Evaluation and staging of musculoskeletal neoplasia

Fortunately, musculoskeletal neoplasia rare and are not commonly encountered by the practicing orthopaedic surgeon [1]. The vast majority of radiographic lesions noted in the clinical setting are associated with prior trauma, an inflammatory or infectious condition, or less commonly, represent metastases from an underlying carcinoma. Often skeletal lesions are noted serendipitously and frequently include developmental conditions, such as osteochondroma. Benign lesions are fortunately far more common than malignant lesions, but the initial clinical presentation can be confusing. Table 1 lists the more common benign lesions of bone, with their associated malignant counterpart. Maintaining an index of suspicion for the presence of neoplasia is important, particularly when evaluating any patient with a soft tissue mass or a painful bone lesion [2]. Typically musculoskeletal tumors go undiagnosed because they are never considered in the differential diagnosis. Given that musculoskeletal lesions appear in virtually all age groups and in all parts of the body, consideration of an underlying neoplasm is important in patients presenting with a mass, unexplained pain, insufficiency fractures, or when the clinical history and the clinical presentation ‘‘don’t quite add up.’’ Careful attention to the patient’s history, complaints, pain pattern, and physical examination should alert