Table 6 Differential diagnosis of Adamantinoma
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 |