Tumors & Tumor-Like Lesions of Bone

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

• Osteosarcoma can develop in patients with Paget disease of bone, enchondromatosis, fibrous dysplasia, or hereditary multiple exostoses

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

  • Immunotherapy has an emerging role

  • 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