Bone Lesions: Benign and Malignant

Abstract

1. Rani Gereige, MD, MPH* 2. Mudra Kumar, MD, MRCP† 1. *Editorial Board. 2. †Associate Professor of Pediatrics, University of South Florida, Tampa, Fla. After completing this article, readers should be able to: 1. Describe the usual presenting symptoms of osteosarcoma. 2. Identify the clinical and laboratory features of osteoid osteoma. 3. Discuss the treatment of fibrous cortical defect. 4. Understand the potential actions of Ewing sarcoma and osteosarcoma. 5. Explain the appropriate procedure for biopsy of a malignant bone tumor. Bone lesions can be benign or malignant. Patients may present to the primary care practitioner with common complaints such as pain or fracture or lesions may be found incidentally on radiographs obtained for other reasons. Pediatricians should maintain a high degree of suspicion and be familiar with the clinical presentation and initial evaluation of a child who has bone pain. This article reviews the common types of bone lesions and their clinical characteristics, differentiating features, diagnostic evaluation, and treatment. Primary bone tumors are the sixth most common neoplasm occurring in children and constitute approximately 6% of all childhood malignancies. Sixty percent of all primary bone tumors occur in patients younger than 45 years of age, with a peak incidence in 15- to 19-year-old individuals. These lesions are the third most common tumors in adolescents and young adults (exceeded only by leukemia and lymphoma). Osteosarcoma and Ewing sarcoma are the most common malignant bone tumors in this age group. Although the overall incidence of osteosarcoma is higher than Ewing sarcoma in adolescents younger than 20 years, Ewing sarcoma is more common in children younger than 10 years of age. Benign bone lesions, fortunately, are more common compared with the (relatively) rare malignant neoplasms of bone. Focal bone lesions can be classified into three primary categories: benign, malignant (primary or …