Evaluation of Musculoskeletal Tumors (Evaluation of Musculoskeletal Tumors)

Clinical Presentation of Bone Tumors (Clinical symptoms of bone tumors)


Understand a newly identified bone injury (newly identified bone lesionmay be difficult, but a well-planned, effective (well-thought-out patient) and routine radiological evaluation will reveal specific phenotypes for quick and effective diagnosis. We will discuss bone tumors based on the patient’s age at discovery, anatomical site and associated symptoms (or lack thereof). We will present a procedure to approach randomly detected lesions and introduce the bone tumor staging system for further administration.

Bone tumors can appear in many different ways, and finding a tumor can cause warnings, fear, despair, and panic for both the patient and the doctor. However, careful, systematic and thorough evaluation can reveal the types of bone tumors, which will help a doctor make an accurate diagnosis in a safe way. This process begins with an extremely thorough physical examination and medical history, followed by careful explanation of the appropriate imaging tools, the development of the differential diagnosis, and ultimately the decision of the care plan. squirrel. It is important for the clinician to confidently determine whether to observe, have a biopsy or perform surgery for bone damage, not simply to “play at chance” (“Play the odds”) or guess a plan of action based on an assumption of what’s most likely to happen. Misdiagnosis or mismanagement of both benign and malignant lesions can have dangerous limb or life-threatening consequences.

For this reason, any doctor who is not completely confident in his or her care plan should refer the patient to a specialist on musculoskeletal cancer (musculoskeletal oncology specialist) or seek the opinion of a specialist. An important step in identifying differential diagnoses is to identify possible diseases based on factors such as age, location, and symptom.


Table 1-1 provides a group of common bone tumors based on the age of the patient. With notable exceptions, bone tumors often show the highest group or incidence in specific ages, so much so that common tumors are generally considered childhood or adult tumors. For example, a damage that destroys bones (destructive bone lesion) in children with a very different differential diagnosis with similar injury in adults over 40 years of age.

Common group of bone tumors are based on the age of the patient
Table 1-1 Group of common bone tumors based on the patient’s age


Many tumors show a predominance towards specific anatomic regions, present in specific bones or in specific locations within the bone.

Figure 1-1 depicts common long bone lesions based on age and location. Onions (metaphysis) is a typical site of bone tumors, but specific lesions show little preference for the head regions (epiphyseal locations) (or overshoot areas, overshoot areas – apophyseal locations).

Figure 1-2 shows common spinal lesions based on location. With exceptions, lesions of the following components are more likely to be benign than those of the vertebral body. Figure 1-3 lists predominant tumors for the flattened bone of the pelvis and fibula.


The following lesions do not have a anatomical advantage (no anatomic preference) and should be considered in every different differential:

  • Osteomyelitis (Osteomyelitis)
  • Eosinophilic granuloma (histiocytosis X) (Eosinophilic granulomatosis)
  • Metastatic bone disease
  • Metabolic bone disease
  • Lymphoma
Figure: locations of common bone tumors in children and adults
Figure: locations of common bone tumors in children and adults

Figure: Common site-based vertebral tumors
Figure: Common site-based vertebral tumors

Figure: Tumor in flat bone
Figure: Tumor in flat bone


Common lesions of the bone tip / nodule include:

  • Chondroblastoma (Chondroblastoma)
  • Clear cell chondrosarcoma (Bright cell cartilage sarcoma)
  • Subchondral cyst / geode / intraosseous ganglion
  • Giant cell tumor of bone (meta-epiphyseal)

Lesions in the bone stem include:

• Fibrous dysplasia (Fibrous dysplasia)
• Ewing sarcoma
• Lymphoma
• Osteoid osteoma (Osteoblastoma)
• Osteoblastoma (Osteoblastoma)

• Osteofibrous dysplasia (tibia / fibula)

• Adamantinoma (tibia / fibula) (Osteodystrophy)

Lesions of the bony cortex include:
• Nonossifying fibroma (Neoplastic fibroids)
• Osteoid osteoma
• Osteochondroma (Cartilage tumors)
• Chondromyxoid fibroma (fibroids of mucous membranes)
• Osteofibrous dysplasia (tibia / fibula)
• Adamantinoma (tibia / fibula) (Enzymatic fibroblasts)


Anterior (Vertebral Body): Anterior vertebrae
Benign (Healthy)
• Eosinophilic granuloma (histiocytosis X)
• Hemangioma (Hemangioma)
• Fibrous dysplasia
• Giant cell tumor of bone
Malignant (Malignant)
• Metastatic bone disease
• Multiple myeloma / plasmacytoma
• Lymphoma
• Osteosarcoma
• Ewing sarcoma
• Chondrosarcoma
• Malignant fibrous histiocytoma
• Chordoma (Raw tumor)
Posterior Elements (In the following elements)
Benign (Healthy)
• Aneurysmal bone cyst (aneurysm bone cyst)
• Osteochondroma
• Osteoid osteoma
• Osteoblastoma

Malignant (Malignant)
• Metastatic bone disease
• Multiple myeloma / plasmacytoma

1. Rosario M, Kim HS, Yun JY, Han I. Surveillance for lung metastasis from giant cell tumor ofbone./Surg Oncol. 2017; 116 (7): 907-913. doi: 10.1002 / jso.24739.
2. EnnekingWF. Stagingtumors. In: Enneking WF, ed. Musculoskeletal Thmor Surgery. New York. NY: Churchill Livingston; 1983: 87-88.
3. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop RelatRes. 1980; 153: 106-120.
4. American Joint Committee on Cancer: Soft Tissue Sarcoma. In: Amin MB, Edge S, Greene F, et al, eds. A / CC Cancer Staging Manual. 8th ed. New York, NY: Springer 2017.

I have briefly introduced about common bone tumors classified by age and location, as well as some words about bone tumor pathology. In the next post, we will learn more about the characteristics, symptoms as well as bone tumor staging.

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