Tumours of Bones, cartilage & joints
Dr Neha MahajanMD PathologyMGM Medical College, AbadTumours of
Bones, cartilage & joints
Tumors and tumor-like conditions of bone- Diverse in their gross
and morphologic features, and clinical behavior.- Benign tumors
outnumber malignancies and are commoner in young- Specific tumor
types have preferential age and sex distribution- Specific tumor
types preferentially involve specific bones and specific regions
within a bone
Metaphysis
CLASSIFICATIONBone formingBenign: Osteoid osteoma
OsteoblastomaMalignant:OsteosarcomaCartilage formingBenign:
Osteochondroma ChrondromaHaematopoetic: Multiple Myeloma
Lymphoma
Notochordal tumorChordomaFibrous lesionsNonossifying fibroma
Cortical desmoid Benign fibrous histiocytomaFibrous dysplasia
Osteofibrous dysplasiaDesmoplastic fibromaTumors of unknown
originBenign: Giant cell tumor Aneurysmal bone cystMalignant:
Ewing`s sarcoma Adamantinoma
Bone tumorsHistologic typeBenignMalignantHematopoietic
(40%)Myeloma, lymphomaChondrogenic (22%)Osteochondroma, chondroma,
chondroblastoma, chondromyxoid fibromaChondroscarcoma,
dedifferentiated and mesenchymal chondrosarcomaOsteogenic
(19%)Osteoid osteoma, osteoblastomaOsteosarcomaUnknown (10%)Giant
cell tumorEwing sarcoma, giant cell tumor,
adamantinomaHistiocyticFibrous histiocytomaMalignant fibrous
histiocytomaFibrogenicFibromaDesomplastic fibroma,
fibrosarcomaNotochordalChordomaVascularHemangiomaHemangioendothelioma,
hemangiopericytoma,
angiosarcomaLipogenicLipomaLiposarcomaNeurogenicNeurilemmoma
(schwannoma)
Osteoma Osteoid osteoma Osteoblastoma. Osteosarcoma
Bone Forming Tumors: Production of bone by the neoplastic
cells
Osteoid Osteoma & OsteoblastomaBenign bone tumors .Osteoid
Osteoma are by definition >>FPELVIS, SCAPULAE, RIBS
28
Osteochondroma29
CHONDROMAChondroma vs. EN-chondromaPURE Hyaline
CartilageMULTIPLE enchondromas = Olliers dis.Maffucci synd. if
hemangiomas present
30
CHONDROBLASTOMARARE, in teenagersM>>FKNEES,
usuallyEpiphysesMUCH LESS matrix than a chondroma
31
CHONDROMYXOID FIBROMARAREST of allTEENS, MALESMYXOID
conceptATYPIA
32
CHONDROSARCOMAMalignant cartilage forming tumor that does not
produce osteoidMay arise from osteochondromaThird most common bone
malignancy after myeloma and osteosarcomaAge group: fourty and
aboveM:F=2:1Sites: large bones - pelvis, ribs, femur, humerus,
vertebrae; unusual in hands, feet, jaw, skull
ANATOMYINTRAMEDULLARYJUXTACORTICALHISTOLOGYCONVENTIONALHYALINEMYXOIDCLEARDE-DIFFERENTIATEDMESENCHYMAL
34
Chondrosarcoma
GrossLarge bulky tumors made of nodules of glistening gray
white,translucent cartilgaeMatrix is often gelatinous or myxoid
oozes out on cutSpotty calcifications and central necrosis can
produce cysticc spacesTumor spreads though cortex into surrounding
muscle and fat
GROSS
MicroscopyCartilage infiltrates the marrow and surrounds
preexisting bony trabeculaeTumor varies in cellularity, cytologic
atypia and mitotic activity are assigned from grade 1 to 3Grade 1
low cellularity,chondrocyte have plump nuclei with small
nucleoliGrade 3 high cellularity ,extreme pleomorphism with bizzare
tumor giant cells and mitoses.
Conventional hyaline, mesenchymal, clear, conventional
myxoid40
41
Direct correlation between grade and biologic behaviour of
tumorGrade 1 tumors rarely metastasize,5 yr survival rate of 80 to
90%( 43% for grade 3)Treatment is wide surgical excision with or
without chemotherapy
GIANT CELL TUMOR/OSTEOCLASTOMAGCT so named histology dominated
by multinucleated osteclast like giant cells(OSTEOCLASTOMA)Uncommon
benign,but locally aggressive neoplasmUsually seen in 20 to 40
yrsArise in EPIPHYSISSite : around knee( distal femur and proximal
tibia)Arthritis like symptoms,pathologic fractureMostly solitary,
multicentric in extrmeties
OSTEOCLASTOMA showing soap bubble appearance
MORPHOLOGYGCT destroy overlying cortex, producing bulging soft
tissue masss delineated by thin shell of reactive boneTumors are
large, red brown masses, frequently undergo cystic degenerationM/E
sheets of uniform oval mononuclear cells and numerous osteoclast
type giant cellsNecrosis and mitotic activity prominent
Giant cell tumor are treated by curettage,but 40 to 60 % recur
locally.4% metastasize to lung, sometimes spontaneously regress and
seldom fatal.RANKL inhibitor, denosunab as adjuvant therapy
Ewing`s sarcoma/PNETSAME TUMORSMALL ROUNDNEUROENDOCRINEIDENTICAL
CHROMOSOME TRANSLOCATIONSECOND most COMMON bone malignancy in
CHILDRENARISE IN MEDULLARY CAVITY of BONELOOK LIKE LYMPHOMA
Ewing Sarcoma
Commonly affects DIAPHYSES of long tubular bones esp femur and
flat bones of plevis
X ray destructive,lytic tumor with permeative marginMay be
confused with osteomyelitis
Commonly affects diaphysis with onion skin appearance
Gross: soft tan white with areas of haemorrhage and necrosis
Small round blue cell tumor
Ewings sarcoma tumors are aggressive malignancies Neoadjuvant
chemotherapy followed by surgical excision with or without
radiation 5 yr survival 75 % and long term in 50%
METASTASES
MALE: PROSTATEFEMALE: BREASTRENAL, THYROID also seek bone early
also
LYTIC?BLASTIC?
55
Evaluation History
Physical examination
Investigations; labs, imaging
Biopsy
Analytic approach to evaluation of the bone neoplasm
What we learned today??Bone tumor classificationBone forming
tumors: Osteoma,osteoid osteoma and osteosarcomaCartilage forming:
Enchondroma and chondrosarcomaOsteoclastoma/Giant cell tumorEwing`s
sarcoma
THANK YOU
