Osteosarcoma: Or something else? Differential Diagnosis

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.

Musculoskeletal system and connective tissue (M00-M99).

  • Fibrodysplasia ossificans progressiva (FOP; synonyms: Fibrodysplasia ossificans multiplex progressiva, Myositis ossificans progressiva, Münchmeyer syndrome) – genetic disorder with autosomal dominant inheritance; describes pathological progressive ossification (ossification) of the connective and supporting tissues of the human body, leading to ossification of the musculature; shortened and twisted big toes are already present at birth as a nonspecific symptom.
  • 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.
  • Ossification (ossification) after fractures (bone fractures).
  • Osteochondrosis dissecans – circumscribed aseptic bone necrosis below the articular cartilage, which can 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 (“hardening”); localized in the metaphyseal-epiphyseal region of long bones, among others; may simulate osteoblastic bone metastases in mammary carcinoma (breast cancer)
  • Ostitis (synonym: osteitis) – inflammation of bone tissue.

Neoplasms – tumor diseases (C00-D48).

  • Other small-round blue-cell neoplasms (neoplasms):
    • Embryonal rhabdomysarcoma.
    • Small cell kazinoma
    • Small cell osteosarcoma
    • Malignant lymphoma (cancer of the lymph nodes)
    • Medulloblastoma (synonym: primitive neuroectodermal tumor (PNET) – malignant embryonal tumor of the cerebellum.
    • Mesenchymal chondrosarcoma
    • Metastatic neuroblastoma
    • Non-Hodgkin’s lymphoma
    • Soft tissue sarcoma
  • Histiocytosis/Langerhans cell histiocytosis (abbreviation: LCH; formerly: histiocytosis X; English histiocytosis X, langerhans-cell histiocytosis) – systemic disease with proliferation of Langerhans cells in various tissues (skeleton 80% of cases; skin 35%, pituitary gland (pituitary gland) 25%, lung and liver 15-20%).
  • Bone metastases (daughter tumors).

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