Pediatric bone tumors: Clinical

Osteosarcoma and Ewing's sarcoma are primary skeletal malignancies that can occur in children.

The tumors cause similar signs and symptoms, so the diagnosis is based on radiography findings and biopsy results.

Both bone tumors cause a dull, aching pain that is mostly non-responsive to NSAIDs or acetaminophen.

One particular aspect of the pain in bone tumors is that the initial mild pain becomes increasingly severe over a few months and sometimes gets worse at night.

Additionally, the site might be swollen and occasionally there can be pathologic fractures after seemingly minor trauma.

Palpation might also reveal a soft tissue mass.

In osteosarcoma, the tumors are mostly on the metaphysis of a long bone like the femur or tibia, while Ewing’s sarcoma most frequently involves the diaphyseal or meta-diaphyseal regions of long bones like the femur, or the pelvis.

Other locations for these tumors include the hip, spine, chest wall, and for Ewing’s sarcoma, even soft tissues.

Usually there’s an isolated localized tumor, but some individuals also have pulmonary metastases, and that can happen for both Osteosarcoma and Ewing's sarcoma. In those situations, individuals can also have dyspnea or cough.

Finally, systemic symptoms such as fever, weight loss, and decreased appetite are quite rare.

If there’s suspicion of a bone tumor, the first step is local plain radiographs.

Let’s start with osteosarcoma which is a tumor derived from neuroectodermal tissue.

Plain films of the tumor site often reveal medullary and cortical bone destruction and a wide zone of transition with a moth-eaten appearance.

The associated soft tissue mass is variably ossified in a radial or "sunburst" pattern, which is characteristic for osteosarcomas, alongside Codman triangle which is a triangular area of new subperiosteal bone that is created when a tumor raises the periosteum away from the bone.