In children, most tumors and benign primary nature are, some are malignant (z. B. osteosarcoma, Ewing’s sarcoma). Metastatic tumors (z. B. neuroblastoma, Wilms’ tumor) are rare. The bone may also be affected by leukemia and lymphoma in childhood.

Bone tumors can be primary or metastatic, benign or malignant. In children, most tumors and benign primary nature are, some are malignant (z. B. osteosarcoma, Ewing’s sarcoma). Metastatic tumors (z. B. neuroblastoma, Wilms’ tumor) are rare. The bone may also be affected by leukemia and lymphoma in childhood. In adults, especially those over 40 years, metastatic tumors occur about 100 times more common than primary malignant tumors. If you close the bone marrow cell tumors (z. B. multiple myeloma) out there in the US each year, only about 2,500 cases of primary malignant bone tumors in children and adults. Synovialtumoren both children and adults are extremely rare. When pigmented villonodular synovitis is a benign but occasionally destructive tumor of the synovial cells. The synovial sarcoma (often both spindelzell- and gland-like components) is a malignant soft tissue tumor nichtsynovialen origin, who rarely occurs within a joint. Symptoms and complaints bone tumors typically cause unexplained, progressive pain and swelling. The pain can no load or bone stress and at rest and occur at night. Diagnostic X-rays Usually MRT rule and occasionally CT bone scan for suspected multicenter or metastatic tumors biopsy, unless the imaging clearly demonstrate the benign character is the most common reason for delayed diagnosis of bone tumors that doctors suspect no tumor and arrange any suitable imaging. Bone tumors should be considered in patients who have unexplained bone pain, particularly pain at night or at rest. Persistent or progressive unexplained pain in the trunk or extremities, v. a. associated with a palpable mass, are suspicious. X-ray plain films represent the first examination. Tumors should be suspected when an imaging study shows an unexplained anomaly that is consistent with a tumor. Lesions that can be a tumor suspect usually require additional clarification, often with additional imaging tests and a biopsy. Tips and risks A bone tumor is to be considered in patients who have unexplained bone pain, especially at night or at rest. Characteristic findings Some tumors (z. B. Paget’s disease, nichtossifizierendes fibroma, fibrous dysplasia, enchondromas) show characteristic radiologic findings and can be diagnosed without biopsy. Radiological findings giving rise to suspicion of a cancer are: lytic, destructive or permeatives appearance irregular tumor limits areas, v. a. a plurality of regions of bone resorption (moth-eaten like appearance) cortical destruction soft tissue expansion pathological fracture a lytic appearance is characterized by clear regions of the bone destruction that are sharply defined. A permeatives appearance is characterized by a weak, gradual bone loss or an infiltration pattern without clear boundaries. Certain tumors have a characteristic appearance (for example, often shows the Ewing’s sarcoma bone removal from permeative type, including a large soft tissue mass with periosteal, zwiebelschalenartigem reactive bones before a vast, lytic, destructive appearance there;.. The giant cell tumor has a cystic look no sclerotic interface between tumor and normal bone). The localization of the tumor, the differential diagnostic possibilities constrict (z. B. itself shows Ewing’s sarcoma in the shaft of a long bone, osteosarcoma occurs in the metaphyseal-diaphyseal region at the end of a long bone on the giant cell tumor concerns usually the epiphysis). However, some benign diseases can mimic a malignant tumor: A heterotopic ossification (myositis ossificans) and an excessive callus formation after fractures mineralization can cause the bone cortex and adjacent soft tissue and thus mimic a malignant tumor. Langerhans cell histiocytosis (histiocytosis X, Letterer-Siwe disease, Hand-Schuller-Christian disease, eosinophilic granuloma) may cause solitary or multiple bone lesions, usually to distinguish radiographically. Solitary lesions may be a periosteal new bone formation that suggests a malignant bone tumor. The osteopoikilosis (dotted bone) is an asymptomatic disease with no clinical significance, but can simulate osteoblastic bone metastases in breast cancer. It is characterized by multiple, small, round or oval lesions with bony sclerosis, mostly in the tarsal, carpal or pelvic bone or in the metaphyseal-epiphyseal region of long bones. Other test methods CT and MRI, the location and extent of a tumor to help determine and sometimes suggest a specific diagnosis. An MRI is usually done when cancer is suspected. If the suspected metastatic or multifocal tumors, a technetium bone scan should be performed to look for additional tumors. A biopsy is essential for the diagnosis of malignant tumors in general, unless the imaging studies show a classically benign appearance. The pathologist should be informed conclusive details of the clinical history and imaging tests. Histopathological diagnosis can be difficult and requires a sufficient amount of vital tissue from a representative portion of the tumor (usually the soft portion). The best results are obtained in centers with extensive experience in bone biopsies. Immediate, accurate and definitive diagnosis is possible in 90% of cases. If a malignant diagnosis is suspected because the histology of the frozen sections, the surgeon will often wait for the results of the permanent histology, before beginning the final treatment. Errors occur more frequently in hospitals that treat rare patients with malignant primary bone tumors. Summary In children, most tumors primary and benign nature, some are primary and malignant and very few are metastatic. In adults, especially those over 40 years, metastatic tumors occur about 100 times more common than primary malignant tumors. The investigation begins with X-ray plain films, but usually requires an MRI and often further investigation. The general radiographic findings that suggest a cancer that includes a destructive appearance (especially with multiple foci), irregular tumor margins, cortical destruction, expansion into the soft tissues and pathological fractures. For the diagnosis of malignant tumors, a biopsy is needed.

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