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Key Features

  • Persistent pain, swelling, or tenderness of a skeletal part

  • Pathologic ("spontaneous") fractures

  • Suspicious areas of bony enlargement, deformity, radiodensity, or radiolucency on radiograph

  • Histologic evidence of bone neoplasm on biopsy specimen

  • Primary tumors of bone are relatively uncommon in comparison with secondary or metastatic neoplasms

  • Osteosarcoma, the most common malignancy of bone, typically occurs in adolescents

Clinical Findings

  • Osteosarcoma may present as pain or swelling in a bone or joint (especially in or around the knee)

  • When the symptoms appear following a sports-related injury, accurate diagnosis may be delayed

Diagnosis

  • Biopsy (which is not always definitive)

  • Differential diagnosis

    • Benign developmental skeletal abnormalities

    • Metastatic neoplastic disease

    • Infections (eg, osteomyelitis)

    • Posttraumatic bone lesions

    • Metabolic disease of bone

    • Osteoid osteomas

    • Osteosarcoma

    • Fibrosarcomas

    • Enchondromas

    • Chondromyxoid fibromas

    • Chondrosarcomas

    • Giant cell tumors (osteoclastomas)

    • Chondroblastomas

    • Ewing sarcoma

Treatment

  • Chemotherapy for some

  • Osteosarcomas: treated by resection and chemotherapy; 5-year survival rate of 60%

  • Osteoid osteomas (seen in children and adolescents) should be surgically removed

  • Tumors derived from cartilage treated with appropriate curettement or surgery have good prognosis

  • Ewing sarcoma (affects children, adolescents, and young adults), has a 50% mortality rate in spite of chemotherapy, irradiation, and surgery

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