The clinical presentation of bone tumors depends on the tumor type, size or extent, location, and stage. Benign (benign) bone tumors are usually asymptomatic and therefore usually an incidental finding on radiography. The following symptoms and complaints may indicate malignant (malignant) bone tumors:
Main symptoms
- Pain that also occurs at rest and/or at night and increases in intensity or is motion-dependent
- Swelling, deformation of joints and bones (palpable) – the swelling may be reddish or bluish in color
- Local bulbous distension (swelling) of the affected bone – especially in the hand quickly visible from the outside (enchondroma).
- If the epiphyseal joints are disturbed: lengthening, bending of the affected bones.
- Complaints of the nose and sinuses or eye complaints (osteoma).
- Pressure-sensitive bursa over the affected area (bursa exostotica) (osteochondroma).
- Feeling of pressure in the nose or head (depending on localization) (osteoma).
- Circulatory disturbances
- Restriction of mobility of the affected body part
- Effusion in the adjacent joint (giant cell tumor/osteoclastoma/chondroblastoma).
- Fractures (bone fractures) after minor trauma, mostly femur (thigh bone) and humerus (upper arm bone) are affected – osteolytic tumors break down bone substance; generally, the bone loses strength due to the tumor
- Joint pain (giant cell tumor/osteoclastoma/chondroblastoma).
- Inhibition of bone growth in the area of the tumor (in children).
- Incontinence (bladder weakness) – when the bone tumor compresses (squeezes) the spinal cord.
- Headaches that slowly increase in intensity and occur sporadically (osteoma).
- Back pain – caused by osteolysis (dissolution of bone tissue), occurring mainly at night with a drilling, gnawing character, which wakes up patients during sleep; location of the back pain suggests quite accurately the location of the tumor (tumors of the spine)
- Numbness and paresis (paralysis) – as a sign of compression of the spinal cord; neurological functional deficits are described in 10-20% of patients with spinal metastases (daughter tumors). They can manifest themselves in the form of sensory deficits, bladder or rectal dysfunction, up to paraplegia (tumors of the spine).
- Too small age-appropriate body size (osteochondroma).
- Asymmetrical growth in length of arms or legs (osteochondroma).
Associated symptoms
- Loss of appetite
- Fatigue
- Vertigo (dizziness)
- B-symptomatics (see below).
B-symptomatics
- Severe night sweats (wet hair, soaked sleepwear).
- Unexplained, persistent or recurrent fever (> 38 °C).
- Unintentional weight loss (> 10% percent of body weight within 6 months).
Localization
Typical of primary bone tumors is that they can be assigned to a characteristic localization in addition to a specific age range. They arise clustered at the sites of most intense longitudinal growth (metaepiphyseal/articular area). The following questions should be answered by diagnostic measures:
- Localization in the skeleton → Which bone is affected?
- Localization in the bone → epiphysis* (joint end of the bone (near the joint)), metaphysis* (transition from epiphysis to diaphysis), diaphysis* (long bone shaft), central, eccentric (not central), cortical (at the solid outer shell of the bone), extracortical, intraarticular (within the joint capsule).
| Benign tumors | Most frequent localizations |
| Benign fibrous histiocytoma | Epimetaphyseal in the long tubular bones of femur (thigh bone), tibia (shin bone) and fibula (calf bone), ribs, pelvis (esp.ilium) |
| Chondroblastoma (Codman tumor) | Epiphysis of the long tubular bones of humerus (upper arm bone), femur (thigh bone), tibia (shin bone) |
| Desmoplastic bone fibroma | Metaphysis of the long tubular bones, mandible (lower jaw), pelvis. |
| Enchondroma | Finger phalanges (phalanges), metaphysis of the long tubular bones, pelvis, ribs |
| Fibrous bone dysplasia (Jaffe-Lichtenstein). | Femur (femur), tibia (tibia). |
| Bone hemangioma | Vertebral body, skull, small bones of metacarpus, metatarsus |
| Nonossifying fibroma (NOF) | Near the epiphysis and migrates with growth toward the metaphysis of the long tubular bones of the femur (thigh bone) and tibia (shin bone) |
| Ossifying bone fibroma (synonym: osteofibroma) (semimalignant). | Mostly in the jawbone |
| Osteoblastoma (synonym: giant osteoid osteoma) | > 40% d. F. in vertebra (dorsal/”backward”); long tubular bones of humerus (upper arm bone), femur (thigh bone), and tibia (shin bone) |
| Osteochondroma (synonym: cartilaginous exostosis; ecchondroma). | Near the joint; metaphysis of the long tubular bones of the humerus (upper arm bone), femur (thigh bone), and tibia (shin bone) |
| Osteoid osteoma | Cortical (outer layer of bone) of the long tubular bones of femur (thigh bone) and tibia (shin bone) (dia/metaphyses), also vertebral bodies |
| Osteoma | Cranial bones, facial skull, sinus bones, ethmoid bone |
| Giant cell tumor (osteoclastoma) (benign). | Epiphysis of the long tubular bones, skull, ischium, hand bones. |
| Malignant tumors | |
| Chondrosarcoma (primary, secondary) | Epiphysis of the long tubular bones of humerus (upper arm bone), femur (thigh bone) and tibia (shin bone), pelvis, shoulder girdle |
| Ewing’s sarcoma | Meta- and diaphysis of the long tubular bones, pelvis |
| Malignant fibrous histiocytoma (MFH). | Skeletal muscles and fascia of the (especially lower) extremities, retroperitoneum (space located behind the peritoneum on the back toward the spine), long tubular bones of the femur (thigh) and tibia (shin) |
| Osseous fibrosarcoma | Metaphysis of the long tubular bones of the femur (thigh bone) and tibia (shin bone) |
| Osteosarcoma | Metaphysis of the long tubular bones of femur (thigh bone), humerus (upper arm bone), tibia (shin bone) |
| Plasmocytoma (synonyms: medullary plasmocytoma; multiple myeoloma, Kahler’s disease). | Diaphysis of vertebral bodies, ribs, pelvis, skull. |
* Example of the structure of a long bone: epiphysis – metaphysis – diaphysis – metaphysis – epiphysis.