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Table 6 Differential diagnosis of Adamantinoma

From: Adamantinoma: A clinicopathological review and update

Lesions Age (yrs) Sex M:F Site Location Clinical Features Radiological Features Gross Microscopy IHC Treatment Remarks
Aneurrysmal bone cyst 10–15 1:1 Vertebrae, flat bones, humerus, tibia Metaphysis Usually history of trauma, f/b gradually increasing swelling with little pain. There may be pathological fracture or spinal pressure symptoms Well defined radiolucent, eccentric cyst Spongy hemorrhagic mass Fibrous tissue, vascular spaces IGF-1 Curettage with bone grafting May heal spontaneously Benign
Unicamaral bone cyst 10–20 3:1 Humerus, femur Metaphysis Usually asymptomatic Well demarcated, radiolucent cyst extending up to physeal plate Cystic mass Well vascularised fibrous tissue with hemosiderin and cholesterol clefts NA Curettage with bone grafting Benign
Fibrous dysplasia 10–30 3:2 Neck of femur, tibia, base of skull Metaphysis diaphysis May be mono or polyostotic, pathological fractures and progressive deformity Cystic areas in metaphysis, lucent patches typically have ground glass appearance Coarse gritty, Grayish yellow Loose cellular fibrous tissue with widespread patches of woven bone and scattered giant cells NA Depending upon location and type of deformity Locally aggressive, rarely sarcoma Develops, Associated Albright syndrome
Chondromyxoid Fibroma 10–25 1:1 Tibia, fibula, femur, feet, pelvis Metaphysis Asymptomatic, pathological fracture Eccentrically placed lytic lesion with well defined sclerotic margins Solid yellowish white or tan Patches of myxomatous tissue with stellate cells, islands of hyaline cartilage, fibrous tissue S-100 Excision Benign
Giant cell tumor 20–40 4:5 Epiphysis and metaphysis Femur, tibia, radius Pain with swelling, pathological fracture Eccentric, cystic lesion in mature bone, extending up to the subchondral plate, soap bubble appearance Reddish fleshy mass Multinucleated giant cells, stromal cells, cellular atypia with mitotic figures Muscle actin, alpha-smooth muscle actin and CD68 Depending upon severity of lesion, curettage with bone graft to excision Potentially malignant, 50% recur, 10% metastasize
Eosinophilic granuloma 5–10 2:1 Metaphysis Flat bones, mandible, spine and long bones Local pain, swelling and tenderness Well demarcated oval radiolucent area, associated with marked reactive sclerosis Soft, granular or gelatinous mass Sheets of Langerhan's cells CD-1a, S-100 Excision or curettage Usually heals spontaneously
Osteomyelitis Any age Male outnumbers female Metaphysis, diaphysis Distal femur, proximal tibia, proximal femur and proximal humerus Discharging sinus, fever, malaise, local pain and swelling Multiple aggressive lytic lesions, serpiginous lytic pattern is more specific sequestrum and involucrum are oft en seen Bone destruction, cavities containing pus with sequestrum Inflammatory cells around areas of acellular bone or microscopic sequestra, prominent periosteal bone proliferation NA Removal of sequestrum antibiotic, excision of sinuses Variable prognosis
Chondrosarcoma 30–60 3:1 Metaphysis Pelvis, rib, humerus, femur, vertebrae Dull ache or gradullay enlarging lump Radiolucent area with central flecks of calcification Lobulated with gelatinous shiny areas Lobules of highly atypical cells, including binucleate cells. S-100, Vimentin Wide excision Malignant
Epithelial metastasis Any age Variable Pattern of these lesions is more diffuse than regional Vertebrae, pelvis, rib, femur, skull, humerus(rare below elbow and knees) Pain Bone destruction, osteolytic; osteoblastic response with Ca prostate Osteolytic, rarely sclerotic Malignant cells with vascular invasion Depend on the site of primary Osteoclast inhibiting agents, radiation therapy Most common primaries breast, prostate, lung, kidney, and thyroid
Hemangioendothelioma 20–30 2:1 Metaphyseal, diaphyseal, or, less commonly, epiphyseal. Calvarium, femur, tibia and feet Pain and swelling Expansive, osteolytic and poorly demarcated lesions. "soap-bubble" matrix with a sclerotic margin Well-circumscribed, irregular borders soft, bright red hemorrhagic appearance Solid nests and anastomosing cords of round, polygonal, or spindle-shaped cells with eosinophilic cytoplasm. Intracytoplasmic vacuolization Factor VIII, CD31, CD34 Depending on the grade of the lesion currettage, or wide resection Multifocal in up to 50% of cases and may be mono-ostotic or polyostotic locally aggressive, metastasize to bone and lung
Angiosarcoma Any age Older male Metaphyseal and diaphyseal Any bone, multifocal Pain and swelling Eccentric, lytic, metaphyseal and diaphyseal, well circumscribed areas of rarefaction Variable Anastomosing vascular channels lined by highly atypical endothelial cells Factor V11I, CD31, CD34 Wide resection and adjuvant therapy Malignant
Nonossifying fibromas 10–20 1:1 Tibia, femur Metaphysis Pain Eccentric, sharply delimited lesion Solid, Granular, brown, dark red Fibrous tissue arranged in storiform pattern, foamy and hemosiderin laden macrophages Little or no application Not necessary Benign
  1. ABBREVIATION: IGF: Insulin like growth factor, IHC: Immunohistochemistry, f/b: followed by, NA: Not applicable