Bone tumors and their mimics

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

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

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

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