Table 6 |
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Differential diagnosis of Adamantinoma |
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Lesions |
Age (yrs) |
Sex M:F |
Site |
Location |
Clinical Features |
Radiological Features |
Gross |
Microscopy |
IHC |
Treatment |
Remarks |
|
|
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Aneurrysmal bone cyst |
10–15 |
1:1 |
Vertebrae, flat bones, humerus, tibia |
Metaphysis |
Usually history of trauma, f/b gradually increasing swelling with little pain. There may be pathological fracture or spinal pressure symptoms |
Well defined radiolucent, eccentric cyst |
Spongy hemorrhagic mass |
Fibrous tissue, vascular spaces |
IGF-1 |
Curettage with bone grafting |
May heal spontaneously Benign |
|
Unicamaral bone cyst |
10–20 |
3:1 |
Humerus, femur |
Metaphysis |
Usually asymptomatic |
Well demarcated, radiolucent cyst extending up to physeal plate |
Cystic mass |
Well vascularised fibrous tissue with hemosiderin and cholesterol clefts |
NA |
Curettage with bone grafting |
Benign |
|
Fibrous dysplasia |
10–30 |
3:2 |
Neck of femur, tibia, base of skull |
Metaphysis diaphysis |
May be mono or polyostotic, pathological fractures and progressive deformity |
Cystic areas in metaphysis, lucent patches typically have ground glass appearance |
Coarse gritty, Grayish yellow |
Loose cellular fibrous tissue with widespread patches of woven bone and scattered giant cells |
NA |
Depending upon location and type of deformity |
Locally aggressive, rarely sarcoma Develops, Associated Albright syndrome |
|
Chondromyxoid Fibroma |
10–25 |
1:1 |
Tibia, fibula, femur, feet, pelvis |
Metaphysis |
Asymptomatic, pathological fracture |
Eccentrically placed lytic lesion with well defined sclerotic margins |
Solid yellowish white or tan |
Patches of myxomatous tissue with stellate cells, islands of hyaline cartilage, fibrous tissue |
S-100 |
Excision |
Benign |
|
Giant cell tumor |
20–40 |
4:5 |
Epiphysis and metaphysis |
Femur, tibia, radius |
Pain with swelling, pathological fracture |
Eccentric, cystic lesion in mature bone, extending up to the subchondral plate, soap bubble appearance |
Reddish fleshy mass |
Multinucleated giant cells, stromal cells, cellular atypia with mitotic figures |
Muscle actin, alpha-smooth muscle actin and CD68 |
Depending upon severity of lesion, curettage with bone graft to excision |
Potentially malignant, 50% recur, 10% metastasize |
|
Eosinophilic granuloma |
5–10 |
2:1 |
Metaphysis |
Flat bones, mandible, spine and long bones |
Local pain, swelling and tenderness |
Well demarcated oval radiolucent area, associated with marked reactive sclerosis |
Soft, granular or gelatinous mass |
Sheets of Langerhan's cells |
CD-1a, S-100 |
Excision or curettage |
Usually heals spontaneously |
|
Osteomyelitis |
Any age |
Male outnumbers female |
Metaphysis, diaphysis |
Distal femur, proximal tibia, proximal femur and proximal humerus |
Discharging sinus, fever, malaise, local pain and swelling |
Multiple aggressive lytic lesions, serpiginous lytic pattern is more specific sequestrum and involucrum are often seen |
Bone destruction, cavities containing pus with sequestrum |
Inflammatory cells around areas of acellular bone or microscopic sequestra, prominent periosteal bone proliferation |
NA |
Removal of sequestrum antibiotic, excision of sinuses |
Variable prognosis |
|
Chondrosarcoma |
30–60 |
3:1 |
Metaphysis |
Pelvis, rib, humerus, femur, vertebrae |
Dull ache or gradullay enlarging lump |
Radiolucent area with central flecks of calcification |
Lobulated with gelatinous shiny areas |
Lobules of highly atypical cells, including binucleate cells. |
S-100, Vimentin |
Wide excision |
Malignant |
|
Epithelial metastasis |
Any age |
Variable |
Pattern of these lesions is more diffuse than regional |
Vertebrae, pelvis, rib, femur, skull, humerus(rare below elbow and knees) |
Pain |
Bone destruction, osteolytic; osteoblastic response with Ca prostate |
Osteolytic, rarely sclerotic |
Malignant cells with vascular invasion |
Depend on the site of primary |
Osteoclast inhibiting agents, radiation therapy |
Most common primaries breast, prostate, lung, kidney, and thyroid |
|
Hemangioendothelioma |
20–30 |
2:1 |
Metaphyseal, diaphyseal, or, less commonly, epiphyseal. |
Calvarium, femur, tibia and feet |
Pain and swelling |
Expansive, osteolytic and poorly demarcated lesions. "soap-bubble" matrix with a sclerotic margin |
Well-circumscribed, irregular borders soft, bright red hemorrhagic appearance |
Solid nests and anastomosing cords of round, polygonal, or spindle-shaped cells with eosinophilic cytoplasm. Intracytoplasmic vacuolization |
Factor VIII, CD31, CD34 |
Depending on the grade of the lesion currettage, or wide resection |
Multifocal in up to 50% of cases and may be mono-ostotic or polyostotic locally aggressive, metastasize to bone and lung |
|
Angiosarcoma |
Any age |
Older male |
Metaphyseal and diaphyseal |
Any bone, multifocal |
Pain and swelling |
Eccentric, lytic, metaphyseal and diaphyseal, well circumscribed areas of rarefaction |
Variable |
Anastomosing vascular channels lined by highly atypical endothelial cells |
Factor V11I, CD31, CD34 |
Wide resection and adjuvant therapy |
Malignant |
|
Nonossifying fibromas |
10–20 |
1:1 |
Tibia, femur |
Metaphysis |
Pain |
Eccentric, sharply delimited lesion |
Solid, Granular, brown, dark red |
Fibrous tissue arranged in storiform pattern, foamy and hemosiderin laden macrophages |
Little or no application |
Not necessary |
Benign |
|
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ABBREVIATION: IGF: Insulin like growth factor, IHC: Immunohistochemistry, f/b: followed by, NA: Not applicable |
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Jain et al. Diagnostic Pathology 2008 3:8 doi:10.1186/1746-1596-3-8 |
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