Non-tumor

  • Bone infarct
  • Infection
  • Paget’s disease

Benign

  • Osteoid osteoma
  • Osteoblastoma
  • Enchondroma
  • Chondromyxoid fibroma
  • Non-ossifying fibroma (fibrous cortical defect, fibrous histiocytoma of bone)
  • Fibrous dysplasia
  • Osteofibrous dysplasia (in tibia)
  • Unicameral bone cyst
  • Histiocytosis X

Malignant

  • Osteosarcoma
  • Chondrosarcoma
  • Non-osteogenic spindle cell sarcoma of bone (MFH of bone, fibrosarcoma of bone)
  • Myeloma
  • Lymphoma
  • Adamantinoma (tibia and, rarely, ulna)
  • Metastatic disease

Notes

This is a long list, but it can be shortened and focused on the basis of radiographic analysis.

  • Osteoid osteoma, infection, enchondroma, bone infarct and Paget’s disease have typical Xray findings.
  • Osteofibrous dysplasia and adamantinoma are typically tibial lesions.
  • Non-ossifying fibroma, fibrous cortical defects, and chondromyxoid fibroma are eccentric geographic lesions.
  • Fibrous dysplasia is suspected by multiple bone involvement, deformities, and ground glass appearance.
  • Osteosarcoma and chondrosarcoma have typical patterns of matrix formation.
  • Non-osteogenic spindle cell sarcoma of bone (ie, MFH, fibrosarcoma, leiomyosarcoma of bone) and lymphoma classically demonstrate permeative bony lysis.
  • Metastatic disease is suggested by the patient’s age and the presence of multiple lesions.
  • Myeloma is generally a highly lytic lesion, often demonstrating diffuse osteopenia.

Other Differential Diagnoses by Anatomic Location