Bone Tumors & Tumor-Like Lesions

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

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

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

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