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