BONE TUMORS (1) PDF

BONE TUMORS ‫وليد نزال هوسي‬.‫د‬.‫م‬ ‫ فرع االمراض‬/ ‫كلية الطب‬ ‫ كلية طب‬-‫طب وجراحة عامة‬ ‫تكريت‬ M.B.CH.B.TUCOM.ABH. ‫شهادة البورد العربي(دكتوراه)تشخيص النسيج المرضي باالبرة القاطعة والدقيقة والهرمونات‬ ‫السرطانية‬ ‫االردن‬/‫بغداد‬ Anatomical Pathology,ABH (Arab Board Of Histopathology) Diagnosi...

BONE TUMORS ‫وليد نزال هوسي‬.‫د‬.‫م‬ ‫ فرع االمراض‬/ ‫كلية الطب‬ ‫ كلية طب‬-‫طب وجراحة عامة‬ ‫تكريت‬ M.B.CH.B.TUCOM.ABH. ‫شهادة البورد العربي(دكتوراه)تشخيص النسيج المرضي باالبرة القاطعة والدقيقة والهرمونات‬ ‫السرطانية‬ ‫االردن‬/‫بغداد‬ Anatomical Pathology,ABH (Arab Board Of Histopathology) Diagnosis of histopathology by Tru-cut biopsy ,FNA(Fine Needle Aspiration) and Immunohistochemistry(IHC) Baghdad/Jordan 34 year female presented with abdominal mass at anterosuperior right upper qudrant full history taking with complete of radiology and check colonoscope showing Polyposis colon, while other examination show , epidermal inclusion cysts and fibrous tumours in the skin Which of the following bone tumor finding make diagnosis of (Gardner syndrome) with such patient : A-Osteoma B-Osteoid osteoma C-Ostioblastoma D-fibrous dysplasia I. OSTEOMA A. Benign tumor of bone(painless) B. Most commonly arises on the surface offacial bones C. Associated with Gardner syndrome Osteoma is a benign chondro-osseous tumour that may be seen in the context of familial adenomatous polyposis. It should not be confused with osteoid osteoma(extremely painful on night relieved by aspirin). Histopathology finding : -Dense and lamellar cortical bone A 12-year-old girl has had sudden onset of severe pain in her left knee that has awakened her from sleep on several occasions during the past 6 weeks. For each episode, her mother has given her acetylsalicylic acid (aspirin), and the pain has been relieved. On physical examination, there are no remarkable findings. A radiograph of the left knee shows a well-defined, 1-cm lucent area surrounded by a thin rim of bony sclerosis located in the proximal tibial cortex. The patient undergoes radioablation of the lesion, and the pain does not recur. What is the most likely diagnosis of this lesion? A Enchondroma B Fibrous dysplasia C Giant cell tumor D Osteoblastoma E Osteochondroma F Osteoid osteoma II. OSTEOID OSTEOMA A. Benign tumor of osteoblasts (that produce osteoid) surrounded by a rim ofreactive bone B. Occurs in young adults < 25 years of age (more common in males) C. Arises in cortex of long bones (e.g., femur) D. Presents as bone pain that resolves with aspirin E. Imaging reveals a bony mass(< 2 cm) with a radiolucent core (osteoid). F. Osteoblastoma is similar to osteoid osteoma but is larger ( > 2 cm), arises in vertebrae, and presents as bone pain that does not respond to aspirin. Histopathology finding: Network of interconnecting bone, widened vessels, osteoblasts, and bone matrix Fibrinoid margin with areas of angiogenesis Nidus usually about 1.5-2 cms, brownish-red, mottled, and gritty lesion that is distinct from the surrounding bone. A 23-year-old man has had pain in the area of the right knee for the past year. On physical examination, there is point tenderness in a 2-cm focal area just below the patella laterally over the tibia. A radiograph of the right leg shows a 3-cm, broad-based excrescence projecting from the metaphyseal region of the upper tibia. The lesion is excised. The figure shows the gross appearance of the sectioned lesion. What is the most likely diagnosis? A Enchondroma B Fibrous dysplasia C Giant cell tumor D Osteoblastoma E Osteochondroma III. OSTEOCHONDROMA A. Tumor of bone with an overlying cartilage cap , most common benign tumor of bone. B. Arises from a lateral projection of the growth plate (metaphysis); bone is continuous with the marrow space. C. Overlying cartilage can transform (rarely) to chondrosarcoma. A 19-year-old man falls and strikes his leg. He feels intense pain. On physical examination there is swelling in his lower leg. MR imaging is performed and shown in the figure with T1 weighting. Which of the following is the most likely diagnosis? A Chondrosarcoma B Ewing sarcoma C Giant cell tumor D Metastatic seminoma E Osteosarcoma IV. OSTEOSARCOMA A. Malignant proliferation of osteoblasts B. Peak incidence is seen in teenagers; less commonly seen in the elderly 1. Risk factors include familial retinoblastoma, Paget disease, and radiation exposure. 2. Arises in the metaphysis of long bones, usually the distal femur or proximal tibia (region of the knee) C. Presents as a pathologic fracture or bone pain with swelling D. Imaging reveals a destructive mass with a 'sunburst' appearance and lifting of the periosteum. E. Biopsy reveals pleomorphic cells that produce osteoid. A 30-year-old woman has experienced pain in the area of the left knee for 1 month. On physical examination, there is tenderness to palpation of the distal left thigh and knee. The area is firm, but there is no erythema or warmth. A radiograph of the left leg shows a 7-cm mass in the distal femoral epiphyseal area, with a “soap bubble” appearance. Microscopic examination of a curettage specimen of the lesion shows the findings in the figure. The lesion recurs in the next year; it is excised and does not recur again. What is the most likely diagnosis? A Chondrosarcoma B Enchondroma C Giant cell tumor D Osteitis fibrosa cystica E Osteoblastoma F Plasmacytoma V. GIANT CELL TUMOR A. Tumor comprised of multinucleated giant cells and stromal cells B. Occurs in young adults C. Arises in the epiphysis oflong bones, usually the distal femur or proximal tibia (region of the knee) D. 'Soap-bubble' appearance on x-ray E. Locally aggressive tumor; may recur A 13-year-old, previously healthy boy has had pain in the right leg for the past month. There is no history of trauma or recent illness. On physical examination, there is warmth and tenderness to palpation of the right lower thigh anteriorly, and the circumference of the right thigh is slightly larger than that of the left. His temperature is 39° C. A radiograph of the right leg shows a 6-cm expansile mass in the diaphyseal region of the right lower femur that extends into the soft tissue and is covered by layers of reactive bone. A biopsy of the mass is done, and microscopic examination shows sheets of closely packed primitive cells with small, uniform nuclei and only scant cytoplasm. Karyotypic analysis of the tumor cells shows a t(11;22) translocation. What is the most likely diagnosis? A Chondrosarcoma B Ewing sarcoma C Giant cell tumor D Metastatic carcinoma E Osteosarcoma F Plasmacytoma VI. EWING SARCOMA A. Malignant proliferation of poorly-differentiated cells derived from neuroectoderm B. Arises in the diaphysis oflong bones; usually in male children(< 15 years of age) C. 'Onion-skin' appearance on x-ray D. Biopsy reveals small, round blue cells that resemble lymphocytes. 1. Can be confused with lymphoma or chronic osteomyelitis 2. t (11;22) translocation is characteristic. E. Often presents with metastasis; responsive to chemotherapy VII. CHONDROMA A. Benign tumor of cartilage B. Usually arises in the medulla of small bones of the hands and feet. 50 year old male presented with chest wall mass(7th rib) CT-scan showing, An expansile lytic lesion involves the right 7th rib, It measures 43 x 46 mm. The mass exhibits clearly delineated cortical outline, no invasion of the soft tissues and harbors calcified matrix, it stretches and elevates the right pectoralis muscle, with no evidence of invasion. What is the diagnosis: A-chondrosarcoma B-Osteosarcoma C-Enchondroma E-Ewing sarcoma VIII. CHONDROSARCOMA A. Malignant cartilage-forming tumor B. Arises in medulla of the pelvis or central skeleton IX. METASTATIC TUMORS A. More common than primary tumors (99% of bone tumor was secondary vs 1% of bone tumor was primary) B. Usually result in osteolytic (punched-out) lesions 1. Prostatic carcinoma classically produces osteoblastic lesions. take home message 1.Secondary (metastasis to bone)(99%) bone tumor more common than primary bone tumor(1%).. 2.Osteochondroma (Exostosis) is the most common bone tumor(benign). 3-Osteosarcoma more common in children and young (15_30)y. 4-Chondrosarcoma more common in adult(old)(50-70)y. 5.Giant cell tumor is locally aggressive tumor but very rarely metastasis to other site. 6-Ewing sarcoma common in child and young (12_30) CX ,fever ,leukocytosis ,joint pain.