The document discusses various bone forming tumors including osteoid osteoma, osteoblastoma, and osteosarcoma.
Osteoid osteoma is a benign bone tumor characterized by a small nidus surrounded by sclerotic bone. Osteoblastoma is a rare benign tumor composed of woven bone trabeculae arranged haphazardly. Osteosarcoma is a malignant bone tumor that can be conventional, affecting long bones in adolescents, or have subtypes like telangiectatic or parosteal osteosarcoma. Radiologic findings, gross appearance, microscopy, and prognosis are described for each tumor type. Differential diagnoses are also provided to distinguish between benign and malignant bone lesions.
This document discusses the diagnosis and radiological analysis of various cystic bone lesions. It provides details on 7 key questions to ask during radiological analysis of lytic bone lesions, including location, size, effect on bone, bone response, matrix type, cortex status, and soft tissue extension. It then summarizes the characteristics, presentation, diagnosis, and treatment of various specific cystic bone lesions such as solitary bone cyst, aneurysmal bone cyst, fibrous dysplasia, enchondroma, chondromyxoid fibroma, and others. Radiological findings, pathology, and management approaches are described for each condition.
This document defines and discusses pigmented villonodular synovitis (PVNS), a benign tumor of the synovium. It most commonly affects large joints like the knee and hip in adults. While the exact cause is unknown, repetitive trauma is thought to play a role in many cases. PVNS can be either localized or diffuse. Treatment involves complete synovectomy, which can be performed either arthroscopically or via open surgery, with the goal of removing all affected synovial tissue. Radiation therapy may also be used in some cases. Prognosis is generally good for localized PVNS but recurrence is more common when disease is diffuse.
Here are the answers to your questions:
1. Most common site of osteomyelitis - Metaphysis of long bones, especially distal femur and proximal tibia.
2. Most common organism causing osteomyelitis - Staphylococcus aureus.
3. Earliest radiographic and MRI findings of acute osteomyelitis - Soft tissue swelling and loss of fascial planes seen within 24-48 hours on radiographs. Bone marrow edema seen as low signal on T1 and high signal on T2/STIR sequences in MRI.
4. What is sequestrum - Avascular/necrotic bone fragment formed due to osteonecrosis in chronic osteomyelitis
This document provides an overview of the approach to cystic bone lesions. It begins with definitions and classifications of benign and malignant cystic bone lesions. Key aspects to consider in the approach include the age of the patient, location of the lesion, characteristics of the transitional zone, presence of a matrix, status of the bone cortex, periosteal reaction, and soft tissue swelling. Specific cystic lesions discussed individually include aneurysmal bone cyst, solitary bone cyst, fibrous dysplasia, and enchondroma. Treatment approaches are also summarized for some of the lesions.
This document summarizes various cartilage forming tumors including:
1. Chondrosarcoma, which is the third most common malignant bone tumor arising in adults. The main subtypes are conventional, dedifferentiated, clear cell, and mesenchymal chondrosarcoma.
2. Osteochondroma, which is a benign cartilage-capped outgrowth most commonly affecting adolescents and young adults.
3. Chondroma, which is a benign tumor composed of hyaline cartilage that can occur intraosseously as enchondromas or juxtacortically.
4. Other rare tumors discussed include chondroblastoma and chondromyxoid fibroma.
This document discusses chondrosarcoma, a type of bone cancer. It is a malignant tumor originating from cartilage that makes up 9% of primary bone cancers. The document covers the classification, most common sites in the body, clinical features, diagnosis using imaging like CT and MRI, histological examination, treatment including wide resection or amputation, and prognosis which depends on grade and size of the tumor. Chondrosarcoma can be primary, arising directly in bone, or secondary from pre-existing benign cartilage lesions. Low-grade lesions have over 90% 10-year survival while high-grade have 20-40% 10-year survival.
Chondroblastoma is a rare benign tumor that develops from cartilage germ cells, most commonly affecting the epiphysis of long bones in teenagers before growth plate closure. It appears lytic with punctate calcification on x-ray and shows clear borders and surrounding edema on MRI. Microscopically it contains islands of chondroblasts with chicken wire calcification and multinucleated giant cells. Treatment involves curettage with bone grafting, and it has a low recurrence rate with marginal excision but high recurrence with intra-capsular curettage.
This document discusses the diagnosis and radiological analysis of various cystic bone lesions. It provides details on 7 key questions to ask during radiological analysis of lytic bone lesions, including location, size, effect on bone, bone response, matrix type, cortex status, and soft tissue extension. It then summarizes the characteristics, presentation, diagnosis, and treatment of various specific cystic bone lesions such as solitary bone cyst, aneurysmal bone cyst, fibrous dysplasia, enchondroma, chondromyxoid fibroma, and others. Radiological findings, pathology, and management approaches are described for each condition.
This document defines and discusses pigmented villonodular synovitis (PVNS), a benign tumor of the synovium. It most commonly affects large joints like the knee and hip in adults. While the exact cause is unknown, repetitive trauma is thought to play a role in many cases. PVNS can be either localized or diffuse. Treatment involves complete synovectomy, which can be performed either arthroscopically or via open surgery, with the goal of removing all affected synovial tissue. Radiation therapy may also be used in some cases. Prognosis is generally good for localized PVNS but recurrence is more common when disease is diffuse.
Here are the answers to your questions:
1. Most common site of osteomyelitis - Metaphysis of long bones, especially distal femur and proximal tibia.
2. Most common organism causing osteomyelitis - Staphylococcus aureus.
3. Earliest radiographic and MRI findings of acute osteomyelitis - Soft tissue swelling and loss of fascial planes seen within 24-48 hours on radiographs. Bone marrow edema seen as low signal on T1 and high signal on T2/STIR sequences in MRI.
4. What is sequestrum - Avascular/necrotic bone fragment formed due to osteonecrosis in chronic osteomyelitis
This document provides an overview of the approach to cystic bone lesions. It begins with definitions and classifications of benign and malignant cystic bone lesions. Key aspects to consider in the approach include the age of the patient, location of the lesion, characteristics of the transitional zone, presence of a matrix, status of the bone cortex, periosteal reaction, and soft tissue swelling. Specific cystic lesions discussed individually include aneurysmal bone cyst, solitary bone cyst, fibrous dysplasia, and enchondroma. Treatment approaches are also summarized for some of the lesions.
This document summarizes various cartilage forming tumors including:
1. Chondrosarcoma, which is the third most common malignant bone tumor arising in adults. The main subtypes are conventional, dedifferentiated, clear cell, and mesenchymal chondrosarcoma.
2. Osteochondroma, which is a benign cartilage-capped outgrowth most commonly affecting adolescents and young adults.
3. Chondroma, which is a benign tumor composed of hyaline cartilage that can occur intraosseously as enchondromas or juxtacortically.
4. Other rare tumors discussed include chondroblastoma and chondromyxoid fibroma.
This document discusses chondrosarcoma, a type of bone cancer. It is a malignant tumor originating from cartilage that makes up 9% of primary bone cancers. The document covers the classification, most common sites in the body, clinical features, diagnosis using imaging like CT and MRI, histological examination, treatment including wide resection or amputation, and prognosis which depends on grade and size of the tumor. Chondrosarcoma can be primary, arising directly in bone, or secondary from pre-existing benign cartilage lesions. Low-grade lesions have over 90% 10-year survival while high-grade have 20-40% 10-year survival.
Chondroblastoma is a rare benign tumor that develops from cartilage germ cells, most commonly affecting the epiphysis of long bones in teenagers before growth plate closure. It appears lytic with punctate calcification on x-ray and shows clear borders and surrounding edema on MRI. Microscopically it contains islands of chondroblasts with chicken wire calcification and multinucleated giant cells. Treatment involves curettage with bone grafting, and it has a low recurrence rate with marginal excision but high recurrence with intra-capsular curettage.
Presentation on bone tumors for undergraduate 2nd year MBBS medical students. The information for this presentation has been taken from texbook of Robbins & Cotran Pathologic Basis of Disease 8th ed.
This document discusses soft tissue tumors. It defines soft tissue and describes its composition. It notes that soft tissue tumors can be caused by radiation, burns, trauma, viruses, or genetic syndromes. The document outlines various tumor types including liposarcomas, fibrosarcomas, and malignant fibrous histiocytomas. It describes histologic patterns seen in different tumors and discusses grading systems. Pseudosarcomas like nodular fasciitis are also summarized.
Simple bone cysts, also known as unicameral bone cysts, are benign bone lesions of unknown cause that typically occur in the metaphysis of long bones like the proximal humerus and femur in children and adolescents. They appear on x-ray as areas of translucency in the bone and often cause pain, swelling or pathological fractures. Treatment involves curettage and bone grafting if the risk of fracture is high or steroid injections if the cyst is small with a low fracture risk.
Giant cell tumor of bone is a neoplasm arising from bone marrow tissue. It commonly affects people aged 20-40 years old and is more common in females. Common sites are the distal femur, proximal tibia, and distal radius. Treatment options include pharmacological therapies like bisphosphonates and denosumab, surgical curettage with or without adjuvants, and radiotherapy. Bisphosphonates and denosumab work to inhibit bone resorption by osteoclasts. Extended curettage with adjuvants provides a compromise treatment that is both oncologically safe and preserves function.
This document discusses various types of cystic bone lesions. It begins by defining what a cyst is and describing the general features of cystic lesions in bone. It then discusses four specific types of cystic bone lesions - solitary bone cyst, aneurysmal bone cyst, intraosseous ganglion cyst, and epidermoid cyst. For each type, it covers locations, pathogenesis, histology, imaging appearance, and treatment options. It also briefly mentions several conditions that can resemble cystic bone lesions. The document provides detailed information on solitary bone cysts and aneurysmal bone cysts.
1. Malignant bone tumors are aggressive cancers that rapidly destroy tissue and commonly spread to other areas. They make up about 0.5% of all cancers.
2. The most common malignant bone tumors are metastases from other primary cancers, which account for 70% of cases. Primary bone cancers include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.
3. Diagnosis involves imaging like x-rays, CT, and MRI to identify bone destruction and tumor extent. Biopsy is needed for histological examination to determine the tumor type and grade. Treatment depends on the cancer but commonly involves surgery along with chemotherapy and radiation.
This document discusses several types of benign bone tumors, including osteoid osteoma, osteoblastoma, osteochondroma, enchondroma, periosteal chondroma, chondroblastoma, chondromyxoid fibroma, fibrous dysplasia, and ossifying fibroma. It describes the clinical presentation, radiographic findings, differential diagnosis, treatment and prognosis for each tumor. Plain radiographs are emphasized as the best initial imaging modality for evaluating these lesions.
This document summarizes information about osteoid osteoma, a benign bone tumor. It describes the typical presentation as a painful lesion most common in younger males, often located in the femur or tibia. Diagnosis typically involves x-ray, CT scan or bone scan to locate the lesion. While traditionally treated with open surgical excision, minimally invasive techniques like CT-guided percutaneous excision have high success rates with less morbidity.
This document discusses various imaging modalities used to analyze bone tumors, including their benefits and limitations. Conventional radiography is still the standard first technique used to determine location, morphology, and suspicious findings. Based on radiography results, further imaging such as CT, MRI, scintigraphy, or angiography may be used to better evaluate tumor extent, involvement of surrounding tissues, and vascular supply. Each additional technique provides more detailed information but also has advantages and disadvantages depending on the tumor characteristics and goals of assessment. Together, imaging tests help diagnose and plan treatment of bone tumors.
Osteosarcoma is a malignant bone tumor that arises from primitive bone-forming cells. It most commonly occurs in adolescents and young adults. The most frequent sites are the distal femur, proximal tibia, and proximal humerus. Treatment involves preoperative chemotherapy, surgical resection with wide margins, and postoperative chemotherapy. Prognosis depends on the stage, with 5-year survival rates of 60-80% for localized tumors and 15-30% for those that have metastasized.
Ewing sarcoma is a highly malignant bone tumor that most commonly affects children and young adults. It is characterized by small, round cancer cells of unknown origin that invade bone and sometimes spread to soft tissues or other bones. Diagnosis involves imaging tests and biopsy showing the characteristic cells. Treatment typically involves chemotherapy, surgery to remove the tumor if possible, and sometimes radiation therapy. While Ewing sarcoma has a poor prognosis if untreated, multidisciplinary treatment with chemotherapy, surgery, and radiation can result in 5-year survival rates of 60-75% for patients without metastasis at diagnosis.
Osteosarcoma is a malignant bone tumor characterized by the production of osteoid bone. It is the second most common primary bone malignancy and occurs most often in the metaphysis of long bones in adolescents and young adults. The tumor may be conventional, presenting as osteoblastic, chondroblastic or fibroblastic subtypes, or may be a rare telangiectatic or well-differentiated variant. While the exact cause is unknown, risk factors include rapid bone growth, genetic conditions, radiation exposure and pre-existing bone diseases.
The document discusses infection of bone and joint, including osteomyelitis, septic arthritis, and tuberculosis. It provides details on the mechanisms, symptoms, investigations, and treatments for acute and chronic osteomyelitis. It describes how septic arthritis can infect joints via the bloodstream or skin. Tuberculosis is caused by Mycobacterium tuberculosis and can infect synovial joints, tendon sheaths, and vertebrae, leading to granuloma formation, joint destruction, and abscesses. Treatment involves chemotherapy with rifampicin and isoniazid.
Osteomyelitis is an infection of bone that can be caused by bacteria entering through the bloodstream or directly through a wound. It most commonly affects the long bones in children and the vertebrae in adults. Symptoms include fever, pain, swelling, and limited movement near the infected bone. Diagnosis involves blood tests, imaging like x-rays, CT, MRI, and bone scans to identify bone changes. Treatment consists of antibiotics given intravenously or orally for several weeks based on bacterial culture results, along with rest and pain medication.
Giant cell tumor of bone is a locally aggressive bone tumor that typically affects young adults near the epiphysis of long bones. It appears lytic and expansile on imaging. Treatment has shifted from intralesional curettage, which has a high recurrence rate, to more extensive curettage with adjuvants like PMMA to fill the defect. For more advanced cases, en bloc resection is preferred but can require reconstruction. Close follow up is important due to the risk of local recurrence and rare pulmonary metastasis.
Synovial biopsy provides tissue that can be used to better understand the pathophysiological mechanisms of arthritis through techniques like immunohistochemistry, electron microscopy, and molecular biology. It is not normally required for routine diagnosis but can help evaluate new treatment approaches. There are different types of synovial biopsies including needle biopsy, arthroscopic biopsy, and open surgical biopsy. Needle biopsy is the most common technique and samples are obtained from joints like the knee using a 14-gauge needle. Synovial biopsy helps diagnose conditions like infectious arthritis, autoimmune diseases like rheumatoid arthritis, and crystal-induced arthritides.
1. Acute septic arthritis and acute osteomyelitis are bacterial infections of joints and bones respectively.
2. They are usually caused by Staphylococcus aureus and can spread hematogenously or from contiguous infected sites.
3. Symptoms include fever, pain, swelling and reduced range of motion near the infected site. Diagnosis involves blood tests, imaging like X-rays and MRI, and joint fluid analysis. Treatment requires antibiotics and may require surgical drainage of pus.
A bone scan uses radioactive tracers to detect areas of increased or decreased bone activity. It can evaluate bone abnormalities throughout the entire skeleton. Some key points:
- Bone scans are useful for detecting cancer metastases, fractures, stress fractures, bone infections, and other bone diseases.
- They have advantages of being able to image the whole body and having relatively low radiation exposure.
- The most common tracer used is technetium-99m MDP, which concentrates in areas of increased bone formation.
- Abnormal findings on bone scans include multiple areas of abnormal uptake indicating cancer metastases, linear areas of uptake indicating fractures, and photopenic defects indicating bone infarcts.
This document discusses osteoid osteoma, a relatively common benign bone tumor. It is characterized by a small nidus less than 1.5 cm in diameter that typically causes persistent night pain relieved by salicylates. Diagnosis is usually made through imaging like CT or MRI that identify the central nidus. Treatment options include long-term anti-inflammatories, percutaneous radiofrequency ablation to destroy the nidus, or surgical removal of the nidus through curettage or en bloc resection. The document also briefly discusses other bone forming tumors like osteoblastoma, osteoma, and their signs, symptoms, diagnosis and treatment.
The document discusses cytology of various bone lesions. It covers classification of bone tumors and describes cytological features of inflammatory conditions like osteomyelitis. It also discusses osteoid forming lesions such as fracture callus and osteoblastoma. Cartilage forming tumors described include chondroma, chondromyxoid fibroma and osteochondroma. Giant cell containing lesions and cystic bone lesions are also mentioned. The document provides cytological details of various bone tumors like osteosarcoma, chondrosarcoma and chondroblastoma through multiple case studies. It highlights differential diagnoses and ancillary techniques used in evaluation of bone lesions.
Presentation on bone tumors for undergraduate 2nd year MBBS medical students. The information for this presentation has been taken from texbook of Robbins & Cotran Pathologic Basis of Disease 8th ed.
This document discusses soft tissue tumors. It defines soft tissue and describes its composition. It notes that soft tissue tumors can be caused by radiation, burns, trauma, viruses, or genetic syndromes. The document outlines various tumor types including liposarcomas, fibrosarcomas, and malignant fibrous histiocytomas. It describes histologic patterns seen in different tumors and discusses grading systems. Pseudosarcomas like nodular fasciitis are also summarized.
Simple bone cysts, also known as unicameral bone cysts, are benign bone lesions of unknown cause that typically occur in the metaphysis of long bones like the proximal humerus and femur in children and adolescents. They appear on x-ray as areas of translucency in the bone and often cause pain, swelling or pathological fractures. Treatment involves curettage and bone grafting if the risk of fracture is high or steroid injections if the cyst is small with a low fracture risk.
Giant cell tumor of bone is a neoplasm arising from bone marrow tissue. It commonly affects people aged 20-40 years old and is more common in females. Common sites are the distal femur, proximal tibia, and distal radius. Treatment options include pharmacological therapies like bisphosphonates and denosumab, surgical curettage with or without adjuvants, and radiotherapy. Bisphosphonates and denosumab work to inhibit bone resorption by osteoclasts. Extended curettage with adjuvants provides a compromise treatment that is both oncologically safe and preserves function.
This document discusses various types of cystic bone lesions. It begins by defining what a cyst is and describing the general features of cystic lesions in bone. It then discusses four specific types of cystic bone lesions - solitary bone cyst, aneurysmal bone cyst, intraosseous ganglion cyst, and epidermoid cyst. For each type, it covers locations, pathogenesis, histology, imaging appearance, and treatment options. It also briefly mentions several conditions that can resemble cystic bone lesions. The document provides detailed information on solitary bone cysts and aneurysmal bone cysts.
1. Malignant bone tumors are aggressive cancers that rapidly destroy tissue and commonly spread to other areas. They make up about 0.5% of all cancers.
2. The most common malignant bone tumors are metastases from other primary cancers, which account for 70% of cases. Primary bone cancers include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.
3. Diagnosis involves imaging like x-rays, CT, and MRI to identify bone destruction and tumor extent. Biopsy is needed for histological examination to determine the tumor type and grade. Treatment depends on the cancer but commonly involves surgery along with chemotherapy and radiation.
This document discusses several types of benign bone tumors, including osteoid osteoma, osteoblastoma, osteochondroma, enchondroma, periosteal chondroma, chondroblastoma, chondromyxoid fibroma, fibrous dysplasia, and ossifying fibroma. It describes the clinical presentation, radiographic findings, differential diagnosis, treatment and prognosis for each tumor. Plain radiographs are emphasized as the best initial imaging modality for evaluating these lesions.
This document summarizes information about osteoid osteoma, a benign bone tumor. It describes the typical presentation as a painful lesion most common in younger males, often located in the femur or tibia. Diagnosis typically involves x-ray, CT scan or bone scan to locate the lesion. While traditionally treated with open surgical excision, minimally invasive techniques like CT-guided percutaneous excision have high success rates with less morbidity.
This document discusses various imaging modalities used to analyze bone tumors, including their benefits and limitations. Conventional radiography is still the standard first technique used to determine location, morphology, and suspicious findings. Based on radiography results, further imaging such as CT, MRI, scintigraphy, or angiography may be used to better evaluate tumor extent, involvement of surrounding tissues, and vascular supply. Each additional technique provides more detailed information but also has advantages and disadvantages depending on the tumor characteristics and goals of assessment. Together, imaging tests help diagnose and plan treatment of bone tumors.
Osteosarcoma is a malignant bone tumor that arises from primitive bone-forming cells. It most commonly occurs in adolescents and young adults. The most frequent sites are the distal femur, proximal tibia, and proximal humerus. Treatment involves preoperative chemotherapy, surgical resection with wide margins, and postoperative chemotherapy. Prognosis depends on the stage, with 5-year survival rates of 60-80% for localized tumors and 15-30% for those that have metastasized.
Ewing sarcoma is a highly malignant bone tumor that most commonly affects children and young adults. It is characterized by small, round cancer cells of unknown origin that invade bone and sometimes spread to soft tissues or other bones. Diagnosis involves imaging tests and biopsy showing the characteristic cells. Treatment typically involves chemotherapy, surgery to remove the tumor if possible, and sometimes radiation therapy. While Ewing sarcoma has a poor prognosis if untreated, multidisciplinary treatment with chemotherapy, surgery, and radiation can result in 5-year survival rates of 60-75% for patients without metastasis at diagnosis.
Osteosarcoma is a malignant bone tumor characterized by the production of osteoid bone. It is the second most common primary bone malignancy and occurs most often in the metaphysis of long bones in adolescents and young adults. The tumor may be conventional, presenting as osteoblastic, chondroblastic or fibroblastic subtypes, or may be a rare telangiectatic or well-differentiated variant. While the exact cause is unknown, risk factors include rapid bone growth, genetic conditions, radiation exposure and pre-existing bone diseases.
The document discusses infection of bone and joint, including osteomyelitis, septic arthritis, and tuberculosis. It provides details on the mechanisms, symptoms, investigations, and treatments for acute and chronic osteomyelitis. It describes how septic arthritis can infect joints via the bloodstream or skin. Tuberculosis is caused by Mycobacterium tuberculosis and can infect synovial joints, tendon sheaths, and vertebrae, leading to granuloma formation, joint destruction, and abscesses. Treatment involves chemotherapy with rifampicin and isoniazid.
Osteomyelitis is an infection of bone that can be caused by bacteria entering through the bloodstream or directly through a wound. It most commonly affects the long bones in children and the vertebrae in adults. Symptoms include fever, pain, swelling, and limited movement near the infected bone. Diagnosis involves blood tests, imaging like x-rays, CT, MRI, and bone scans to identify bone changes. Treatment consists of antibiotics given intravenously or orally for several weeks based on bacterial culture results, along with rest and pain medication.
Giant cell tumor of bone is a locally aggressive bone tumor that typically affects young adults near the epiphysis of long bones. It appears lytic and expansile on imaging. Treatment has shifted from intralesional curettage, which has a high recurrence rate, to more extensive curettage with adjuvants like PMMA to fill the defect. For more advanced cases, en bloc resection is preferred but can require reconstruction. Close follow up is important due to the risk of local recurrence and rare pulmonary metastasis.
Synovial biopsy provides tissue that can be used to better understand the pathophysiological mechanisms of arthritis through techniques like immunohistochemistry, electron microscopy, and molecular biology. It is not normally required for routine diagnosis but can help evaluate new treatment approaches. There are different types of synovial biopsies including needle biopsy, arthroscopic biopsy, and open surgical biopsy. Needle biopsy is the most common technique and samples are obtained from joints like the knee using a 14-gauge needle. Synovial biopsy helps diagnose conditions like infectious arthritis, autoimmune diseases like rheumatoid arthritis, and crystal-induced arthritides.
1. Acute septic arthritis and acute osteomyelitis are bacterial infections of joints and bones respectively.
2. They are usually caused by Staphylococcus aureus and can spread hematogenously or from contiguous infected sites.
3. Symptoms include fever, pain, swelling and reduced range of motion near the infected site. Diagnosis involves blood tests, imaging like X-rays and MRI, and joint fluid analysis. Treatment requires antibiotics and may require surgical drainage of pus.
A bone scan uses radioactive tracers to detect areas of increased or decreased bone activity. It can evaluate bone abnormalities throughout the entire skeleton. Some key points:
- Bone scans are useful for detecting cancer metastases, fractures, stress fractures, bone infections, and other bone diseases.
- They have advantages of being able to image the whole body and having relatively low radiation exposure.
- The most common tracer used is technetium-99m MDP, which concentrates in areas of increased bone formation.
- Abnormal findings on bone scans include multiple areas of abnormal uptake indicating cancer metastases, linear areas of uptake indicating fractures, and photopenic defects indicating bone infarcts.
This document discusses osteoid osteoma, a relatively common benign bone tumor. It is characterized by a small nidus less than 1.5 cm in diameter that typically causes persistent night pain relieved by salicylates. Diagnosis is usually made through imaging like CT or MRI that identify the central nidus. Treatment options include long-term anti-inflammatories, percutaneous radiofrequency ablation to destroy the nidus, or surgical removal of the nidus through curettage or en bloc resection. The document also briefly discusses other bone forming tumors like osteoblastoma, osteoma, and their signs, symptoms, diagnosis and treatment.
The document discusses cytology of various bone lesions. It covers classification of bone tumors and describes cytological features of inflammatory conditions like osteomyelitis. It also discusses osteoid forming lesions such as fracture callus and osteoblastoma. Cartilage forming tumors described include chondroma, chondromyxoid fibroma and osteochondroma. Giant cell containing lesions and cystic bone lesions are also mentioned. The document provides cytological details of various bone tumors like osteosarcoma, chondrosarcoma and chondroblastoma through multiple case studies. It highlights differential diagnoses and ancillary techniques used in evaluation of bone lesions.
This document provides information about various bone tumors. It begins by describing the structure of long bones and bone cells. It then classifies bone tumors as either benign or malignant, and lists examples of tumors from bone, cartilage, fibrous tissue and other origins. For each tumor type, it provides details on characteristics such as typical age, location, symptoms, radiological features, pathology and treatment options. Some of the specific bone tumors covered include osteoma, osteoid osteoma, osteoblastoma, osteochondroma, chondroma, chondroblastoma and giant cell tumor.
This document provides information about different types of bone tumors. It begins by describing the normal anatomy of bones and then discusses various benign and malignant bone tumors. Some of the tumors covered include osteoma, osteoid osteoma, osteoblastoma, osteosarcoma, chondroma, and chondrosarcoma. For each tumor, the document discusses clinical features, radiographic findings, pathology, histology, treatment and prognosis. It provides classifications of bone tumors and highlights important diagnostic and prognostic factors for osteosarcoma.
This document provides information about different types of bone tumors. It begins by describing the normal anatomy of bones and then discusses various benign and malignant bone tumors. Some of the tumors covered include osteoma, osteoid osteoma, osteoblastoma, osteosarcoma, chondroma, and chondrosarcoma. For each tumor, the document discusses clinical features, radiographic appearance, pathology, histology, treatment and prognosis. It provides classifications of bone tumors and lists some prognostic factors for osteosarcoma.
This document provides information about bone tumors, including benign and malignant types. It discusses the classification and characteristics of common bone tumors such as osteoma, osteoid osteoma, osteoblastoma, and osteosarcoma. For each tumor, the document outlines clinical features, radiographic appearance, pathology, histology, treatment and prognosis. It emphasizes that osteosarcoma is the most common primary malignant bone tumor, occurring most frequently in adolescents and young adults. The etiology may include genetic factors, radiation exposure, and certain pre-existing bone conditions.
This document discusses several types of primary bone tumors. It begins with an introduction to the classification of bone tumors based on histologic criteria. It then discusses several benign bone tumors in more detail, including chondroma, osteoma, osteoid osteoma, benign osteoblastoma, and osteochondroma. For malignant tumors, it focuses on explaining osteosarcoma, including its etiology, classification, and characteristics. It provides histologic images and descriptions of the key features of many of these tumors. In summary, the document provides an overview of the classification and characteristics of both benign and malignant primary bone tumors.
1. The document discusses several skeletal developmental and genetic disorders including osteogenesis imperfecta, as well as metabolic bone diseases such as osteoporosis, renal osteodystrophy, osteomalacia, rickets, and hyperparathyroidism.
2. Inflammatory bone disorders including osteomyelitis, sarcoidosis, Paget's disease of bone, and osteonecrosis are described. Trauma and fracture repair processes are also summarized.
3. Several primary bone tumors are discussed including osteoid osteoma, osteosarcoma, chondroma, osteochondroma, and chondroblastoma.
1. The document discusses several skeletal developmental and genetic disorders including osteogenesis imperfecta, as well as metabolic bone diseases such as osteoporosis, renal osteodystrophy, osteomalacia, rickets, and hyperparathyroidism.
2. Inflammatory bone disorders including osteomyelitis, sarcoidosis, Paget's disease of bone, and osteonecrosis are described. Trauma and fracture repair processes are also summarized.
3. Several primary bone tumors are discussed including osteoid osteoma, osteosarcoma, chondroma, osteochondroma, and chondroblastoma.
This document provides an overview of benign bone tumors. It discusses that most bone tumors are benign and seen in patients under 30 years old. A new bone tumor in the elderly is more likely to be malignant. Biopsy is the most conclusive test for diagnosis as it confirms if a tumor is malignant or benign. Common benign bone tumors mentioned include osteoid osteoma, bone islands, chondromas, osteochondromas, fibrous dysplasia, non-ossifying fibromas, aneurysmal bone cysts, and hemangiomas. Treatment depends on the specific tumor but may include observation, biopsy, curettage, bone grafting, or surgery. Radiology can provide important information on tumor location, growth
Fibro osseous lesions are intraosseous lesions characterized by replacement of normal bone by collagenous tissue containing varying amounts of mineralized substances. They are classified into developmental, reactive/reparative, neoplastic, endocrinal/metabolic, and idiopathic lesions. Common examples include solitary bone cysts, central giant cell granulomas, ossifying fibromas, and fibrous dysplasia. These lesions are typically benign and often asymptomatic, with imaging and histopathological examination required for diagnosis and guidance of treatment.
Simple and aneurysmal Bone cyst - Definition, Classfication, Investigations, ...orthoslides
This document provides information on simple bone cysts and aneurysmal bone cysts. Simple bone cysts typically occur in children before bone growth plates close and present as asymptomatic lesions. Aneurysmal bone cysts can occur at any age and commonly present with pain, swelling, or fracture. They appear multilocular on imaging with fluid-fluid levels. Both lesions are benign but aneurysmal bone cysts have a higher recurrence rate after treatment with curettage and grafting due to their vascular nature.
This document provides an overview of benign bone tumors. It discusses osteoma, osteoid osteoma, osteoblastoma, giant cell tumor (osteoclastoma), chondroblastoma, osteochondroma/exostosis, and enchondroma. For each tumor, it describes characteristics such as common locations, symptoms, radiological features, histopathology, differential diagnosis, and treatment options. Common features of benign bone tumors are also reviewed, including well-defined margins, sclerotic rims, and lack of soft tissue involvement. Treatment methods like curettage, extended curettage, and various reconstruction techniques are presented.
Dr. Gaurav S. Salunkhe presented on oral and maxillofacial pathology. The document discussed the classification, development, diseases and conditions that affect bone, including the alveolar bone. Specific conditions discussed in detail include cherubism, osteogenesis imperfecta, osteopetrosis, and cleidocranial dysplasia. Cherubism is a rare hereditary condition causing bilateral jaw swelling in children that typically resolves after puberty.
The document discusses several non-neoplastic bone lesions that can mimic bone tumors including malignant lesions on imaging. These include brown tumors caused by hyperparathyroidism, bone islands, bone infarcts, stress fractures, and post-traumatic osteolysis. Correct diagnosis is important to avoid unnecessary biopsies, as many of these lesions can be diagnosed based on clinical history, lab tests, and characteristic imaging features without biopsy.
This document provides an overview of common benign bone lesions. It begins with an introduction to bone tumors and their classification as benign or malignant. Several common benign bone tumors are then described in detail, including their clinical features, radiological appearance, diagnosis, treatment, and prognosis. Examples discussed include osteoid osteoma, osteoblastoma, bone islands, chondromas, osteochondromas, chondromyxoid fibroma, chondroblastoma, non-ossifying fibroma, fibrous dysplasia, unicameral bone cyst, aneurysmal bone cyst, and hemangioma. For each lesion, the key presenting symptoms, diagnostic imaging findings, treatment approaches such as surgery or observation, and recurrence risks
Dr.salah.radiology.radiological approach to bone diseasesabas_lb
This document provides guidance on evaluating solitary bone lesions based on radiographic findings. Key factors include the patient's age, location and characteristics of the lesion, presence of cortical destruction or a periosteal reaction, and whether the lesion is mono- or polyostotic. Together these factors can help determine if a lesion is likely benign and slow-growing or potentially malignant and aggressive.
This document provides guidance on evaluating solitary bone lesions based on radiographic findings. Key factors include the patient's age, location and characteristics of the lesion, presence of cortical destruction or a periosteal reaction, and whether the lesion is focal or generalized. Aggressive lesions are suggested by an irregular shape, indistinct borders, breakthrough of the cortex, or involvement of multiple bones. Benign lesions tend to be well-defined, expand the bone, and have a narrow transition zone between abnormal and normal bone.
This document provides information on several types of musculoskeletal tumors and bone lesions:
1. Spinal tuberculosis (Pott's disease) shows granuloma formation with epithelioid and Langhans giant cells on pathology.
2. Osteochondromas appear as bony projections and most are solitary, benign lesions. Microscopically, they display a benign cartilaginous cap overlying bony cortex.
3. Enchondromas on pathology show lobules of mature cartilage separated by fibrous tissue on microscopy.
4. Giant cell tumors are composed of multinucleated giant cells in a sea of mononuclear cells and are treated with curettage or resection
This document discusses various benign bone tumors. It begins by defining a neoplasm and classifying tumors as benign, potentially malignant, or malignant. It then discusses the epidemiology and classification of benign bone tumors. Specific benign bone tumors discussed in detail include bone island, osteoma, osteoid osteoma, osteoblastoma, chondroma, chondroblastoma, and chondromyxoid fibroma. For each tumor, the document outlines characteristics such as typical age, location, radiographic appearance, and distinguishing features.
Similar to osteogenic bone tumors & fibrous dysplasia (20)
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
2. NORMAL BONE
Parts of bones
1. Epiphysis : ends of bone
2. Diaphysis : shaft
3. Metaphysis : epiphysial end of
diaphysis
Macroscopically the architecture of bone
may be
1. Compact
2. cancellous/spongy/trabeculae
4. Unmineralised matrix laid down by osteoblasts
Stains homogenously pink on H&E
On polarized light demonstrates criss cross or
woven pattern of collagen fibers
Can be confused with fibrin, collagen or
chondroid.
OSTEOID
5. NORMAL BONE
Woven bone : In these, collagen is deposited in a
random weave manner.
Lamellar bone : Collagen is deposited in a order. It
replaces woven bone during growth ,deposited much
slowly & stronger than woven bone
6. Woven bone (top) deposited on the surface of
preexisting lamellar bone(bottom)
11. BONE FORMING TUMOURS
1. OSTEOID OSTEOMA
2. OSTEOBLASTOMA
3. OSTEOSARCOMA
CONVENTIONAL OS
TELANGIECTATIC OS
SMALL CELL OS
LOW GRADE CENTRAL OS
SECONDARY OS
PAROSTEAL OS
PERIOSTEAL OS
HIGH GRADE SURFACE OS
13. OSTEOID OSTEOMA
Benign lesion characterized by less than 2 cm pea like
mass of abnormal bone-nidus
Limited growth potential
Clinical features
1. children & adolescents, occasionally in older individuals
2. more common in males
3. any bone except sternum.
1. most common in the long bones (metaphysis or shaft).
2. The tumour tend to involve the cortex rather than medulla
14. OSTEOID OSTEOMA
Signs & symptoms:
1. Pain-characteristically relieved by salicylates and
NSAIDS
2. Swelling & redness
3. Joint effusion
4. Scoliosis
5. Bone growth abnormalities
Genetics : involvement of 22q13 & loss of 17q
15. OSTEOID OSTEOMA:
RADIOLOGIC FINDINGS
X-RAY : Dense
cortical sclerosis
surrounding a
radiolucent nidus,
CT SCAN : best
imaging study to
demonstrate OO, help
16. OSTEOID OSTEOMA:
RADIOLOGIC FINDINGS
MRI SCAN: Useful in demonstrating medullary
or periarticular lesions and peri-tumoural oedema,
also help to localize the lesion
BONE SCAN: associated with hot bone scan,
helpful in localizing the lesion
17. OSTEOID OSTEOMA : GROSS
FINDINGS
Small , cortically
based, red, gritty
or granular round
lesion
surrounded (well
circumscribed)
by ivory white
sclerotic bone
18. MICROSCOPIC FINDINGS
The tumour consists of a central area of
vascularised connective tissue within which
differentiating osteoblasts are engaged in the
production of osteoid and sometime bone
if actual bone is present osteoclast may also
be seen engaged in remodelling
23. Osteoid osteoma v/s Solitary
enostosis
SOLITARY
ENOSTOSIS : does
not cause pain or
host bone sclerosis.
Usually consists of
lamellar bone with
haversian systems
27. OSTEOBLASTOMA
A rare benign tumor, usually larger than 2 cm,
characterized by osteoid and woven bone
production.
Age: 10-30 yrs
M:F is 2.5:1
Skeletal distribution: predilection for spine
particularly posterior elements and sacrum, others-
long bones-proximal and distal femur, proximal
tibia
Site: majority intra-osseus but a small percentage
can occur on the surface of the bone in a
28. OSTEOBLASTOMA
Symptoms: dull, aching, nocturnal pain not relieved
by aspirin
Genetics : 1. chromosomal rearrangements have
been described in 4 cases, with chr no. ranging
from hypodiploid to hyperdiploid.
2. MDM2 amplification
3. TP53 deletion in aggressive
osteoblastoma
29. OSTEOBLASTOMA:
RADILOGICAL FINDINGS
SPINAL LESION
1. Main mass centered in
vertebral arch
2. Round to ovoid lytic lesion
with bone expansion
3. Periosteal new bone
formation
4. Intra-lesional bone forming
30. X-ray showing expansion of the left fourth lumbar pedicle :
transeverse process and superior facet
31. OSTEOBLASTOMA: GROSS
FINDINGS
Lesion is well
demarcated,
Round to oval with thin
cortex
Mostly granular, gritty, &
deep red on cutting
Whitish yellow if bone
33. OSTEOBLASTOMA:
MICROSCOPIC FINDINGS
Tumour is composed of woven bone spicules
or trabeculae which are arranged haphazardly
& lined by single layer of osteoblast
Rich vascularity
Osteoblast may have mitosis but not atypical
Scattered multinucleated giant cells often
present
35. Osteoblastoma shows trabeculae of woven bone
lined by layer of polygonal osteoblast and the well
vascularised inter-trabecular stroma
36. OSTEOBLASTOMA:
MICROSCOPIC FINDINGS
Malignant osteoblastoma : histologically same but are
more cellular, has large no. of giant cells & large amount
of spiculated blue bone.
locally aggressive & does not develop distant
metastasis
Aggressive osteoblastoma : characterised by presence
of epitheloid osteoblasts, trabecular or sheet-like osteoid &
osteosclerotic resorption. locally aggressive & does not
develop distant metastasis
Pseudomalignant osetoblastoma : tumor cells have
hyperchromatic nuclei. However, the nuclei have the
40. 0steoid osteoma osteoblastoma
1. involvement Every bone except
sternum
Predilection for spine
2. size < 2cm > 2cm
3. pain Characteristically
relieved by NSAIDs
Not relieved by
NSAIDs
3. imaging Dense, cortical
sclerosis surrounding
a radiolucent nidus
Lytic, well
circumscribed ,
confined by a
periosteal shell of
reactive bone
4. gross Gritty or granular
round lesion
surrounded by ivory
white sclerotic bone
Round to oval, thinned
cortex & periosteal
reactive bone
5. microscopy Central nidus with
dense sclerotic bone
Composed of woven
bone trabeculae
arranged haphazardly
42. OSTEOBLASTOMA: D/D
ABC Osteoblastoma
1. Age First 2 decade 10-30yr
2. Sex No sex predilection M>F
3. Site Metaphysial Majority intraosseus
4. Gross Well demarcated,
multiloculated mass of
blood filled cystic
spaces separated by
tan white gritty septa
Well demarcated,
round to oval.
Granular, gritty & deep
red on cutting
5. Microscopy
6. Recurrence
Well circumscribed,
blood filled cystic
spaces, separated by
fibrous septa rich in
collagen producing
fibroblasts & callus like
tissue
Tumor composed of
haphazardly arranged
woven bone spicules
or trabeculae
Unusual
43. Osteoblastoma v/s ABC
ABC with blood filled cystic space surrounded by wall containing
proliferating fibroblasts, reactive woven bone, & osteoclast type
giant cells
45. OSTEOSARCOMAS
Osteosarcomas is a mesenchymally derived malignant
tumor that produces osteoid and/or bone.
They can be:
1. INTRAMEDULLARY OS
2. INTRACORTICAL OS
3. JUXTACORTICAL OS
46. OSTEOSARCOMA
PRIMARY OSTEOSARCOMA
1. CONVENTIONAL OSTEOSARCOMA
a) Osteobalstic
b) Chondroblastic
c) Fibroblastic
2. SMALL CELL OSTEOSARCOMA
3. TELANGIECTATIC OSTEOSARCOMA
4. LOW GRADE CENTRAL OSTEOSARCOMA
47. OSTEOSARCOMA
5. SURFACE OSTEOSARCOMA
a) Parosteal osteosarcoma
b) Periosteal osteosarcoma
c) High grade surface osteosarcoma
SECONDARY OSTEOSARCOMA
1. Osteosarcoma in paget’s disease
2. Postirradiation osteosarcoma
3. Osteosarcoma in other benign precursors
48. age/sex site c/f prognosis
Convention
al OS
2nd decade
M>F
Metaphysis
(91%) of
long bones
Pain,swellin
g,path #
If untreated
fatal
Telangiectat
ic OS
(<4%)
2nd decade
M>F
Metaphysis
of long
bones
Pain,swellin
g ,path #
As above
Small cell
OS(1.5%)
2nd decade,
slightly mc
in female
>50%
metaphysis
of long
bones
Pain,swellin
g
Slightly
worse than
convention
al OS
Low grade
central
OS(1-2%)
2nd-3rd ,
M=F
80% in long
bones
Pain,swellin
g
excellent
49. age/sex site c/f prognosis
OS sec. to
paget ds
65yr
M>F,2:1
Long
bones,
pelvis, skull
Pain,
swelling,
path#
Poor
Post-
radiation
OS (3.4%-
5%)
Children
are at
greatest
risk
Any bone,
mc in pelvis
& shoulder
region
Pain,
swelling
5yr survival
rate for
extremity
lesion is
68.2% &
axial lesion
27.3%
Parosteal
OS
Young
adult, slight
female
predominan
ce
Long bones Pain,
swelling,
inability to
flex the
knee
excellent
50. age/sex site c/f prognosis
Periosteal
OS
2nd-3rd
decade
Slightly mc
in male
Diaphysial
or dia-meta
region of
long bones
Painless
swelling
initially,
later pain
excellent
High grade
surface OS
2nd decade,
slightly mc
in male
Long bones Mass &/or
pain
Depend
upon
response to
chemothera
py
52. CONVENTIONAL
OS:RADIOLOGIC FINDINGS
Metaphysial location
It may be pure oseoblastic or
osteolytic. In most cases it is mixed
lytic/blastic lesion accompanied by
cortical destruction and extension
into soft tissue
Tumours tend to be eccentric.
Mixed blastic/lytic lesion
involving the femoral metaphys
54. CONVENTIONAL OS :GROSS
FINDINGS
OS often a large (over
5cm), metaphysial centered , fleshy
or hard tumour which may contain
cartilage
It frequently transgresses the
cortex & is associated with a soft
tissue mass
55. CONVENTIONAL OS
:MICROSCOPIC FINDINGS
1. It is highly anaplastic , pleomorphic tumor.
2. The tumour cells may be epithelioid ,plasmacytoid ,
fusiform, ovoid, small round cells, clear cells, giant
cells or spindle cells. Most cases are mixture of 2 or
more of these cell types.
3. Osteoid and/or bone production by tumor cells.
dense, pink, amorphous,curvilinear with small
nubs,arborisation,abortive lacunae formation,
intercellular material.
56. On the basis of production of predominant matrix
by tumors the conventional OS is subdivided into:
1. OSTEOBLASTIC (50%)
2. CHONDROBLASTIC (25%)
3. FIBROGENIC (25%)
57. OSTEOBLASTIC
OSTEOSARCOMA
1. Bone &/or osteoid are
the predominant
matrix
2. The matrix may be
thin, arborising
osteoid (i.e.,
filigree) to dense
compact osteoid &
Osteoblastic OS: showing
osteoid
59. CHONDROBLASTIC
OSTEOSARCOMA
Chondroid matrix is predominant.
It tends to be high grade hyaline cartilage.
Myxoid and other forms of cartilage are
uncommon, except in the jaws & pelvis.
Osteoid is seen between spindle cells or in center of
chondroid lobules.
69. Small cell OS of distal
femur : X-ray image
showing lytic and
blastic tumour tissue
at the soft tissue
compartment of the
lesion.
SMALL CELL
OSTEOSARCOMA
70. SMALL CELL
OSTEOSARCOMA
GROSS : Indistinguishable from those of conventional
OS
HISTOPATHOLOGY
•Small cells associated with osteoid production.
•Tumours are classified according to predominant cell
type : round cell type or spindle cell type.
•The nuclear diameter of round cells can be very
small(comparable to Ewing sarcoma) to
large(comparable to large cell lymphoma).
74. CENTRAL LOW GRADE
OSTEOSARCOMA
Microscopy
Tumor is composed of hypocellular spindle
cell proliferation.
The osteogenic matrix is produced as well
formed trabeculae of bone.
The spindle cell show minimal cytolgical
atypia
Mitotic figures are sparse.
The tumor tend to permeate marrow fat &
surrounding bony trabeculae.
75. CENTAL LOW GRADE OSTEOSARCOMA
Bony trabeculae surrounded by a hypocellular
spindle cell stroma with minimal cytologic atypia.
77. OS SECONDARY TO PAGET'S
DISEASE
Grossly : destructive tumors along with fleshy soft
tumors
Microscopically: high grade OS, mostly osteoblastic or
fibroblastic. A great number of osteclast like giant cell
may be found.
Genetics : linked to 18q
78. PAGET’S SARCOMA
Proximal femur shows
thickened cortical and
medullary bone
characteristic of underlying
paget’s disease with a large
hemorrhagic tan-white
sarcomatous tumor that has
broken through cortex
79. PAGET’S SARCOMA
High grade osteosarcoma permeating abnormal bone
seen in Paget’s disease which is thickened and lined by
osteoclasts
81. POSTIRRADIATION
SARCOMA
Criteria for diagnosis
1. The affected bone may have been normal/benign
tumour/non-bone forming malignancy.
2. History of prior radiation therapy & tumour
developed in the path of radiation beam.
3. A symptom free latent period must follow.
4. Sarcoma must be biopsy proven.
82. DIFFERENTIAL DIAGNOSIS
OF OS
CALLUS
OSTEOBLASTOMA
ANEURYSMAL BONE CYST
CHONDROBLASTOMA
GCT
EWING’S SARCOMA
MALIGNANT LYMPHOMA
CHONDROSARCOMA
FIBROSARCOMA
FIBROUS DYSPLASIA
83. HISTOLOGIC
FEATURES
CALLUS OSTEOBLASTOM
A
OSTEOSARCOM
A
Osteoblastic
rimming
+++ 0-++ 0
Trapping of host
lamellar bone
0-++ 0 ++-+++
Circumscribed 0 +++ 0
Lesional fibrous
tissue
0-+++ No ++-+++
Lesional hyaline
cartilage
0-+++ Very rare 0-++++
Scattered atypical
nuclei
0 Rare 0-++++
Atypical mitotic
figures
0 0 0-++++
Extensive necrosis 0-+ 0 0-+++
85. HISTOLOGIC FEATURES ANEURYSMAL BONE
CYST
TELANGIECTATIC
OSEOSARCOMA
Osteoblastic rimming 0-++ 0
Trapping host lamellar bone - 0-++++
Pure woven bone Yes or no Yes
Lesional fibrous tissue 0-+ 0-++
Scattered atypical nuclei Rare +-+++
Atypical mitotic figures 0 0-+++
Large blood filled cysts +-++++ +++
Extensive necrosis 0-+ +-++++
Anaplasia - Yes
86. Osteosarcoma v/s ABC
ABC with blood filled cystic space surrounded by wall containing
proliferating fibroblasts, reactive woven bone, & osteoclast type
giant cells
87. HISTOLOGIC FEATURES FIBROUS DYSPLASIA LOW GRADE OS
Osteoblastic rimming 0 0-+
Trapping host lamellar
bone
0 0-++
Pure woven bone Yes Usually no
C &Y spicules of bone Yes No
Lesional fibrous tissue ++-+++ +-++
Lesional hyaline cartilage Rare 0-++
Scattered atypical nuclei Rare +-++
Atypical mitosis 0 0-+
Extensive necrosis 0 0-+
88. DIFFERENTIAL DIAGNOSIS
OF OS
Chondroblastoma : Epiphyseal centering , it is rarely
occur in OS
Fibrosarcoma : Not associated with any tumor osteoid,
bone, or cartilage
Chondrosarcoma : >50yr, cartilage forming tumor, on X-
ray it present as area of radiolucency with variably
distributed punctate opacities, periosteal reaction is
absent or minimal, osteoid is absent
89. Osteosarcoma v/s GCT
Giant cell tumor : epiphysial
centering, occur in 20-40yr, show
bone expanding & eccenteric area of
lysis, & multinucleated giant cells on
90. Features distinguishing both are:
1. Location
2. Codman’s triangle
3. Intralesional bone fluffs
4. Anaplasia of stromal cells
5. Production of malignant osteoid
OSTEOSARCOMA vs GCT
91. OS v/s Ewing sarcoma
Ewing sarcoma : More common in men,
pelvis & ribs are mc site, onion skin
periosteal reaction seen on X-ray & on
histo composed of small round cells with
97. PAROSTEAL
OSTEOSARCOMA
Gross findings:
1. Hard lobulated mass
attached to cortex
2. Nodules of cartilage may
be present; occ cartilage
may be incomplete cap
like
3. Soft at periphery
4. Fleshy, soft areas
98. PAROSTEAL
OSTEOSARCOMA
Microscopic findings:
1. Well formed bony trabeculae
2. Hypocellular stroma
3. With or without osteoblastic rimming
4. Stromal cells show minimal atypia
5. 20% show moderate atypia
6. 50% of the tumour show cartilage differentiation
99. Moderately atypical spindle tumor
cells grow between irregularly
shaped bone trabeculae
Shows mature appearing bone
surrounded by a hypocellular
fibroblastic stroma with minimal
cytologic atypia
100. DIFFERENTIAL DIAGNOSIS
Fibrous dysplasia
Myositis ossificans : It does not involve cortex, show
much more cellularity than parosteal OS & atypical
mitosis not seen
Osteochondroma : In osteochondroma radiography
shows continuity between the bone and the
osteochondroma, and the intertrabecular spaces
contain fatty or hematopoietic marrow
101. Parosteal OS v/s Myositis
Ossificans
MO showing osteoid production in a cellular fibrous
tissue
102. Parosteal OS V/S
Osteochondroma
Image showing
thickened hyaline
cartilage cap
which mature via
enchondral
calcification to
bony trabeculae
surrounded by fat
& hematopoietic
marrow
104. PERIOSTEAL
OSTEOSARCOMA
Radiologic findings:
1. Sunburst appearance
2. Codman’s triangle is frequent
3. Cortex appears thickened
4. CT-scan & MRI : important in the evaluation of
tumor size, integrity of cortex, soft tissue
extension, & relationship to soft tissue bundle
105.
106. PERIOSTEAL
OSTEOSARCOMA
Gross findings:
1. Tumor arises from bone surface
2. May involve part or entire circumference
3. Calcified spicules can be seen, longest in center
and tapering on both sides
4. Well delineated by capsule/pseudocapsule
5. Merges imperceptibly with cortex at base
107.
108. PERIOSTEAL
OSTEOSARCOMA
Microscopic findings:
1. Tumour is arranged in lobules with moderately
atypical chondrocytes
2. There is spindling at the periphery & spindle
cells shows matrix production
3. The centre of the chondroid lobule also show
bone formation
111. HIGH GRADE SURFACE
OSTEOSARCOMA
Radiologic findings: surface lesion , partially
mineralized, mass extending in soft tissue
Underlying cortex is destroyed with periosteal new
bone formation
112. HIGH GRADE SURFACE
OSTEOSARCOMA
Gross findings:
1. Situated on surface of bone
2. Underlying cortex is eroded
3. Surface is multilobulated
4. Colour depends on amount of chondroid matrix,
hemorrhage & necrosis
5. Soft areas separate it from parosteal
osteosarcoma
113. HIGH GRADE SURFACE
OSTEOSARCOMA
Microscopic findings: same features seen in
conventional OS
1. Show osteoblastic, fibroblastic or chondroblastic
differentiation
2. High grade cytologic atypia
3. Lace like osteoid
4. Chondroblastic area rich tumor may be confused
with periosteal osteosarcoma
114. HIGH GRADE SURFACE OS:
DIFFERENTIAL DIAGNOSIS
1. Parosteal OS :pattern of osteoid production & high grade
cytological atypia is seen in high grade OS
2. Periosteal OS : In high grade OS, tumour shows larger
regions of spindle cell morphology & more cellular atypia
116. Fibrous dysplasia
• Benign medullary fibro-osseous lesion
• May involve one or more bone
• Occur in children & adults with equal sex distribution
• Sites : m.c. in jaw bones,in women long bones & in
men ribs & skull are favoured sites
• Types : 1. monostotic form(more common) : skull more
commonly followed by femur, tibia, ribs
2. polystotic form : femur, pelvis, tibia in majority
of cases
117. Fibrous dysplasia : Radiographic
features
-Often show a non-
aggressive lesion with a
ground glass matrix
-No soft tissue extension
-periosteal reaction is not
seen unless there is a
complicating fracture
-CT-scan & MRI better
define the extent
There is a well defined lucency with
Sclerotic margins
118. Fibrous dysplasia : Gross
features
The bone is often
expanded
tan grey colour
firm-to-gritty
consistency.
There my be cysts,
which may contain some
yellow-
tinged fluid
circumscribed blue
tinged translucent
material if cartilage is
119. Fibrous dysplasia : Microscopy
Well cirumscribed
Composed of fibrous & osseus component
The fibrous component is composed of bland spindle
cell with low mitotic rate
The osseus component is comprised of irregular
curvilinear trabeculae of woven bone(rarely lamellar
bone)
Secondary changes : foam cells, multinucleated giant
cells, aneurysmal bone cyst or myxoid changes
120. Fibrous dysplasia : Microscopy
The fibrous stroma is composed of bland spindle cells
arranged in whorled or storiform pattern
121. Fibrous dysplasia : Microscopy
Anastomoting trabeculae of immature woven bone without
osteoblastic rimming
122. Fibrous dysplasia : Microscopy
Curvilinear trabeculae often describing as resembling
‘Chinese characters’
123. Fibrous dysplasia : Microscopy
Characteristic
C shaped
bony spicules
with spindle
cell stroma
124. Fibrous dysplasia : D/D
1. Parosteal OS :
• juxtacortical position,
• show moderate stromal anaplasia
2. Low grade intramedullary OS; fibrous dysplasia like :
•radiologically more aggresive, &
• lack rim of benign host bone sclerosis
125. Fibrous dysplasia : D/D
3. Osteofibrous dysplasia :
exclusively seen in tibia &/or fibula of
children < 10yr,
show predilection for cortex,
characteristically shows focal to diffuse
osteoblastic rimming of the bone trabeculae
126. Fibrous dysplasia
Genetics :1. Mutation in GNAS1 in monostotic & polystotic
forms
2. structural rearrangements involving 12p13 & trisomy
2
Prognosis : good , rarely malignant transformation may occu
127. SUMMARY
Constant
fundament
al tissue
Variable
fundament
al tissue
Reactive
tissue
(possible)
Benign to
locally
aggressive
tumor
Malignant
tumor
Osteoid,
&/woven
bone
A. Cartilage
B. No
cartilage
Fibrous,
OLGCs,
osteoclasts
osteoclasts
Callus(early
to
mid),periost
itis
ossificans
OO,OB
Osteosarco
ma all types
Osteoid ,
woven
bone, &
cartilage Osteoclasts
like giant
cells
Fibrous
dysplasia
Parosteal
OS
Recognition of osteoid is important 1. mistaking chondroid of benign chondroblastoma for osteoid may result in diagnosis of osteosarcoma 2. rendering a acorrect diagnosis of os may depend on findng minute amt of osteoid in which well formed matrices r nt identified. Alkphosstin to diff frm fibrin and chondroid
Size is typically <1cm. Blastic center is homogenously dense but the degree may vary. Peripheral radiolucent zone represents fibrovascular zone
OB has no nidus,>2cm and expand affected bone.
Posterior elements involved. Osteosarcomas involve body then spreads to psterior part. Os never cause bone expansion
Ob does not produce lamellar bone and does not contain entrapped host lamellar bone a feature of os. Gc when present in solid masses indicate gc rich os
Ob does not produce lamellar bone and does not contain entrapped host lamellar bone a feature of os. Gc when present in solid masses indicate gc rich os
Anaplaticstromal cells are seen in 75% cases. 25% show subtle anaplasia. Malignant Osteoid must be distinguished from reactive osteoid. Chondroid is round homogenous masses by stromal cells resembling chondroblasts.
Shows partial mineralisation and cortical thickening. Sun burst appearance