The diagnosis and differential diagnosis of bone tumor is a comprehensive judgment process, which requires a combination of clinical, imaging and pathology.
I. Diagnosis of patients with bone disease we need to distinguish.
1, tumor and non-tumor.
2.Tumor or tumor-like.
3, whether the tumor is benign or malignant.
4.The origin of the tumor.
5, whether the tumor is primary or secondary.
Classification and differential diagnosis of benign and malignant bone tumors
1.Classification
Benign (55.7%): osteochondroma, chondrosarcoma, osteoma, ossifying fibroma, hemangioma, bone-like osteoma, giant cell tumor of bone grade I-II.
Malignant (27.2%): osteosarcoma, chondrosarcoma, fibrosarcoma, osteomyeloma, Ewing’s sarcoma, and giant cell tumor of bone grade III.
Neoplastic lesions (11.2% ): fibrous heteroplasmosis, bone cyst, eosinophilic granuloma.
2.Differential diagnosis
C. Characteristics of primary bone tumors.
1.Low incidence, mostly in adolescents.
2.Surgical treatment is the main means. Some malignant tumors such as osteosarcoma, fibrosarcoma, lymphoma and Ewing’s sarcoma need other treatments such as chemotherapy and radiotherapy.
3.Benign tumors and tumor-like tumors (as below) are subject to lumpectomy or intracapsular resection, with better prognosis; intermediate bone tumors with higher recurrence rate can be treated with extra-marginal resection or extensive and radical resection biological or mechanical reconstruction; malignant tumors are treated with palliative surgery, lumpectomy mechanical reconstruction or non-surgical-based comprehensive treatment.
4. Diagnosis is the first and treatment is the second.
4. Characteristics of bone metastases (see below).
1.Higher incidence, mostly middle-aged and elderly.
2.The rate of diseases seen in bone oncology department is increasing year by year.
3.Onset sites are often multiple, diagnosis needs to be integrated with various clinical data, and indicators of clinical monitoring are complicated.
The treatment is mainly comprehensive, and the focus of treatment is to improve the quality of life and prolong the life time.
V. Identification of bone metastases.
1.Multiple myeloma: imaging manifestations are mostly penetrating chisel-like changes, especially in the skull, pelvis and spine lesions are more obvious, urine periampullin is often positive, and serum protein is abnormal.
2.Lymphoma: Most lymphomas occurring in the skeletal system are non-Hodgkin’s lymphoma, which is a stage IV manifestation with poor prognosis, mostly in adolescents, with diffuse osteolytic destruction and with or without generalized lymph node enlargement.
Ewing’s sarcoma: Mostly adolescent patients, with a history of fever before onset, often accompanied by elevated white blood cells. The imaging manifestation is mostly osteolytic destruction with poorly defined borders.
4, isolated bone metastases: need to be distinguished from tuberculosis, giant cell tumor of bone, fibrosarcoma, etc.