Bone tumors under 10 years age

1-Neuroblastoma :

 

Neuroblastoma is a solid tumor arising from embryonal cells. In most instances the primary is in the abdomen, but metastases are very frequent. Due to dissemination to the bones, one of the most common presentations is pain in the bones and a limping gait. The urine catecholamines, vanillylmandelic acid and homovanillic acid, are elevated in 90% of patients and are highly accurate for diagnostic purposes. The prognosis depends on the severity of dissemination. Localized neuroblastoma might have excellent prognosis with excision of the tumor. The outcome of patients with disseminated disease is poor. The x-ray shown demonstrates a permeative destructive lesion involving the proximal fibula (arrow), associated with periosteal reaction and soft-tissue mass due to metastatic neuroblastoma.

2-Ewing's Sarcoma of long bones :

 

Ewing sarcoma of femur. Frontal radiograph and lateral radiographs of the femur
demonstrate mottled, osteolytic lesion (blue circle) with poorly marginated edges in the diaphysis of the bone.
There is sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white arrows).

Differential Diagnosis

• Ewing sarcoma is one of the small, round cell lesions of bone, including
• Neuroblastoma
• Histiocytosis X
• Leukemia
• Reticulum cell sarcoma
• Multiple myeloma
• Age and skeletal location may be important factors in narrowing the differential diagnosis
• Osteomyelitis
• Shorter duration of pain and less aggressive periosteal reaction than Ewing’s
• Eosinophilic granuloma
• Benign bone lesion with solid periosteal reaction
• Osteosarcoma
• Commonly occurs in long bones of young patients
• Homogeneous, cloudlike osteoid deposition in soft tissues
• Lymphoma
• Older age range
• Clinically healthy

While neuroblastoma usually occurs within first two years of life, the Ewing's sarcoma usually occurs within 5-30 years of life.