Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Pediatric musculoskeletal neoplasms are relatively rare. They can be categorized as either benign or malignant, as has been done for this document. Musculoskeletal neoplasms are often also categorized by the type of tissue they produce or from which they are derived.

The most common types of tumors that affect the musculoskeletal system are cysts, bone-producing tumors, cartilage tumors, fibrous tumors, soft tissue tumors, and peripheral neuroectodermal tumors. Most benign tumors, such as nonossifying fibromas, result in little or no disability and require no treatment. Other benign tumors may require surgical intervention. Painful or prominent osteochondromas may require surgical excision. Simple bone cysts can weaken the bone, increase fracture risk, and may require surgical treatment in order to resolve the cyst and prevent or treat fracture. Other benign tumors include lipomas, fibrous dysplasia, enchondromas, osteoid osteoma, and osteoblastomas.

The most common malignant tumors of the pediatric musculoskeletal system are osteosarcoma, Ewing sarcoma/peripheral neuroectodermal tumor, rhabdomyosarcoma, and synovial cell sarcoma. Osteosarcoma is the most common malignant bone tumor in patients under 20 years of age, with an incidence of approximately 29 per 1 million people. Ewing sarcoma is the second most common pediatric malignant musculoskeletal tumor and is part of the Ewing family of tumors, which includes peripheral neuroectodermal tumors. Most of the tumors in the family have a genetic translocation.1 Long-term survival of patients with both tumors has drastically improved with the routine use of chemotherapy.

For additional information on musculoskeletal tumors in children, you can refer to the Tumors section of this report.

Healthcare Utilization

Neoplasms, including both benign and malignant, were diagnosed in 155,500 children and adolescent healthcare visits in 2013, of which 43,100 had a primary diagnosis of a neoplasm. About one in seven (5%) of children and adolescents with any neoplasm diagnoses were hospitalized (23,000), but fewer than 1% of hospital discharges had a primary diagnosis of neoplasm (3,600). (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Slightly more males than females had a hospital discharge with any or a primary neoplasm diagnosis. For each year from birth until 18 years, there is an increasing incidence of neoplasm prevalence resulting in hospitalization.

Any diagnoses of neoplasm accounted for 4.4% of hospitalizations for any musculoskeletal condition diagnosis, and 0.4% of all hospitalizations for any healthcare condition. Hospitalizations with a primary diagnosis of neoplasm accounted for 0.7% of all musculoskeletal diagnoses and only 0.1% of hospitalizations for any health condition diagnosis. Benign neoplasms accounted for 59% of neoplasm diagnoses, but 87% of hospitalized diagnoses are malignant. (Reference Table 7C.8 PDF CSV)

Hospital Charges

Total charges averaged $48,500 for a mean 4.6-day stay when children and adolescents were hospitalized with any diagnosis of neoplasm along with other medical conditions. With a primary neoplasm diagnosis, the stay was slightly longer (6.4 days), and mean charges were higher at $93,100. Mean length of stay was highest for children less than one year of age; however, hospital charges were highest for children ages 5 to 9 years old. Total hospital charges for primary neoplasm diagnosis discharges in 2013 were $335.2 million. (Reference Table 7C.8 PDF CSV)


  • 1. Genetic translocation is the process of exchange of genetic material between chromosomes. A balanced translocation results in no gain or loss of material, while an unbalanced translocation may result in trisomy or monosomy of a specific chromosome segment. A trisomy is a type of polysomy in which there are three instances of a specific chromosome, instead of the normal two—one from each parent. In a monosomy, one of the two normal chromosomes are missing.


  • Fourth Edition

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