Differential Diagnosis for Bone Lesions

January 9, 2021 || By : Dr. MhmadFarooq || Orthopaedic Pathology


What are the Differential Diagnosis for Bone Lesions based on the location of the bone?

Bone lesions can be found in any location of the bone, but every location of the bone has it’s own lesions.

Bone SectionLesions
Epiphyseal Lesions■ Chondroblastoma (ages 10-25)
■ Giant cell tumor (ages 20-40)
■ Clear chondrosarcoma (rare)
Diaphyseal Lesions■ Ewing sarcoma (ages 5-25)
■ Lymphoma (adult)
■ Fibrous dysplasia (ages 5-30)
■ Adamantinoma (consider in the tibia)
■ Histiocytosis (ages 5-30)
Spine LesionsOlder than 40 Years:
■ Metastases
■ Multiple myeloma
■ Hemiangioma
■ Chordoma (in sacrum)
Younger than 30 Years:
■ Vertebral body
■ Histiocytosis
■ Hemangioma
■ Posterior elements
■ Osteoid osteoma
■ Osteoblastoma
■ Aneurysmal bone cyst
Multiple Lesions■ Histiocytosis
■ Enchondroma
■ Osteochondroma
■ Fibrous dysplasia
■ Multiple myeloma
■ Metastases
■ Hemangioma
■ Infection
■ Hyperparathyroidism

What are the Differential Diagnosis for Bone Lesions based on the bone type?

BoneLesions
Sacrum in young patients (10-40)– Giant cell tumor
– ABC
– Ewing’s
– Osteosarcoma
Sacrum in older patients (40-80)– Chordoma
– Metastasis
– Myeloma
– Lymphoma
– Chondrosarcoma
– MFH
Tibial lesions– Adamantinoma
– Osteofibrous dysplasia
– Fibrous dysplasia
– Osteomyelitis
Hand and Foot Intramedullary destructive
lesions
– Enchondroma
– Giant cell tumor
– ABC
– Giant cell reparative granuloma
– Metastatic carcinoma (only in older patients)

What are the Differential Diagnosis for Bone Lesions based on age?

AgeBenign LesionsMalignant Lesions
Infants and childres
(0 to 5 years)
– Osteomyelitis
– Osteofibrous dysplasia
– Metastatic rhabdomyosarcoma
– Metastatic neuroblastoma
– Leukemia
Young patient
(10-40 years)
– NOF
– Osteoid osteoma
– Giant cell tumor
– ABC
– UBC
– Osteochondroma & MHE
– Chondroblastoma
– Fibrous dysplasia
– Osteomyelitis
– Eosinophillic granuloma
– Osteosarcoma
– Ewing’s
– Desmoplastic fibroma
– Leukemia
– Lymphoma
Older patient
(40-80 years)
– Enchondroma
– Bone infarct
– Bone island
– Paget’s disease
-Hyperparathyroidism
– Metastatic bone disease
– Myeloma
– Lyphoma
– Chondrosarcoma
– MFH
– Secondary sarcoma (Paget’s, irradiation)
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