Primary Bone tumors by age

• 1st or 2nd decade: Ewing's Sarcoma
  
• Location: diaphysis of long bones
  
• t(11;22)(q24;q12)
• characteristic "onion skin" periosteal reaction on plain XR.
• 10-25 yrs: Oseosarcoma/Osteogenic Sarcoma
  
• "fir-tree" or "sun-burst" appearance on X-ray examination
• Codman's triangle - periosteum lifted into a triangle as the tumour emerges through the cortex
• the American Cancer Society states: "Probably in no other cancer is it as important to perform this procedure properly. An improperly performed biopsy may make it difficult to save the affected limb from amputation"
• Location: metaphysis
• "far from the elbow, close to the knee"
• proximal humerous, the distal radius, the distal femur and the tibia
  
• >30 yrs: Chondrosarcoma
• >50 yrs: Multiple Myeloma

How to keep the locations of Ewing's vs Osteosarcoma straight...
"E" is closer to "D" (Ewing's-Diaphysis)
"O" is closer to "M" (Osteosarcoma-Metaphysis)

Familial syndromes causing sarcomas include:

• neurofibromatosis
• familial retinoblastoma
• Li-Fraumeni syndrome
• Beckwith-Wiedemann syndrome
• basal cell nevus
• Gardner syndrome