Differential Diagnosis for Bone Lesions

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

DD for Bone Lesions based on the location of the bone

Bone Section	Lesions
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 Lesions	Older 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

Differential Diagnosis for Bone Lesions based on the bone type

Bone	Lesions
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)

Differential Diagnosis for Bone Lesions based on age

Age	Benign Lesions	Malignant Lesions
Infants and children (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)

References & More

• Campbel’s Operative Orthopaedics 12th edition Book.
• Millers Review of Orthopaedics -7th Edition Book.
• Subramanian S, Viswanathan VK. Lytic Bone Lesions. [Updated 2022 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539837/
• Ewerbeck V, Mau H. Differentialdiagnose der benignen Knochentumoren. Klinik und bildgebende Verfahren [Differential diagnosis of benign bone tumors. Clinical aspects and imaging procedures]. Orthopade. 1995 Feb;24(1):15-23. German. PMID: 7892002.