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The unique pattern of distribution of bone tumors and the nature of their interaction with native bone creates distinct radiologic-pathologic correlates that are critical in the diagnostic evaluation of these lesions. The rarity of these lesions makes them especially daunting for the general pathologist and radiologist faced with the diagnostic evaluation of these entities. This chapter presents a richly illustrated synopsis of common pediatric bone lesions based on a rational integrated approach incorporating the gross anatomy of the lesions (via radiologic imaging) and pathologic analysis. This chapter presents entities and their mimics based on their anatomic location within the bone just as they would present in “real life”. This integrated approach, with emphasis on overlapping features of different entities, provides practical guidance for health care providers and trainees.