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! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Description}}
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|I
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*Inactive or static lesions
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|II
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*Actively growing lesions
*Most osteochondromas occur in this stage.
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|III
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*Actively growing lesions that are locally destructive/aggressive
*Deformity secondary to mass effect
*Malignant degeneration
*Low-grade chondrosarcoma
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Revision as of 19:31, 28 January 2016

Stage Description
I
  • Inactive or static lesions
II
  • Actively growing lesions
  • Most osteochondromas occur in this stage.
III
  • Actively growing lesions that are locally destructive/aggressive
  • Deformity secondary to mass effect
  • Malignant degeneration
  • Low-grade chondrosarcoma


Differential Diagnosis Similar Features Differentiating Features
Enchondroma
  • Usually found in children, enchondromas are asymptomatic
  • These tumors arise from rests of growth plate
  • Located in the metaphyseal region
  • In enchondroma, differentiating features include:
  • Imaging features, such as endosteal scalloping, well circumscribed masses, and lytic lessions
Chondroblastoma
  • Benign cartilaginous neoplasm
  • Affects young patients
  • Located on long bones
  • In chondroblastoma, differentiating features include:
  • They arise in the epiphysis or apophysis of a long bone
  • Classical location is one-third of the tibia
Periosteal chondroma
  • Benign cartilaginous neoplasm
  • Commonly located on the proximal humerus and distal femur
  • Affects young patients
  • In periosteal chondroma, differentiating features include:
  • Symptomps are usually present for a long period of time
  • Imaging features include there is no stalk or peduncle as in an osteochondroma
Chondromyxoid fibroma
  • Benign cartilaginous neoplasm
  • Located in the metaphyseal region of long bones
  • In chondromyxoid fibroma, differentiating features include:
  • Occur in young adults (second and third decades)
  • Usually located in the tibia


Type of osteochondroma Features
Solitary osteochondroma
  • Non-hereditary
  • 85% of osteochondromas
  • No genetic mutations
  • Located in long bones, 85% of osteochondromas
  • Onset is in early adolescence
Multiple osteochondromas (hereditary)
  • Hereditary
  • Approximately 20% of osteochondromas
  • Related genetic mutations EXT-1 and EXT-2,
  • Early onset of disease (newborn or children)



Genes implicated in HNPCC Frequency of mutations in HNPCC families Locus
MSH2 approximately 60% 2p22
MLH1 approximately 30% 3p21
MSH6 7-10% 2p16
PMS2 relatively infrequent 7p22
PMS1 case report 2q31-q33
TGFBR2 case report 3p22
MLH3 disputed 14q24.3







Type of osteoid osteoma Characteristics
Intracortical Dense sclerosis around the nidus
Periosteal Periosteal reaction
Cancellous (medullary) Produces very little reactive bone
Subarticular Simulates arthritis as it produces synovial reactions



Differential Diagnosis Similar Features Differentiating Features
Osteoblastoma
  • Benign, male predilection, and also present in long bones
  • In osteoblastoma, differentiating features include: uncommon tumor, affect the axial skeleton more frequently and lesions are typically larger than 2 cm
Brodie abscess
  • Present in children, limb pain, and ocassionaly affects long bones
  • In brodie abscess differentiating features include: fever, subacute onset, and location is usually affects the metaphysis of tubular bones
Osteosarcoma
  • Affects same group of population (children and adolescents), patients usually present with bone pain, and the location is usually long bones
  • In osteosarcoma, differentiating features include: malignancy, infiltration to surrounding tissue, and elevation of serum alkaline phosphatase (ALP)
Enostosis
  • Affects same group of population (children and adolescents), small size, and the location is usually long bones
  • In enostosis, differentiating features,include: pathognomonic radiological appearance, incidental finding
Differential Diagnosis Similar Features Differentiating Features
Fibrous dysplasia
  • Benign, often an incidental finding, and affects the same group of patients.
  • In fibrous dysplasia, differentiating features include: More common presentation is on ribs: 28%, no gender predilection, and complete resection is usually not possible.
Osteoblastoma
  • Benign, incidental, and male predilection.
  • In osteoblastoma, differentiating features include: normally affect the axial skeleton, lesions are typically larger than 2 cm, and surgical excision is often the treatment of choice.
Adamantinomas
  • Benign, slow growing, similar clinical onset.
  • In adamantinomas , differentiating features include: locally aggressive tumor, common in the 3rd to 5th decades of life, location is usually confined to the jaw.
Chronic sinusitis
  • Affects same group of population (young to middle aged adults), clinical onset is similar.
  • In chronic sinusitis, differentiating features include: fever, previous history of acute sinusitis, and lack of facial deformation or imaging findings compatible with osteoma.




Differential Diagnosis Similar Features Differentiating Features
Cardiac tamponade
  • Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension.
  • In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes.
Chronic obstructive pulmonary disease
  • Elevated jugular venous pulse (JVP), shortness of breath, and tachypnea.
  • In cardiac tamponade, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%.
Mediastinitis
  • Elevated venous pressure, tachypnea and shortness of breath.
  • In mediastinitis, differentiating features include: fever, positive confirmation of organisms and elevated leukocytes.
Pneumonia
  • Hypotension, tachypnea,cough, and chest pain.
  • In pneumonia, differentiating features include: Bronchial breath sounds, leukocytosis with left shift, positive blood culture and altered laboratory findings (procalitonin).
Acute respiratory distress syndrome
  • Low blood pressure,hypotension, and shortness of breath.
  • In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles and pulmonary wedge pressure < 18 mmHg.
Syphilis
  • Enlarged lymph nodes, hypotension and dysphagia.
  • In syphilis, differentiating features include: Positive treponemal tests, history of unprotected sex, and superficial mucosal patches.


Differential Diagnosis Similar Features Differentiating Features
Familial adenomatous polyposis (FAP)
  • Familial inheritance, increased risk of colorectal cancer, extra-colonic tumors.
  • Autosomal recessive, 100+ polyps and age under 40, centinel tumors are differently located than HNPCC, such as: Osteomas, dental anomalies, congenital hypertrophy of the retinal pigment epithelium (CHRPE)
Juvenile polyposis
  • Familial inheritance, autosomal dominant, high risk of GI and non GI cancer, also a germline mutation.
  • Gastrointestinal hamartomatous polyps, on physical exam lip pigmentation is common.
Cowden syndrome
  • Rare autosomal dominant inherited disorder, increased risk of colorectal cancer, also has gene mutations.
  • Intestinal hamartomatous polyps, physical exam may show macrocephaly, gene affected PTEN.