Skeletal Metastases
Christopher G. Anton, MD
DIFFERENTIAL DIAGNOSIS
Common
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Neuroblastoma
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Leukemia
Less Common
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Rhabdomyosarcoma
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Ewing Sarcoma
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Osteosarcoma
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Retinoblastoma
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Lymphoma
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Medulloblastoma
Rare but Important
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Clear Cell Sarcoma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Neuroblastoma, sometimes leukemia, rarely lymphoma, may present with multiple skeletal metastases (mets)
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Langerhans cell histiocytosis and multifocal osteomyelitis may mimic skeletal mets
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Metastatic bone disease looks alike; can be lytic, sclerotic, or mixed
Helpful Clues for Common Diagnoses
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Neuroblastoma
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Most common metastatic bone tumor in pediatrics
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Bone mets: Lucent, sclerotic, or mixed
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Liver mets also common
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Leukemia
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1/4 of children with leukemia have bone mets
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Children: Long bones
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Femur > humerus > pelvis > spine > tibia
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Spectrum of radiographic findings: Normal, diffuse osteopenia, “leukemic lines,” periostitis, bone destruction, sclerosis, pathologic fracture, chloroma
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Helpful Clues for Less Common Diagnoses
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Rhabdomyosarcoma
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Lung mets most common
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Bone mets has poorer prognosis
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Ewing Sarcoma
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More commonly metastasizes to lung, 15-30% at presentation
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Mets to bone less frequent
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Osteosarcoma
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More commonly metastasizes to lungs (calcifying nodules)
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Bone mets may be blastic
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Retinoblastoma
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May have blastic bone mets
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Lymphoma
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Focal or patchy marrow involvement
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Medulloblastoma
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Often blastic mets
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