Diagnosis Of Primary Bone Tumors Research Articles

Detecting bone lesions in X-ray under diverse acquisition conditions.

The diagnosis of primary bone tumors is challenging as the initial complaints are often non-specific. The early detection of bone cancer is crucial for a favorable prognosis. Incidentally, lesions may be found on radiographs obtained for other reasons. However, these early indications are often missed. We propose an automatic algorithm to detect bone lesions in conventional radiographs to facilitate early diagnosis. Detecting lesions in such radiographs is challenging. First, the prevalence of bone cancer is very low; any method must show high precision to avoid a prohibitive number of false alarms. Second, radiographs taken in health maintenance organizations (HMOs) or emergency departments (EDs) suffer from inherent diversity due to different X-ray machines, technicians, and imaging protocols. This diversity poses a major challenge to any automatic analysis method. We propose training an off-the-shelf object detection algorithm to detect lesions in radiographs. The novelty of our approach stems from a dedicated preprocessing stage that directly addresses the diversity of the data. The preprocessing consists of self-supervised region-of-interest detection using vision transformer (ViT), and a foreground-based histogram equalization for contrast enhancement to relevant regions only. We evaluate our method via a retrospective study that analyzes bone tumors on radiographs acquired from January 2003 to December 2018 under diverse acquisition protocols. Our method obtains 82.43% sensitivity at a 1.5% false-positive rate and surpasses existing preprocessing methods. For lesion detection, our method achieves 82.5% accuracy and an IoU of 0.69. The proposed preprocessing method enables effectively coping with the inherent diversity of radiographs acquired in HMOs and EDs.

Automatic detection, segmentation, and classification of primary bone tumors and bone infections using an ensemble multi-task deep learning framework on multi-parametric MRIs: a multi-center study.

To develop an ensemble multi-task deep learning (DL) framework for automatic and simultaneous detection, segmentation, and classification of primary bone tumors (PBTs) and bone infections based on multi-parametric MRI from multi-center. This retrospective study divided 749 patients with PBTs or bone infections from two hospitals into a training set (N = 557), an internal validation set (N = 139), and an external validation set (N = 53). The ensemble framework was constructed using T1-weighted image (T1WI), T2-weighted image (T2WI), and clinical characteristics for binary (PBTs/bone infections) and three-category (benign/intermediate/malignant PBTs) classification. The detection and segmentation performances were evaluated using Intersection over Union (IoU) and Dice score. The classification performance was evaluated using the receiver operating characteristic (ROC) curve and compared with radiologist interpretations. On the external validation set, the single T1WI-based and T2WI-based multi-task models obtained IoUs of 0.71 ± 0.25/0.65 ± 0.30 for detection and Dice scores of 0.75 ± 0.26/0.70 ± 0.33 for segmentation. The framework achieved AUCs of 0.959 (95%CI, 0.955-1.000)/0.900 (95%CI, 0.773-0.100) and accuracies of 90.6% (95%CI, 79.7-95.9%)/78.3% (95%CI, 58.1-90.3%) for the binary/three-category classification. Meanwhile, for the three-category classification, the performance of the framework was superior to that of three junior radiologists (accuracy: 65.2%, 69.6%, and 69.6%, respectively) and comparable to that of two senior radiologists (accuracy: 78.3% and 78.3%). The MRI-based ensemble multi-task framework shows promising performance in automatically and simultaneously detecting, segmenting, and classifying PBTs and bone infections, which was preferable to junior radiologists. Compared with junior radiologists, the ensemble multi-task deep learning framework effectively improves differential diagnosis for patients with primary bone tumors or bone infections. This finding may help physicians make treatment decisions and enable timely treatment of patients. • The ensemble framework fusing multi-parametric MRI and clinical characteristics effectively improves the classification ability of single-modality models. • The ensemble multi-task deep learning framework performed well in detecting, segmenting, and classifying primary bone tumors and bone infections. • The ensemble framework achieves an optimal classification performance superior to junior radiologists' interpretations, assisting the clinical differential diagnosis of primary bone tumors and bone infections.

Delay in Diagnosis and Treatment of Primary Bone Tumors

Background. Delay in the diagnosis and treatment of bone tumors continues to be a common problem. Prolonged diagnosis can significantly reduce the chances of successful treatment of the disease. Accordingly, the aim of this study was to assess the delay in the diagnosis of primary bone tumors, identify the most common symptoms and analyze the course of the diagnostic and therapeutic path.Material and methods. Thirty-two (K=18; M=14) patients treated surgically for primary bone tumors were included in the retrospective study. Patient records were analyzed. Delay in diagnosis was defined as the time from the onset of symptoms to the initial diagnosis and referral to an orthopedic oncology center.Results. The median delay in diagnosis was 7 (3-12) months. For tumors located in the pelvis, the delay was 10 months, compared to 5 months for the upper limb and 7 months for the lower limb (p=0.2312). The delay was 6 months In patients with osteosarcoma, and 8 months in chondrosarcoma patients (p=0.1786). At the first office visit, an x-ray was ordered in 19 cases (59.4%), of whom 9 patients (47.4%) were referred on to the oncology center. The most common symptoms were pain in the affected area (90.6%), limited mobility (28.1%) and pathological fracture (25%). After admission to an orthopedic department, a biopsy was performed after 5.5 (3-8.2) days. The histology results were ready after another 14 (8-18) days, and surgical treatment was performed after 95 (76-100) days.Conclusions. 1. Although patients show typical symptoms of bone tumors, only a small proportion are referred directly to an oncology center. After a primary bone tumor is suspected, further diagnostic and therapeutic activities proceed efficiently, in accordance with the current guidelines.

Evaluation of osteonectin as a diagnostic marker of osteogenic bone tumors

Introduction: Immunohistochemistry plays an important but limited role in the diagnosis of primary bone tumors. Sometimes it is very difficult to differentiate osteosarcomas histologically from other tumors with similar morphology but with different malignant potential and treatment protocol. The correct diagnosis of OSA relies on identification of osteoid production by malignant cells which can be detected by the use of osteonectin. Materials and Methods: The present study was carried out on 200 patients of benign and malignant lesions of bone. After a detailed clinical history and local examination, paraffin section of resected specimens were studied by hematoxylin and eosin and immunohistochemical stain, osteonectin and matrix was graded on a four-tiered grading system with statistical analysis of osteonectin positivity in osteogenic bone tumours and tumour-like lesions. Results: Benign and malignant tumours accounted for 74.6% and 25.0% of the total cases. Osteoid production were seen in 36 cases (100.0%) of osteosarcomas, followed by fibrous dysplasia in 18 cases (100.0%) and osteoid osteoma in 10 cases (100.0%). Both polygonal and spindle shaped tumour cells in osteosarcoma showed Grade 4 positivity with osteonectin. Fibroblastic variant of osteosarcoma showed diffuse (Grade 4) and focal strong staining (Grade 2) alternating with negative areas. Chondroblastic variant of osteosarcoma showed Grade 4+ immunoreactivity in conventional osteosarcoma like areas, whereas chondrocyte- like tumour cells surrounded by chondro-osteoid –like matrix showed well- defined osteonectin staining. Conclusions: Osteonectin is a helpful osteogenic marker for establishing the diagnosis of osteoblastic origin of a tumour that produce no or scarcely any matrix. Keywords: Bone Tumors, Immunohistochemistry, Osteonectin.

Primary Bone Tumors in North of Jordan

ObjectivePrimary tumors of bone are relatively uncommon. Little information is available about the etiology, pathophysiology, risk factors and epidemiologic features of bone tumors. In this article, we present the epidemiological data about the primary (benign and malignant) bone tumors in Jordan.MethodsRetrospectively, we identified and assessed those patients who were diagnosed with primary bone tumor between January 2004 and December 2018 at King Abdullah University Hospital. The following information was obtained: demographics (age, sex), clinical presentation, and location of the tumor. Also, the histopathological results and finding and recurrence of the tumors were retrieved. The included primary bone tumors were those tumors fulfill the World Health Organization classification of soft tissue and bone tumors.ResultsDuring the study period, four-hundred and thirty-seven cases of the primary bone tumor were diagnosed in our institution. More than half of the cases were males (52.5% males and 47.5% females). In most cases, young adults are affected. The mean age for the diagnosis of giant cell tumor of bone (GCTB) is 34.1 years. The appendicular skeleton was involved in 269 (81.5%) patients while the axial skeleton in 60 patients. The most common encountered pathology is the multiple myeloma with 120 patients. After that, osteochondroma was diagnosed in 110 patients. Females were mostly affected by giant cell tumor while the osteochondroma and chondrosarcoma were seen mostly in males. Multiple myeloma tends to develop in elderly while juvenile ossifying fibroma occurred in young pediatrics and Ewing sarcoma in school-age children and adolescents. Giant cell tumor and osteoid osteoma have the tendency to recur.ConclusionThe diagnosis of primary bone tumors is of particular important. The reporting of epidemiological studies is essential in order to expand our knowledge regarding this uncommon type of tumors.

Primary Clear Cell Sarcoma of Bone: Report of a Case Arising from Distal Femur in a Pediatric Patient and Review of the Literature

Clear cell sarcoma is a rare mesenchymal tumor with melanocytic differentiation, firstly described by Enziger in 1965. It accounts for less than 1% of all soft tissue sarcomas and occurs predominantly in the extremities of adults. Primary clear cell sarcoma of bone is even rarer; current literature consists of only 13 cases with a mean age of presentation of 45-year-old, ranging from 18 to 81. Because of the overlapping expression of melanocytic markers, the differential diagnosis should be addressed with metastatic malignant melanoma and metastasis from clear cell sarcoma of soft parts. Essential for the diagnosis is the evidence of translocations t (12;22) or t (2;22) resulting respectively in EWSR1/ATF1 and EWSR1-CREB1 gene fusion. Clinical history and radiological assessment could help discriminate between bone or soft parts origin. We report an unusual case of clear cell sarcoma of distal femur involving a 13-year-old patient. Histological sections showed a malignant neoplasm composed of nests of uniform cells separated by fibrous septa, showing strong immunoreactivity for melanoma triple cocktail. Real Time-Polymerase Chain Reaction revealed the presence of the fusion product EWSR1-ATF1, confirming the diagnosis of clear cell sarcoma of bone. Our purpose was to revise the current literature in order to find common clinicalradiological features to this rare entity. To the best of our knowledge, our case is the first bone clear cell sarcoma arising from the distal femur in a pediatric patient described in the literature: it highlights the importance of considering this rare entity in the differential diagnosis of primary bone tumor, although extremely rare and of the use of molecular means to confirm the diagnosis.

Diagnostic value of SPECT/CT tomographic fusion imaging and magnetic resonance imaging in primary bone tumors

Objective To study the effects of single photon emission computed tomography/computed tomography (SPECT/CT) and magnetic resonance imaging (MRI) in the diagnosis of primary bone tumors. Methods A total of 104 patients with primary bone tumors in Zibo Central Hospital hospital from January 2016 to January 2018 were enrolled in this study. SPECT/CT and MRI examinations were performed on these patients, and the results of the examinations were compared with the results of surgical pathology. The diagnostic efficacy of the two methods for primary bone tumors were compared. Results ⑴Results of pathological examination: 70 cases were malignant tumors, and 34 cases were benign tumors; results of SPECT/CT: 72 cases were malignant tumors, and 32 cases were benign tumors; MRI: 76 cases were malignant tumors, and 28 cases were benign tumors; there was no difference between the two methods in the diagnosis of primary bone tumors. ⑵ The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SPECT/CT were 92.86%, 79.41%, 88.46%, 90.28% and 84.38% respectively, slightly higher than those of MRI (91.43%, 64.71%, 82.69%, 84.21% and 78.57%), but the difference was not statistically significant (P>0.05). ⑶ There was a high consistency between SPECT/CT and MRI in the diagnosis of primary bone tumors (Kappa value=0.613). ⑷ SPECT/CT is more accurate in the diagnosis of osteosarcoma, giant cell tumor, myeloma and fibrous dysplasia, while MRI is more accurate in the diagnosis of osteosarcoma, chordoma, Ewing's sarcoma and schwannoma. Conclusions SPECT/CT fusion imaging and MRI have high sensitivity and accuracy in the diagnosis of primary bone tumors, and the results of the two diagnostic methods have high consistency. SPECT/CT has a high accuracy in the diagnosis of ossification and calcification, while MRI has a high accuracy in the diagnosis of bone tumors in bone soft tissue and nervous system. Therefore, the joint application of the two methods can make up for each other's shortcomings and make the diagnosis of primary bone tumor more accurate. Key words: Tomography, emission-computed, single-photon; Magnetic resonance imaging; Bone neoplasms

Solitary costal plasmacytoma mimicking lung cancer metastasis.

Key Clinical MessageA clinical diagnosis of metastatic bone tumors is usually based on radiological findings without bone biopsy. Plasmacytoma can present as a single osteolytic lesion as described in this case. Early bone biopsy should be considered in unusual clinical settings for a differential diagnosis of primary bone tumors.

A retrospective analysis of computed tomography guided biopsy in the diagnosis of primary bone tumors

<p><strong>Background:</strong> Primary bone tumors account for a small yet significant number in the total incidence of tumors. Computed tomography (CT) guided percutaneous core biopsy is a novel yet significant step in the approach towards the diagnosis of bone tumors and is increasingly performed by orthopaedic oncologists around the world. This study is aimed to evaluate the diagnostic accuracy of CT guided biopsy in the diagnosis of primary bone tumors. <strong></strong></p><p><strong>Methods:</strong> Patients who underwent CT guided biopsy and subsequent excision for primary bone tumors from January 2008 to July 2015 were analysed. CT guided biopsy results were compared with post-operative histopathological reports to evaluate its sensitivity and specificity.</p><p><strong>Results:</strong> A total of 161 patients were included in the retrospective study. Among them, 147 were true positives, 7 were false negatives, 6 were true negatives and one was false positive. The sensitivity of CT guided biopsy in the diagnosis of primary bone tumor was 95.4 % with specificity of 85.7% with a diagnostic efficiency of 90.5%. The complication rate was 4.3%.</p><p><strong>Conclusions:</strong> CT guided biopsy is a safe, simple and effective procedure to rule out and rule in the diagnosis of primary bone tumors.</p>

Xanthogranulomatous osteomyelitis of femur masquerading as neoplasm

Xanthogranulomatous osteomyelitis (XO) is a very rare chronic granulomatous inflammation. It can mimic malignant bone tumors on its clinical presentation, gross features, and radiological imaging. However, histopathological examination can differentiate it from malignancy. We describe the case of a 20-year-old male presented with fever and pain in the right knee joint for 4 months. Plain radiography and magnetic resonance imaging of the right knee joint revealed osteolytic lesion in the lower metaphyseal region of femur. With this clinical presentation and radiological imaging, a diagnosis of primary bone tumor was made. However, XO was confirmed by histopathological examination. This case highlights the rare occurrence and also it can mimic as bone tumor.

Fine needle aspiration cytology versus core needle biopsy in the diagnosis of primary bone tumors: a retrospective study

Background Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are two outpatient procedures used in the differential diagnosis of a suspected bone tumor. Although open biopsy is a recommended procedure, its invasive nature mandates the search of a minimally invasive procedure for the diagnosis of a bone tumor prior to surgical resection or radio/chemotherapy. Therefore, the aim of this study was to compare the FNAC and CNB regarding their diagnostic accuracy in the diagnosis of primary bone tumor.

Radiography in the Initial Diagnosis of Biologic Activity or Growth Rate of Primary Bone Tumors

Radiography in the Initial Diagnosis of Biologic Activity or Growth Rate of Primary Bone TumorsBinit Sureka1, Mahesh Kumar Mittal1 and Brij Bhushan Thukral1Audio Available | Share

Radiography in the initial diagnosis of primary bone tumors.

3 nosed lesions are best divided into biologically aggressive or nonaggressive categories. Biopsy is indicated if the lesion is aggressive. Otherwise, watchful waiting with follow-up imaging can be pursued. Aggressive features are detected on radiographs by evaluation of imaging characteristics, such as the appearance of the margin, cortical expansion, and periosteal reaction. Clinical examination findings, such as pain, are also contributory.

Primary Spinal Natural Killer/T-Cell Lymphoma Successfully Treated With Concurrent Chemoradiotherapy and Autologous Stem Cell Transplantation

This case report shows primary natural killer (NK)/T-cell lymphoma originating in the spine as the first case of successful treatment with autologous stem cell transplantation, along with case presentation and literature review. For the proper treatment of this spinal tumor, the pathologic confirmation includes immunophenotypic profiling, the understanding of tumor characteristics, and the consideration of spinal stability are necessary. NK/T-cell lymphomas are rare, aggressive neoplastic disorders with a distinctive clinical pathologic profile and an unfavorable clinical prognosis. The extranodal nasal-type NK/T-cell lymphomas, which are characterized by an extranodal presentation and an aggressive clinical course, are prevalent in Asia and Central and South America. A 49-year-old woman presented with thoracic back pain that developed 3 months before she was admitted to Chung-Ang University. The radiological image showed a 6 × 4 × 5-cm mass lesion within the T6-T7 vertebral body. The histopathology was consistent with the finding of NK/T-cell lymphoma. Treatment with chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) in combination with radiotherapy (total dose, 30 Gy) was done, and salvage therapy with autologous stem cell transplantation was performed. Two-year follow-up magnetic resonance image showed shrinking remnant mass without spinal deformation and/or instability. Rebiopsy for remnant mass, nasal area study, and positron emission tomographic scan were performed to determine the tumor recurrence. There was no evidence of recurrence at the 2-year follow-up evaluations. Some primary NK/T-cell lymphomas that originate at sites other than the nasal cavity/nasopharynx do not present with typical clinical features and symptoms. A primary NK/T-cell lymphoma of the spine should be considered in the differential diagnosis of primary bone tumors. We report the first case of successful treatment with chemoradiotherapy and autologous stem cell transplantation in a patient with a primary spinal NK/T-cell lymphoma.

Intraosseous spindle cell hemangioma of the calcaneus: a case report and review of the literature

Spindle cell hemangioma, a rare benign tumor characterized by cavernous blood vessels and spindled areas, typically arises in the subcutis of the distal extremities, particularly the hand. The case of intraosseous spindle cell hemangioma is extremely rare, and only 1 case arises in the frontal bone has been reported previously. We describe herein a case of intraosseous spindle cell hemangioma occurring in the left calcaneus in a 65-year-old woman. The patient was successfully treated by the operation. The present case is instructive especially in the differential diagnosis of primary bone tumor structured by spindle cells, for which the possibility of spindle cell hemangioma should be considered.

An Intraosseous Malignant Peripheral Nerve Sheath Tumor of the Cervical Spine

Case description. To report a rare case of intraosseous malignant peripheral nerve sheath tumors (MPNST), and review the pertinent medical literature. The spinal MPNST that develops from spinal nerve roots and secondary bony erosion is well-known entity. However, primary intraosseous MPNSTs of the spine are extremely rare. A 41-year-old male presented with a 1-month history of radiating pain to his right shoulder and arm. Magnetic resonance images showed a large extradural mass extending from C6 to T1 with destruction of the posterior elements of C6, C7, and T1. Complete excision of the tumor and posterior stabilization were performed through a posterior approach. The tumor was noted to originate from the posterior element of C7. The histopathology was diagnostic for a MPNST. Adjuvant chemotherapy was administered after surgery. The patient remained symptom-free for 30 months after surgery without local recurrence or metastasis. We report an intraosseous MPNST of the cervical spine. Complete surgical excision and adjuvant chemotherapy resulted in a good functional outcome. MPNST should be added to the differential diagnosis of primary bone tumors causing spinal cord compression.

Primary rhabdomyosarcoma of the sacrum: a case report and review of the literature

We describe herein a rare case of primary rhabdomyosarcoma (RMS) occurring in the sacrum. A 16-year-old woman presented with a 2-month history of pain in bilateral buttocks and posterior thighs. Computed tomography showed a primary tumor with bone destruction in the 2nd sacral vertebra and invasion to the 1st to 3rd vertebrae and retroperitoneal space. Histological examination of the tumor showed proliferation of spindle-shaped cells intermingled with rhabdomyoblasts in a fascicular and storiform growth pattern. Tumor cells showed immunoreactivity for vimentin, desmin, muscle-specific actin, sarcomeric actin, alpha-smooth muscle actin and CD99, and partial immunoreactivity for myoD1, myf-4, myogenin and myoglobin. Reverse transcription polymerase chain reaction demonstrated expression of myoD1. On the basis of the aforementioned findings, a poorly differentiated spindle cell variant of embryonal RMS was diagnosed. The patient underwent combined therapy with chemotherapy and radiotherapy, but died 17 months after incisional biopsy. The present case is instructive in differential diagnosis of primary bone tumors, and the possibility of skeletal RMS needs to be considered.

Serum Bone Turnover Markers in Patients with Primary Bone Tumors

Objectives: It was the aim of this study to investigate parameters of bone turnover such as serum bone-specific alkaline phosphatase (BALP) and N-terminal midfragment of osteocalcin (N-MID), as well as serum C-terminal telopeptide of type I collagen (CTX) in patients with primary bone tumors and to investigate their validity in differentiating malignant from benign bone tumors. Methods: A total of 219 patients with primary bone tumors entered the study. The patients were divided into 2 groups according to their age, including a teenage (10–19 years old) and an adult group (≧20 years old). In each group, the patients were divided into several subgroups (osteosarcoma, benign bone tumors or tumor-like lesions, giant cell tumor, and other primary malignant bone tumors). An age- and gender-matched control population was also studied in each group. Blood samples were taken for measurement of serum BALP, N-MID and CTX. Results: The serum BALP levels in patients with osteosarcoma were significantly higher than those of patients in the other subgroups and the controls, both in the teenage (p = 0.01) and the adult group (p = 0.000). The serum N-MID and CTX levels did not significantly differ among patients of different subgroups and the controls, both in the teenage (p = 0.773 and p = 0.747, respectively) and the adult group (p = 0.163 and p = 0.074, respectively). Conclusions: A high serum BALP level is valuable for the diagnosis of adult osteosarcoma, but its use in the development of a differential diagnosis in the teenage patients is not advised because serum BALP levels are also affected by age, pubertal stage and growth velocity. Both serum N-MID and serum CTX are hardly useful in the differential diagnosis of primary bone tumors.

Fine-needle aspiration of chondrosarcoma

Fine-needle aspiration (FNA) is a reliable, safe and cost-effective procedure with an established role in the diagnosis of various solid tissue neoplasms. However, the role of FNA in the diagnosis of primary bone tumors, including chondrosarcoma (CS) is controversial. To determine the accuracy of FNA as a diagnostic procedure, the author reviewed the institutional experience of a series of patients with CS who underwent FNA for diagnosis. The author's objectives were to determine the accuracy of the technique as well as possible limitations to sensitivity and specificity, and perhaps to suggest the most appropriate use for this procedure. Computer records and then subsequently archives of the department were searched for patients diagnosed and treated for CS between 1993 and 2003. Patients without adequate clinical follow-up, missing materials or records otherwise unavailable for review were eliminated from study. All patients who underwent FNA for a diagnosis had to have a subsequent histological confirmation to be included in the study. FNAs were largely performed with image-guided assistance. In those that were palpable, the aspiration was performed by the aspiration cytologist using standard methods. Histologic materials were processed according to standard methods. All cytological and histologic materials were reviewed for accuracy and appropriateness of diagnosis by the author. There were 34 aspirates from 32 patients with CS (2 patients with 2 aspirates each). Attempts at diagnoses were made from 27 primary lesions, 6 recurrent lesions, and one metastatic lesion. There were an additional two patients who were assigned a diagnosis of CS on FNA who ultimately were proven to have chondroblastic osteosarcoma. Of the primary CS, 18 were definitively diagnosed as CS or "malignant chondroid neoplasm," 8 of the aspirates were considered equivocal in that an additional diagnostic procedure was required to clarify or confirm the diagnosis. Two aspirates were diagnosed as negative. Both of the false negatives were due to inadequate sampling of the lesion on FNA. Diagnostic accuracy of FNA for primary CS in this series was 67% (18/27). Accuracy for recurrent or metastatic lesions was higher at 86% (6/7). FNA appears to be a reliable means of diagnosis of recurrent and/or metastatic CS in patients with a documented history. In primary lesions, however, the accuracy of the technique is lower. In addition, there are problems of sampling chondroid components of non-CS lesions such as this study's experience with chondroblastic osteosarcoma.

Imaging and differential diagnosis of primary bone tumors and tumor-like lesions of the spine

Primary bone tumors and tumor-like lesions of the spine and sacrum are rare. A wide variety of benign and malignant lesions can arise in the spine and sacrum. Specific diagnosis is based on the location, matrix appearance and patient's age at time of presentation. In this location CT is often necessary for matrix characterization, particularly, detection of mineralization. MRI can be helpful for further characterization and radiological differential diagnosis. An overview of age distribution and imaging features including pattern for differential diagnosis is presented for the most frequent primary spinal bone tumors and tumor-like lesions.