Bone tumors

1. BONE TUMORS

2. • Bone tumors diverse in size & gross &
histologic features
• Inocuous to rapidly fatal
• Critical to diagnose , stage & treat
• Classified according to normal tissue type
they recapitulate or normal cell

4. • Benign tumors within first 3 decades of life
• Elderly malignant
• Cause – unknown , genetic alterations
• Benign lesions – asymptomatic
• Pain , slow growing mass , sudden
pathologic fracture
• Radiology & biopsy

5. BONE FORMING TUMORS
• Production of bone by neoplastic cells
• Tumor bone deposit as woven trabeculae
& variably mineralized

6. Osteosarcoma
• Malignant mesenchymal tumor in which
the cancerous cells produce bone matrix
• Paget disease , bone infarcts & prior
irradiation

7. • Metaphyseal region of long bones of
extremities
• Depending on their location within bone –
medullary & parosteal

8. Medullary / central osteosarcoma
• Common, 10-20yrs, male common
• Metaphysis of long bones – lower end of
femur & upper end of tibia

10. Based on pathogenesis – primary &
secondary
• Primary – unknown etiology, evidence
linking with genetic factors, period of
active growth, environmental infleunces
• Hereditary retinoblastoma

11. • Secondary – preexisting bone diseases –
paget’s disease of bone, fibrous dysplasia,
multiple osteochondromas, chronic
osteomyelitis, infarcts & #
• More aggressive

12. Medullary osteosarcoma – highly malignant
• Metaphysis -> extends centrally & expands
laterally on either side breaking through the
cortex & lifting periosteum -> surrounding soft
tissue
• X – ray – sunburst pattern due to osteogenesis
within the tumor
Codmann’s triangle – formed at the angle
between elevated periosteum & underlying
surface of cortex

13. • Clinical features – pain, tenderness &
swelling
• Alkaline phosphatase raised
• Metastasis – rapidly, hematogenous route
– lungs, bones, brain

14. Morphology
• Grey white, bulky, mass
• c/s – greywhite, areas of hemorrhage &
necrosis, hard & gritty if abundant osteiod
& cartilage present, cystic degeneration

15. osteosarcoma of upper end of tibia

16. Osteosarcoma- Femur

17. • Tumor cells have large hyperchromatic
nuclei , bizarre tumor giant cells
• Formation of bone by tumor cells- lace like
architecture , deposited in broad sheets or
primitive trabeculae

19. Osteosarcoma

20. Clincal course• Painful & progressively enlarging mass
• Sudden fracture
• X – ray –large destructive , mixed lytic &
blastic mass with permeative margins
• Breaks through cortex , lifts periosteum –
reactive periosteal bone formation

21. • Codman’s triangle
• Chemotherapy & limb salvage therapy

23. Parosteal / Juxtacortical osteosarcoma
• Uncommon, better prognosis
• Older age grp
• Lower end of femur, upper end of
humerus

24. MISCELLANEOUS TUMORS
Ewing sarcoma
• 10 -15 yrs, highly malignant
• Shafts & metaphysis of long bones
• Arise in medullary cavity , invades cortex
& periosteum producing soft tissue mass
• Tan with areas of hemorrhage & necrosis

25. • Sheets of uniform small , round cells with
scant cytoplasm
• Homer- Wright rosettes – around bld
vessels
• Painful enlarging mass

26. Ewing sarcoma

27. Ewing sarcoma

28. • Plain x- ray – destructive lytic tumor with
permeative margins
• Periosteal reaction produces layers of
reactive bone deposited in onion-skin
fashion
• Treatment chemotherapy & surgery

29. Giant cell tumor
• Osteoclastoma
• Benign but locally aggressive neoplasm
• 20-40yrs
• Monocyte macrophage lineage

30. Morphology• Large red brown , undergo cystic
degeneration
• Uniform oval mononuclear cells with
indistinct cell membrane , grow in
syncytium

31. • Scattered within background are
numerous osteoclast type giant cells
• Necrosis , hemorrhage , hemosiderin
deposition , reactive bone formation

32. Osteoclastoma

33. Osteoclastoma

34. • Involves epiphysis & metaphyses
• Arise around knee , solitary
• Arthritic symptoms
• X – ray – large purely lytic , eccentric &
erode into subchondral plate , overlying
cortex destroyed

35. Giant cell tumor - MRI

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