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Differential Diagnosis



Bone tumors

Primary Bone Tumors (single site of disease) may present with local and systemic symptoms.

Local symptoms:

  • Pain
    • Increasingly severe
    • Interferes with sleep
    • Localized to involved site
  • Adjacent soft tissue swelling

Systemic symptoms:

    • Fever
    • Night sweats
    • Weight loss

Pain is often a predominant feature.

Significant back pain in a child is unusual and should raise concerns about possible malignancy.

Differential Diagnosis of a Primary Bone Tumor:

Congenital vs Acquired




Infection Osteomyelitis
Non-infectious Arthritis and Tendonitis
Traumatic Injury  


Benign Aneurysmal Bone Cyst


Giant cell Tumor
Langerhans Cell Histiocytosis (can have a aggressive course)
Malignant Ewing Sarcoma
Osteogenic sarcoma
Primary Lymphoma of bone
Metastatic disease from another site (eg. rhabdomyosarcoma)


Multiple Bone Lesions

Differential Diagnosis of Multiple bone lesions:


Infection Disseminated Osteomyelitis
Non-infectious Rheumatoid arthritis
Traumatic Injury Multiple metastatic bone deposits in neuroblastoma can sometimes be misdiagnosed as non-accidental injury



Primary bone marrow malignancy - leukemia ALL, AML, CML



Metastatic disease to bones. For example:

  • Neuroblastoma
  • Rhabdomyosarcoma
  • PNET



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