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Primary Malignant Bone Tumors: Epidemiology
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Classification: WHO Classification of Malignant Bone Tumors
Osteogenic tumors
Osteosarcoma
Conventional
Chondroblastic
Fibroblastic
Osteoblastic
Telangiectatic
Small cell
Low-grade central
Secondary
Parosteal
Periosteal
High-grade surface
Ewing sarcoma/primitive neuroectodermal tumor
Ewing sarcoma
Cartilage tumors
Chondrosarcoma
Central, primary, and secondary
Peripheral
Dedifferentiated
Mesenchymal
Clear cell
Fibrogenic tumors
Fibrosarcoma
Fibrohistiocytic tumors
Malignant fibrous histiocytoma
Giant cell tumor
Malignancy in giant cell tumor
Notochordal tumors
Chordoma
Vascular tumors
Angiosarcoma
Smooth muscle tumors
Leiomyosarcoma
Lipogenic tumors
Liposarcoma
Miscellaneous tumors
Adamantinoma
Hematopoietic tumors (see respective sections)
Plasma cell myeloma
Malignant lymphoma, NOS
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Work-up
History and physical examination
Laboratory tests: CBC with differential; electrolytes; liver function tests; mineral panel, including alkaline phosphatase; lactate dehydrogenase
Plain films of affected bone
Chest x-ray (PA and lateral)
CT scan of chest, abdomen, and pelvis (particularly chest because 80% of metastatic lesions occur here)
MRI to ascertain extent of the tumor, involvement of surrounding neurovascular structures, invasion of the adjacent joint, and the presence of skip metastases
Bone scan to identify skip lesions within affected bones or distant metastatic disease
Bone marrow aspirate for light microscopy examination in the case of Ewing sarcoma
No radiologic studies are pathognomonic, so bone biopsy remains essential to diagnosis
Echocardiogram or MUGA scan to determine cardiac ejection fraction as clinically indicated
Audiogram before cisplatin chemotherapy
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