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 often 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

ABBREVIATION: IGF: Insulin like growth factor, IHC: Immunohistochemistry, f/b: followed by, NA: Not applicable