Sie sind auf Seite 1von 963

Eduardo Santini-Araujo Ricardo K. Kalil Franco Bertoni Yong-Koo Park Editors

Tumors and Tumor-Like Lesions of Bone

Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and
Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and
Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and
Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and
Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and
Yong-Koo Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and

For Surgical Pathologists, Orthopedic Surgeons and Radiologists

123

Tumors and Tumor-Like Lesions of Bone

Eduardo Santini-Araujo • Ricardo K. Kalil Franco Bertoni • Yong-Koo Park

Editors

Tumors and Tumor-Like Lesions of Bone

For Surgical Pathologists, Orthopedic Surgeons and Radiologists

Park Editors Tumors and Tumor-Like Lesions of Bone For Surgical Pathologists, Orthopedic Surgeons and Radiologists

Editors Eduardo Santini-Araujo Laboratory of Orthopaedic Pathology Buenos Aires , Argentina

Ricardo K. Kalil Laboratory of Orthopaedic Pathology Buenos Aires , Argentina

Franco Bertoni Villa Erbosa Hospital University of Bologna Bologna , Italy

Yong-Koo Park Department of Pathology Kyung Hee University Hospital Seoul , Korea, Republic of (South Korea)

ISBN 978-1-4471-6577-4 DOI 10.1007/978-1-4471-6578-1

Library of Congress Control Number: 2015939586

ISBN 978-1-4471-6578-1

(eBook)

Springer London Heidelberg New York Dordrecht © Springer-Verlag London 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

Springer-Verlag London Ltd. is part of Springer Science+Business Media (www.springer.com)

To our mentors Fritz Schajowicz and David Dahlin, two giants of orthopedic pathology, stand behind us all. K Krishnan Unni, whose experience, knowledge, charisma, and leadership influenced all of us, being tireless and obstinate in his long-lasting support and incentive through several years. To them, we would like to add those people who had a high influence in our choices and development in pathology, especially R L Cabrini.

Eduardo Santini-Araujo, Ricardo K. Kalil, Franco Bertoni, Yong-Koo Park

To our families

E Santini-Araujo

Wife Romina and sons and daughters, Maria Gala, Martina, Julian, Pedro Ferreol, and Margarita

R K Kalil

Wife Angela and daughter, sons, and stepsons, Luciana, Sergio, Marcelo, Marcio, and Mateus

My beloved family

F Bertoni

Y-K Park

My parents, wife Dan-Young, son Byung-Chul, and daughter Ko-Un To them, our endless love.

Foreword

The present book on bone tumors and related lesions represents the continuity of a “classic” on bone tumors by Fritz Schajowicz, one of the most outstanding bone pathologists of all times. The last edition by Springer-Verlag was published over 20 years ago (Histopathological Typing of Bone Tumors, 1993) and has been for many years a very useful tool for diagnostic histopa- thologists all over the world. This new book maintains the philosophy of its predecessor but is adapted to the new chal- lenges in the clinical and histological diagnosis of these infrequent tumors providing insights into therapeutic approaches and their prognostic outcome. In recent years, the clinical approach to bone tumors has been innovated, thanks to the new diagnostic imaging techniques that complement conventional radiology with CT scan, PET, and MR, alone or in combination, thanks to which the diagnostic identification of each tumor entity is much more precise. Also the microscopic phenotyping of tumors and tumor-like lesions is more efficient based upon the use of fine-needle aspiration cytology, a technique that requires a profound knowledge of tissue at the histological level and a good understanding of bone tumor biology. Moreover, histopathology has been enhanced by new methodological techniques such as electron microscopy and immunohistochemistry, offering the surgical pathologist unforeseen possibilities for more accurate differential diagnosis of borderline lesions or doubtful histological tumor types. Nevertheless, the handling of bone tumors still requires a high degree of specialization for all those involved in this pathology, as well as demanding cooperation between all specialists. Bone tumors are not exclusively age based nor particularly anatomically related; thus, pedi- atric and adult orthopedists are frequently involved in simultaneous consultations, which is also the case for radiologists and oncologists. This affects the surgical pathologist who needs highly specific training in the field and a case-by-case analysis of each patient in close coop- eration with their clinical colleagues. Precisely one of the major aims of this book is to cover this necessity, providing the informative doctrine needed for this end. Today everyone is pressed for time and, when trying to acquire new knowledge on a field or looking for a precise diagnosis, needs to find clearly explained concepts in a short, readable, informative format. This guideline has been followed by each author, thus providing a clear structure to each chapter. Long academic case discussions and details on etiopathological anal- ysis have been avoided, compiling brief information on the most update available publications. Of course no book today can cover all the available literature on a given field or for a par- ticular tumor type, but should contain, as in this new book on bone tumors, the most up-to-date data to facilitate the best practical clinical handling of the patient’s pathology. The present book aims to cover all these objectives, approaching the diagnosis of bone tumors in a dynamic form and placing the histopathologist at the center of the game, perform- ing both cytology and histology and working in close cooperation with the radiologist and the orthopedic surgeon. Nevertheless, the clinical orthopedist and oncologist have to be aware of the difficulty of some cases in which the true nature of the process is unpredictable or the final

viii

Foreword

diagnosis cannot be established with absolute precision. To help in clarifying the tumor type, each chapter provides clues for the differential diagnosis, facilitating this task. Today, the new advances in the molecular biology of cancer attract particular attention, especially in the case of bone disease and bone tumors. Major interest is devoted to this field and in the practical applications oriented toward the differential diagnosis and prognosis. This is a completely new field not generally covered by other bone tumor books due to its continu- ous advances and novelties. The present book is a collaborative cooperation by numerous highly distinguished bone and osteoarticular pathologists, under the outstanding guidance of the four main editors: Drs. Eduardo Santini-Araujo (Argentina), Ricardo K. Kalil (Brazil), Franco Bertoni (Italy), and Yong-Koo Park (Korea). All are well known in this field, and their multiple contributions to the literature of bone pathology reinforce the high quality not only of their own chapters but also that of the ample selection of coauthors heading each chapter. Many of them are leaders in their field and provide seminal and novel information in a clear and practical format in which not only high-quality histological images exemplify each chapter but also excellent diagnostic illustrations complement the comprehensive overview of the patient pathology in which major clinical insights are also considered. Particular thanks go to these colleagues, all editors, or authors in their own right, for having agreed to participate in this new challenge, adding their admirable expertise to the work. In this context, we want to extend our warmest appreciation to them. Most essential has been the task performed by Springer-Verlag in providing the orientation to maintain the high quality of the book and also in accepting the additional costs involved in producing the comprehensive iconography considered necessary by all four editors to attain the level of excellence and utility of this book.

Valencia, Spain

Antonio Llombart-Bosch , MD, PhD

Pref ace

The overall intention of this book is to provide day-to-day assistance in tumors and tumor-like lesions of bone, for general surgical pathologists, radiologists, and orthopedic surgeons, with practical image diagnosis, histopathological and molecular diagnosis, and basic therapeutic guidelines. Our main objective is to provide the essential information that any orthopedic surgeon, radiologist, and surgical pathologist, whether general or specialized, in practice or training, needs for evaluating a patient with a lesion in the area of orthopedic pathology. The philosophy of the book is to offer generous coverage of epidemiology, clinical features, radiology, pathology, and differential diagnosis not only for the distribution of the statistical average of the lesion’s features but also to illustrate the standard deviations, including the clues in the images and histopathology needed to arrive at a sharp differential diagnosis. To achieve this goal, we gathered a selected team of the more experienced and knowledge- able people in this field in the world, in pathology, imaging diagnosis, and oncologic orthope- dic surgery, and who, generously, made available their unsurpassed expertise in order to make this a most valuable tool for the practical diagnosis of tumors and tumor-like lesions of the bone.

Buenos Aires , Argentina Buenos Aires , Argentina

Eduardo Santini-Araujo Ricardo K. Kalil

São Paulo, SP, Brazil Bologna , Italy

Franco Bertoni

Seoul , South Korea

Yong-Koo Park

Acknowledgments

Our first acknowledgment goes, naturally, to our dear friend and advisor, Antonio Llombart- Bosch, for his deep involvement and permanent support during the development of this book. To build this book, we had the inestimable helping hand of selected collaborators, already mentioned in the preface, and who are listed in the following pages. To them goes our deep acknowledgment. They were brilliant and added irreplaceable information and data, without which this book would never have attained its goal and would have not been completed in time. All the epidemiological drawings and schemes were contributed by Dr. Blas Dios. Besides them, it is important to mention the importance that some people and institutions had in the professional evolution of some of us in various ways. I, Eduardo Santini-Araujo, would like to express my debt of gratitude to my mentor in Orthopedic Pathology, Prof. Fritz Schajowicz, to whom I had the privilege of assisting for 15 years and also to the University of Buenos Aires, School of Medicine, and especially the

School of Dentistry that under the successive leadership of Profs. R L Cabrini, M E Itoiz, and

M

B Guglielmotti allowed me to carry out several research works. In like manner, I would like

to

thank the Radiobiology Department of the Atomic Energy National Commission where I

have been working for decades under the tutorship of its Research and Development Director Dr. R L Cabrini, a mentor in pathology and in life, with the permanent collaboration of my colleague and friend Dr. A M Ubios. My warm gratitude to the team of the Laboratory of Orthopedic Pathology in Buenos Aires, especially to Dr. L Olvi and Dr. M L Gonzalez; my collaborators W Escalante, M Arevalo, M Santini-Araujo, and L Pecina; and to our photogra- phers T Benitez and A Gonzalez Llanos. And last but not least, I would really like to thank

very much the A. C. Camargo Cancer Center, Sao Paulo, Brazil, especially Drs. J J Salto Jr, F

A Soares, and A Nascimento for generously having treated and taken care of me.

My (Ricardo K. Kalil) deep thanks go to Dr. H H Japp, who influenced me to go into pathol- ogy, a friend of all time, and then to Dr. Claudio Lemos and Dr. C J Campbell who unselfishly opened their experience and their files to me in my early steps in Orthopedic Pathology. A selected team of British pathologists – Drs. H A Sissons, M Catto, and C Godfrey-Price – also left their permanent print in my background. Then, to Sarah Network of Rehabilitation

Hospitals, in Brazil, by allowing me to start, grow professionally, and get more than 40 years

of experience in the field. The support of its directive body, led by Dr. A Campos da Paz and

Dr. L W Braga, as well as of the whole medical team, was paramount to achieve the high level

of pathology that was attained. The institutional view of the patient as the objective and final

goal of its work influenced definitely the way I look at medicine in general and pathology in

particular. A special mention goes to the exceptional team constituted by my young colleagues

in the institution, Drs. J S Antunes, F S Souza, A Monteiro Jr, H B de Moura, A P B Pinto, I C

Brandao, F Indelli, M I Lima, E B Silveira, and A Lacerda. Also thanks to L Sollaci, the insti- tution head librarian, for being always at hand with her expert help and advice. I, Franco Bertoni, thank my colleague Dr. Patrizia Bacchini for her strong support and con- tribution. I consider myself lucky in having the opportunity to spend time with great mentors

as Drs. Dave Dahlin and Kris Unni that were not only teachers in bone pathology but deep friends and example in wise style of life.

xii

Acknowledgments

I, Yong-Koo Park, would like to express my deep gratitude to my mentors, Drs. Yang, Moon Ho, and Lee, Jung Dal, for giving me valuable advice and lessons when I was taking the first step as a pathologist. My sincere thanks go also to Dr. Ryu, Kyung Nam, and the staff of the Departments of Pathology and Diagnostic Radiology in Kyung Hee University Hospital. In particular, Ms. Yoon, Minji merits special mention for she has taken on all the stressful, com- plicated tasks. Needless to say, to our families, as mentioned in the Dedication, who abdicated of so much time of living together as well as by taking charge of many of our daily duties, out of pure love, allowing us to concentrate so much time and effort in the production of this book. To the editors of Springer-Verlag, especially Joanna Bolesworth who escorted us all the way with editorial advice and constant contact, we also dedicate a special acknowledgment.

Buenos Aires , Argentina Buenos Aires , Argentina

Eduardo Santini-Araujo Ricardo K. Kalil

São Paulo, SP, Brazil Bologna , Italy

Franco Bertoni

Seoul , South Korea

Yong-Koo Park

Contents

Part I

Introduction

1 Practical Approach to the Diagnosis of Bone Tumors Eduardo Zambrano and K. Krishnan Unni

3

2 An Imaging Approach to Bone Tumors Darlene M. Holden, Hakan Ilaslan, and Murali Sundaram

11

3 . Eduardo Santini-Araujo, Ricardo K. Kalil, Blas Dios, and Rómulo L. Cabrini

.

Methods of Bone Biopsy

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

57

4 Basic and Ancillary Techniques in Bone Pathology Yong-Koo Park

73

5 Grading and Staging Yong-Koo Park

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

85

6 Surgical Treatment of Tumors and Tumorlike Lesions of Bone Brian E. Walczak, Peter S. Rose, Joel M. Post, and Franklin H. Sim

 

89

Part II

Bone-Forming Tumors

7

. Liliana G. Olvi, Gustavo M. Lembo, and Eduardo Santini-Araujo

Medullary

Osteoma .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

109

8

. Liliana G. Olvi, Gustavo M. Lembo, and Eduardo Santini-Araujo

Parosteal Osteoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

119

9

. Liliana G. Olvi, Gustavo M. Lembo, and Eduardo Santini-Araujo

Osteoid Osteoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

127

10

. Liliana G. Olvi, Gustavo M. Lembo, Osvaldo Velan, and Eduardo Santini-Araujo

.

Osteoblastoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

151

11

Conventional Central Osteosarcoma Franco Bertoni and Patrizia Bacchini

175

12

. María L. Paparella and Rómulo L. Cabrini

Osteosarcoma

.

of

the

Jaws .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

207

13

. Carrie Y. Inwards and Doris Wenger

Osteosarcoma.

Parosteal

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

217

14

. Carrie Y. Inwards and Doris Wenger

Periosteal Osteosarcoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

227

xiv

Contents

15

High-Grade Surface Osteosarcoma Carrie Y. Inwards and Doris Wenger

235

Part III

Cartilage-Forming Tumors

 

16 Enchondroma .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

243

 

Yong-Koo Park

17 Multiple Enchondromatosis (Ollier’s Disease) Yong-Koo Park

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

253

18 Periosteal Chondroma . Yong-Koo Park

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

259

19 Osteochondroma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

265

 

Yong-Koo Park

20 Multiple Osteochondromatosis Yong-Koo Park

 

273

21 Chondroblastoma.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

277

 

Yong-Koo Park

22 Chondromyxoid Fibroma Yong-Koo Park

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

287

23 . Sergio Piña-Oviedo, Jae Y. Ro, Alberto G. Ayala, and Yong-Koo Park

.

.

Chondrosarcoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

295

Part IV

Giant Cell Tumor

 

24

Giant Cell Tumor of Ricardo K. Kalil

Bone .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

351

Part V

Round Cell Tumors

 

25 Ewing’s Sarcoma Family of Tumors

. Isidro Machado and Antonio Llombart-Bosch

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

369

26 Lymphoma of Bone S. Fiona Bonar

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

385

27 . Michael J. Klein

Myeloma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

413

Part VI

Fibrous Tumors

 

28 Desmoplastic Fibroma of Bone Ricardo K. Kalil

 

427

29 Fibrosarcoma of Bone Ricardo K. Kalil

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

435

Part VII

Fibrohistiocytic Tumors

 

30 Benign Fibrous Histiocytoma of Bone Ricardo K. Kalil

 

443

31 Malignant Fibrous Histiocytoma of Bone Ricardo K. Kalil

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

451

Contents

xv

Part VIII

Vascular Tumors

 

32 . Liliana G. Olvi, Maria L. Gonzalez, and Eduardo Santini-Araujo

.

Hemangioma.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

461

33 Epithelioid

Hemangioma.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

479

 

Ricardo K. Kalil

34 Glomus Tumor Ricardo K. Kalil

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

487

35 Epithelioid Hemangioendothelioma Ricardo K. Kalil

 

495

36 Angiosarcoma Ricardo K. Kalil

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

507

Part IX

Adamantinoma

 

37

Adamantinoma.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

517

Edward McCarthy

 

Part X

Notochordal Tumors

 

38 Benign Notochordal Cell Yasuaki Nakashima

 

523

39 Chordoma .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

533

 

Yasuaki Nakashima

 

Part XI

Leiomyosarcoma

 

40

Leiomyosarcoma of Bone Ricardo K. Kalil

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

557

Part XII

Adipocytic Tumors

 

41 Lipoma of Bone Ricardo K. Kalil

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

563

42 Liposarcoma

of

Bone .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

569

 

Ricardo K. Kalil

Part XIII

Neurogenic Tumors

 

43 Schwannoma

of

Bone.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

577

 

Ricardo K. Kalil

44 Neurofibroma

of

Bone .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

583

Ricardo K. Kalil

Part XIV

Phosphaturic Mesenchymal Tumor

xvi

Contents

Part XV

Metastatic Carcinoma Involving Bone

46

. Patrizia Bacchini and Franco Bertoni

Metastatic Bone Carcinoma

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

601

Part XVI

Tumorlike Lesions and Other Conditions That Simulate Primary Bone Tumors

 

47 . Liliana G. Olvi, Gustavo M. Lembo, Osvaldo Velan, and Eduardo Santini-Araujo

.

Simple

Bone

Cyst .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

611

48 Aneurysmal Bone Cyst

. Liliana G. Olvi, Gustavo M. Lembo, Osvaldo Velan, and Eduardo Santini-Araujo

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

635

49 Juxta-articular

Bone

Cyst .

.

.

.

.

.

.

.

.

.

.

. Liliana G. Olvi, Gustavo M. Lembo, Osvaldo Velan, and Eduardo Santini-Araujo

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

683

50 . Liliana G. Olvi, Maria L. Gonzalez, Osvaldo Velan, and Eduardo Santini-Araujo

Bone

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Epidermoid

Cyst.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

701

Metaphyseal Fibrous Defect

51 . Liliana G. Olvi and Eduardo Santini-Araujo

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

709

52 . Liliana G. Olvi and Eduardo Santini-Araujo

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Periosteal

Desmoid.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.