Pathology of Bone Tumors PDF

Pathology of Bone Kevin Carnevale M.D. Neoplastic Disorders of Bone Ø General Ø Bone forming tumors Ø Cartilage forming tumors Ø Others OSSEOUS LESIONS SYSTEMATIC APPROACH ??? ASK 5 QUESTIONS ??? Œ  Ž   What is the lesion’s pattern of growth? Are the cells of the lesion producing anything? What d...

Pathology of Bone Kevin Carnevale M.D. Neoplastic Disorders of Bone Ø General Ø Bone forming tumors Ø Cartilage forming tumors Ø Others OSSEOUS LESIONS SYSTEMATIC APPROACH ??? ASK 5 QUESTIONS ??? Œ  Ž   What is the lesion’s pattern of growth? Are the cells of the lesion producing anything? What do the cells of the lesion look like? Based on the cellular features – and the imaging studies – is the lesion more likely benign or malignant? Does the anatomical diagnosis (i.e. pathology !) correlate with the clinical picture and the radiographic appearance of the lesion? IF IT DOESN’T, CAREFULLY RECONSIDER ALL OF THE INFORMATION FOR THE CASE !!! How Are Bone Tumors Like Real Estate ? Location ! Location ! Location ! Abbreviations used: ABC = Aneurysmal bone cyst CMF = Chondromyxoid fibroma EG = Eosinophilic Granuloma GCT = Giant cell tumor FD = Fibrous dysplasia HPT = Hyperparathyroidism with Brown tumor NOF = Non Ossifying Fibroma SBC = Simple Bone Cyst General Locations of Bone Tumors Location, location, location !!! DIAPHYSIS EWING SARCOMA CHONDROSARCOMA METAPHYSIS OSTEOSARCOMA PHYSIS GIANT CELL TUMOR EPIPHYSIS BONE TUMORS Bone-forming: Osteoma rare benign tumor of mature bone usually asymptomatic may cause local & mechanical problems (e.g. sinus obstruction; osteoma in endosteal surface of brain) Age: 40-50 yo Site: cortical bones of skull and face X-ray: well-delimited nodule Prognosis: good (simple excision) slow-growing not invasive no malignant transformation BONE TUMORS Bone-forming: Osteoid osteoma & Osteoblastoma Ø Ø Ø Ø benign neoplasms with identical histology differ in size, sites of origin, x-ray features & symptoms l osteoblastoma = “giant osteoid osteoma” X-ray: central area of tumor (nidus); usually radiolucent, surrounded by rim of sclerotic bone Both painful lesions, however, the pain is relieved by aspirin in osteoid osteoma where it is not in osteoblastoma Osteoid osteoma BONE TUMORS Bone-forming: Osteoblastoma Age: teens- twenties Site: vertebral column, other Size: > 2 cm X-ray: radiolucent nidus, less (or no) sclerotic rim Prognosis: good, if totally excised histologic appearance: identical to osteoid osteoma: interlacing trabeculae of woven bone surrounded by osteoblasts; loose connective tissue stroma (no marrow elements); may see giant cells Pain not relieved by aspirin BONE TUMORS Bone-forming: Osteosarcoma malignant mesenchymal tumor; neoplastic cells produce osteoid (unmineralized bone matrix); sometimes makes cartilage Ø most common 1° malignant tumor of bone (20% of 1° bone malignancies); M:F = 1.6:1 Ø bimodal age distribution: l 75% occur in patients