Bone Tumors: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Hyperparathyroidism (parathyroid hyperfunction) – osseous manifestation of the disease: osteodystrophia cystica generalisata von Recklinghausen (hemorrhaged resorption cysts = brown tumors with irregularly distributed giant cell clusters) (rather rare).

Infectious and parasitic diseases (A00-B99).

  • Bone tuberculosis – 2-3% of all tuberculosis cases involve the skeletal system, of which approximately 50-60% involve the spine; peak incidence: 40-60 years of age.

Mouth, esophagus (esophagus), stomach and intestines (K00-K67; K90-K93).

  • Reparative giant cell granuloma – slow-growing lesion resulting in painless distension of the bone with tooth displacement and loosening.

Musculoskeletal system and connective tissue (M00-M99).

  • Aneurysmal bone cyst – aggressive, expansive growing cyst.
  • Brodie abscess – form of hematogenous osteomyelitis (acute or chronic inflammation of bone and bone marrow) in childhood; pressure-painful swelling, often in the tibial area
  • Dysplasia epiphysealis hemimelica (synonym: Trevor’s disease) – histologically similar changes as osteochondroma, with an osseous base and a cartilage cap with enchondral ossification (ossification); disease of childhood and adolescence.
  • Eosinophilic granuloma – solitary tumor-like osteolytic lesions.
  • Fibrodysplasia ossificans progressiva (FOP; synonyms: Fibrodysplasia ossificans multiplex progressiva, Myositis ossificans progressiva, Münchmeyer syndrome) – genetic disease with autosomal dominant inheritance; describes the pathological, progressive ossification (ossification) of the connective and supporting tissues of the human body, which leads to ossification of the musculature; already at birth, shortened and twisted big toes are present as a non-specific symptom.
  • Fibrous dysplasia – malformation of bone tissue, that is, the bones form tumor-like protrusions.
  • Ischemic bone necrosis (“bone infarction”) – demise of bone tissue.
  • Bone abscess
  • Paget’s disease (osteodystrophia deformans) – bone disease that results in bone remodeling and gradual thickening of several bones, usually the spine, pelvis, extremities or skull.
  • Myeloma, solitary – plasma cell disease with formation of a single tumor in the bone.
  • Ossification (ossification) after fractures (bone fractures).
  • Osteochondromatosis, familial – multiple osteocartilaginous exostoses as a hereditary systemic disease with a higher risk of degeneration.
  • Osteochondrosis dissecans – circumscribed aseptic bone necrosis below the articular cartilage, which may end with the rejection of the affected bone area with the overlying cartilage as a free joint body (joint mouse)
  • Osteomyelitis – acute or chronic inflammation of the bone and bone marrow, usually due to bacterial infection; combination of osteitis and myelitis (bone marrow/spinal cord).
  • Osteopoikilosis (synonyms: osteopathia condensans disseminata, osteopoikilia; “stippled bone”) – multiple, small, round or oval foci of bony sclerosis; localized in metaphyseal-epiphyseal region of long bones, among others; may simulate osteoblastic bone metastases in breast carcinoma
  • Ostitis (synonym: osteitis) – inflammation of bone tissue.
  • Plasmocytoma (synonym: multiple myeloma) (spine) – malignant (malignant) systemic disease, which is one of the non-Hodgkin’s lymphomas of B lymphocytes.
  • Stress fracture

Neoplasms – tumor diseases (C00-D48)

  • Epidural tumors (tumors outside the spinal cord skin).
  • Gardner syndrome (synonym: familial polyposis) (in multiple osteomas) – hereditary disease in which there is development of colonic polyps (colon polyps), benign bone tumors, and multiple soft tissue tumors.
  • Histiocytosis/Langerhans cell histiocytosis (abbreviation: LCH; formerly: histiocytosis X; Engl.histiocytosis X, langerhans-cell histiocytosis) – systemic disease with proliferation of Langerhans cells in different tissues (skeleton 80% of cases; skin 35%, pituitary gland (pituitary gland) 25%, lung and liver 15-20%).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Growing pains-about one-third of all children between 2 and 12 years of age occasionally suffer from growing pains; they usually occur in the evening or at night (80% of cases); the next morning, the child is able to move without pain and without restrictions
    • Symptoms/complaints:
      • Brief burning, pulling, or throbbing pain in both legs or arms.
      • Can be so painful that children are jolted from sleep
    • Localizations:
      • Front sides of the thighs
      • Backs of knees
      • Shins or calves
      • Pain always occurs on both sides, alternating between both extremities if necessary, and can vary in intensity
      • Joints are not affected
    • Growing pains are pain at rest, not pain on exertion [diagnosis of exclusion! Conditions to clarify include rheumatic diseases, bone tumors, bone infections or unnoticed bone injury]
    • Complaints are self-limiting
    • Warning signs (red flags) of malignancy (malignant tumor): B symptoms (severe night sweats, unexplained persistent or recurrent (recurrent) fever (> 38 °C); unwanted weight loss (> 10% percent of body weight within 6 months)), back pain as the main localization, palpable mass, bleeding tendency, nonarticular bone pain (bone pain that does not involve a joint); abnormalities in the blood count and smear, LDH ↑
    • Physical examination: no abnormal examination results.
    • Laboratory diagnostics:
      • Small blood count
      • Differential blood count
      • ESR (erythrocyte sedimentation rate)
      • If necessary, also determination of transaminases, alkaline phosphatase (AP), LDH, creatinine.
    • Medical Device Diagnostics:
      • X-ray in two planes
      • Magnetic resonance imaging (MRI) of the affected region.

Injuries, poisonings and other consequences of external causes (S00-T98).

  • Injuries/sports injuries