier Disease or Mafucci Syndrome Metaphysis of long bones in hands or feet; oval lesion with sclerotic edges and central lucency Malignant transformation to chondrosarcoma if multiple lesions present
Langerhans cell histiocytosis of bone Painful swelling of skull in children, typically frontal bone, or long bones Lytic, punched out lesion Lesion of skull can be associated with diabetes insipidus or other CNS disease; pathological fracture of long bone
Osteoblastoma Adolescent male with chronic pain in spine, most often seen in posterior column Similar to osteoid osteoma but typically > 2cm May appear like osteoid osteoma on plain film but DOES NOT respond to Aspirin/NSAIDs
Osteochondroma Adolescent male with painless mass over distal femur Osseous spur that arises from cortex pointing away from joint Observation without treatment; small risk of transformation to chondrosarcoma
Osteoid Osteoma Adolescent male with bone pain over femur; pain worse at night and unrelated to activity Radiolucent nidus with sclerotic edges most often seen in proximal femur Nidus produces prostaglandins, Aspirin/NSAIDs can relieve pain; most soft resolve

Malignant[2]

Name Presentation Radiograph Findings Clinical Importance
Adamantinoma Bone pain over anterior tibia in adolescent or young adult Soap bubble osteolytic appearance on plain radiograph Metastasis to lungs; may need amputation
Chordoma Constant pain if in sacrum; neurological deficits if at base of skull, most commonly in cranial nerves to the eye Plain radiograph will show a destructive bone lesion often with an associated soft tissue mass Slow growing but locally aggressive; metastasis is uncommon, local recurrence is much more likely
Fibrosarcoma and Undifferentiated pleomorphic sarcoma Similar to osteosarcoma except malignant fibroblasts but less common Most common in distal femur and proximal tibia Similar outcome to osteosarcoma
Primary bone lymphoma Adult > 40 years of age with bone pain or pathologic fracture Bone destruction; soft tissue mass 5 year survival is greater than 50% with radiation and chemotherapy

Differential Diagnosis

Bone tumors and their mimics

Malignant

Benign

Other

See Also

References

  1. Czerniak, Bogdan. “Benign Osteoblastic Tumors.” Dorfman and Czerniak's bone tumors. Elsevier Health Sciences, 2015, pp. 144 – 199.
  2. Niederhuber, John E., et al. “Sarcomas.” Abeloff's Clinical Oncology E-Book. Elsevier Health Sciences, 2019, pp. 1604 – 1654.e8.