Table 3.

Differential Diagnosis of Benign and Malignant Bone Tumors

DiseasePeak Age (years)Typical LocationFindingsPrognosis
Chondroblastoma10–20Long bone epiphysesRegional muscle atrophy and localized tenderness; radiographic appearance of a cyst containing calcium depositsGood
Chondroma>20Central diaphysesUsually asymptomatic;radiographs show stippled calcificationGood
Chondromyxoid fibroma<30Distal long bonesSharply circumscribed, lytic lesion on radiographsGood
Chondrosarcoma30–50Flat bones, long bone diaphysesLobular radiographic appearance with punctate calcificationFair with surgical resection but resistant to chemotherapy
Ewing’s Sarcoma10–18Long bone diaphyses and flat bonesLocalized pain or swelling; `onion peel` periosteal reaction on radiographsGood if nonmetastatic, poor if metastatic
Giant cell tumor<2, >24EpiphysesLytic appearance on radiographsGood; tendency to recur
Osteochondroma5–15Distal femur, proximal tibiaPainless, hard palpable mass; most common benign bone tumorGood; 10% with multiple lesions develop a malignancy
Osteoid osteoma5–20Femur, tibiaNocturnal pain relieved by aspirinGood
Osteosarcoma10–18Long bone metaphysesLocalized pain or swelling; sclerotic or lytic destruction on radiographsGood if nonmetastatic; poor if metastatic