Osteoma New bone growth Mainly in Skull & flat bones

Associated with Gardner syndrome (multiple polyps in the colon + tumors

outside)

Osteoblastoma Vertebral bones (benign tumor of

osteoblasts)
-

> 2 cm mass
Pain that doesnt respond to aspirin

Osteoid Osteoma Metaphysis of long bones (benign tumor

of osteoblasts)
-

< 2 cm mass (dense sclerotic rim)

Pain that is relieved by aspirin
Fever / pain / night sweats due to production of PGE2
Xray:
o Bony mass with radiolucent core (osteoid = malformed bone = not
calcified)
Micro:
o Haphazardly interconnecting trabeculae of woven
bone rimmed by prominent osteoblasts

Osteoblastoma & Osteoid osteoma are similarBoth arise from Cortex of bone
(outer layer)

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Osteochondroma Metaphysis (lateral growth from growth
plate)

Pain while walking / doing shit

No fractures
Mushroom shaped growth covered by hyaline cartilage
o

Overlying cartalige can tranform to chondrosarcoma

Most common benign tumor of bone

Echondroma Small bones of hand/feet In the Medulla

(center) - fractures
-

Multiple Echondroma:
o Pain & Fracture seen = Ollier syndrome
o Soft tissue Hemangiomas = Maffucci syndrome (Increased risk for
CNS gliomas)

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Giant Cell Tumor Epiphysis
-

Soap Bubble on x-ray

Benign but can become malignant
o Sign of malignancy = Spindle shaped
mesenchymal cells
Micro: multinucleated giant cells

Aneurysmal bone cyst Metaphysis of long

bones
-

Rapidly growing expandable tumor

o

filled with blood b/c of aneurysm

Xray: Eccentric lytic lesion surrounded

by thin wall
o

Eccentric means it has a center and grows out from

there

Micro: Blood filled cystic spaces + multinucleated

osteoclast like giant cells

Malignant Tumors
Osteosarcoma (osteogenic sarcoma) Metaphysis of distal femur (knee)
Malignant osteoblasts
-

Bimodal distribution (20s & 60s)

Metastasizes to the lungs
Primary: seen in 20s
o Familial retinoblastoma (Retinoblastoma
o Li-Fraumeni syndrome (germline P53
Secondary: seen in 60s due to
o Pagets disease of the bone

X-ray: Codman Triangle (growth lifts periosteum) + Sunburst pattern

(calcified malignant osteoid)

Chondrosarcoma Pelvic bones / Ribs (flat bones)

-

Metastasizes to the lungs

Micro: atypical chondrocytes chondroblasts with multiple
nuclei
o w/ lacy white cartilage in the background

Ewing Sarcoma Diaphysis

-

mutation)
mutation)

Small round blue cell tumor (kids)

Neuroectoderm derived
Translocation (11:22)

Radiograph:
o "onion skin" appearance around bone
(periosteal reaction)
Extreme metastasis but good response to
chemotherapy

Osteosarcoma young people

- Femur
- Sun burst appearance
- Codmans triangle
Chondrosarcoma old people
- Flat bones (pelvis / ribs)
- Multiple nucleated tumor with lacy white cartilaginous background
Fibrous Dysplasia benign tumor with malignant potential
-

Targets Rib/femur/cranial bones

Localized developmental arrest of bone fibrous tissue takes over for the
marrow
o Risk of pathological fracture
Multiple bone involvement is associated with Albright's
syndrome
o Caf-au-lait spots on skin
o Precocious sexual development
X-ray: shepherd crook deformity (bending of the femur
like a cane)

Micro: Chinese letter pattern

o curved immature trabeculae that lack osteoblastic
rimming
- trabeculae = type of cancellous bone at ends of long bones

Bone tumors mainly metastasize from somewhere else. Primary bone tumors are
rare.