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Tumors of bone
- Clinical presentation
- Incidentally detected
- Swelling and pain
- Pathological fracture
Interpret bone tumors with full knowledge of
- Clinical picture
- Radiology and imaging
- Pathological findings
Tumors of bone
Notochordal Chordoma
Hemangioendothelioma,
Vascular Hemangioma
hemangiopericytoma, angiosarcoma
Metaphysis
Osteogenic Sarcoma
10 20 30 40 50 60 70 yrs
Chondrosarcoma
10 20 30 40 50 60 70 yrs
Bone tumors
Notochordal Chordoma
Hemangioendothelioma,
Vascular Hemangioma
hemangiopericytoma, angiosarcoma
matrix
- Arises from metaphysis of long bones. 60% arise around the knee
10 20 30 40 50 60 70 yrs
Osteosarcoma - subcategorization
Based on Subtypes
Solitary / multicentric
Others
Primary / secondary
Osteosarcoma
Gross: Bulky, gritty, hemorrhage and necrosis,bone destructive and
spreading in different directions
Microscopy:
- Bizarre tumors cells with pleomorphic nuclei
- Multinucleated giant cells
- Formation of “lacy osteoid”
- Formation of other types of matrix
- Conspicuous vascular invasion - metastasize to lungs, brain
X-ray:
- Large destructive lytic and osteoblastic mass with infiltrating margins
- Lifts periosteum (Codman triangle) and produces reactive periosteal
bone formation
Tumor grading
- Low grade
- High grade
- Cell pleomorphism
- Tumor
differentiation
- Necrosis
- Mitotic activity
Hematogenous spread is very common and 10-20% have
pulmonary metastases at the time of diagnosis
Bone tumors
Histologic type Benign Malignant
Hematopoietic (40%) Myeloma, lymphoma
Notochordal Chordoma
Hemangioendothelioma,
Vascular Hemangioma
hemangiopericytoma, angiosarcoma
Chondroma:
- Enchondroma ( intramedullary) or juxtacortical
- Usually solitary and metaphyseal in short tubular bones and < 3 cms dia
- Multiple tumors form part of Olliers disease (enchondromatosis)
- Develop from rests of growth plate cartilage
- Contain well circumscribed nodules of cartilage and cytologically benign
chondrocytes
- Endochondral ossification is seen at periphery
- X-ray shows typical “O ring” sign
- Malignant transformation more common in Ollier disease
Chondrosarcoma
- Malignant tumors that form neoplastic cartilage
- Subtypes:
a) Intramedullary and juxtacortical
b) Conventional (hyaline / myxoid), clear cell, dedifferentiated,
mesenchymal
c) Low grade to high grade
- Usually seen in patients above 40, more in men (2:1)
- More often in central parts of skeleton
- Large bulky tumors with glistening cut surface with central
necrosis
- Tumor spreads by pushing margins
Notochordal Chordoma
Hemangioendothelioma,
Vascular Hemangioma
hemangiopericytoma, angiosarcoma
- Large, red-brown
- Hemorrhage and cystic
degeneration
- Uniform mononuclear cells
in sheets with increased
mitoses
- Numerous osteoclast type
of giant cells with > 100
nuclei