Monday, April 27, 2015

Bone Tumors

Bone tumors have several features that are characteristic and can be used to narrow a differential diagnosis for a suspicious lesion. This table is by no means comprehensive but it is meant to be a quick reference for various benign and malignant osseous lesions. The following features are relevant: patient age, lesion borders, location within bone, bones, involved, bone matrix changes, periosteal reaction, matrix mineralization, and soft tissue component.

The patients can be divided into two groups based on age: younger than 30 vs older than 30. The lesion borders can be described as a narrow zone of transition (the border is easy to define) vs a broad zone of transition. Periosteal reactions can be described as thin, thick, lamellated, hair-on-end, sunburst, or Codman's triangle. Matrix mineralization is either chondroid (rings and arcs) or osteoid (cloud-like). A soft tissue component is either present or absent.

Diagnoses Age Bones Borders Physis? Cortex? Periosteal Reaction Matrix Mineralization Soft Tissue Mass
Fibrous Dysplasia under 30 Face, ribs, femur Narrow Metadiaphysis No No No No
Eosinophilic granuloma under 30 Face, humerus, ribs, femur Narrow Metadiaphysis Possible Variable No Yes, if fx
Osteoid osteoma under 30 Long bones Narrow Metaphysis Yes No No No
Nonossifying fibroma under 30 Distal femur, distal tibia Narrow Metaphysis Yes No No No
Simple Bone Cyst under 30 Proximal humerus, proximal femur Narrow Metaphysis No No No No
Osteochondroma under 30 Distal femur, proximal tibia Narrow Metaphysis Yes No No No
Ewing Sarcoma under 30 Long bones, ribs Broad Diaphysis Yes Lamellated No Yes
Osteosarcoma under 30 Long bones Broad Metaphysis Yes Sunburst, hair-on-end, Codman's Osteoid Yes
Enchondroma under 30 Small bones Narrow Metadiaphysis Yes No No No
Aneursymal Bone Cyst under 30 Posterior vertebrae, flat bones, long bones Narrow Epiphysis Yes Yes No No
Chondromyxoid fibroma under 30 Long bones Narrow Metaphysis Yes No Chondroid No
Chondroblastoma under 30 Distal femur, proximal humerus Narrow Epiphysis Yes No Chondroid No
Osteomyelitis any age Any Broad Any Yes Thick No No
Myeloma over 30 Any Narrow Metadiaphysis Yes No No No
Geode over 30 Periarticular Narrow Epiphysis Yes No No No
Hyperparathyroidism over 30 Any Narrow Metadiaphysis Thinned No No No
Giant Cell Tumor over 20 Knee, distal radius, sacrum Narrow Epiphysis No No No Eggshell ossification

Bone Tumors By Location


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