Benign bone tumors Osteoma Osteoid osteoma Osteoblastoma Chondroma Chondroblastoma Chondromyxoid fibroma Ossifying fibroma Malignant bone tumors Osteosarcoma Chondrosarcoma Metastatic disease of bone Fibrosarcoma Malignant fibrous histiocytoma Ewing’s Sarcoma Haemangioendotheliosarcoma

1. BONE TUMORS
Dr. AMITHA G, BDS, MDS
Department Of Oral And Maxillofacial Pathology

2. BONE TUMORS
Benign bone tumors
Osteoma
Osteoid osteoma
Osteoblastoma
Chondroma
Chondroblastoma
Chondromyxoid fibroma
Ossifying fibroma
Malignant bone tumors
Osteosarcoma
Chondrosarcoma
Metastatic disease of bone
Fibrosarcoma
Malignant fibrous histiocytoma
Ewing’s Sarcoma
Haemangioendotheliosarcoma

3. Normal bone histology
Haversian system

6. Osteoma
• The osteoma is a benign neoplasm characterized by a proliferation of
either compact or cancellous bone, usually in an endosteal or
periosteal location.

7. Clinical Features:
• May arise at any age (common in the young adult).
• Its a slow-growing tumor.
• Periosteal origin - circumscribed swelling on the jaw producing obvious asymmetry.
• Endosteal origin is slower to present clinical manifestations.

8. Radiographic Features.
Dense, well circumcribed
radiopaque mass
that ranges from 1 cm – 8.5 cm
in maximum size

9. Histologic Features.
• In any given area the bone formed appears
normal
• The osteoma is composed either of extremely
dense, compact bone or of coarse cancellous
bone.
• The lesion is most often well circumscribed, but
not encapsulated.
• In some tumors foci of cartilage may be found, in
which case the term ‘osteochondroma’ is often
used.
• Myxomatous tissue also may be intermingled on

10. Treatment and Prognosis.
• Surgical removal
• The osteoma does not recur after surgical removal.
Differential diagnosis :
osteoblastoma

11. Osteoid Osteoma
• The osteoid osteoma is a benign tumor of
bone which has seldom been described in
the jaws.
• true nature - unknown.
• Jaffe and Lichtenstein have suggested that
the lesion is a true neoplasm of
osteoblastic derivation,
• Other workers have reported that the
lesion occurs as a result of trauma or
inflammation.

12. Clinical Features.
• Young children under the age of 10 years / 5 years are frequently
affected. (after the age of 30 years).
• Males > females = 2 : 1.
• Commonly seen : femur or tibia
• Chief symptoms - severe pain (unrelenting and sharp, worse at night),
• Relieved by aspirin.
• Localized swelling of the soft tissue over the involved area of bone
may occur and may be tender.

13. Oral Manifestations.
Greene and his associates have reviewed the literature
• mandible > maxilla.
• Of the mandibular lesions, in the body and in the condyle, while maxillary
lesion in the antrum.

14. tibia
Nidus and surrounding
sclerosis

15. Radiographic Features.
• pathognomonic picture
characterized by a small ovoid or
round radiolucent area surrounded
by a rim of sclerotic bone.
• The central radiolucency may
exhibit some calcification.
• The lesion is larger than 1 cm in
diameter, but the overlying cortex
does become thickened by
subperiosteal new bone formation.
Nidus

16. Histologic Features.
• Consists of a central nidus composed of compact
osteoid tissue, varying in degree of calcification,
interspersed by a vascular connective tissue.
• in older lesions - definite trabeculae occurs,
outlined by active osteoblasts.
• Osteoclasts and foci of bone resorption are
evident.
• Overlying periosteum exhibits new bone
formation,
• Interstitial tissue collections of lymphocytes may
Scanning magnication of central nidus composed
of microtrabecular arrays of immature bone and
osteoid, surrounded by dense sclerotic bone.

17. This dense central nidus is characteristic,
showing small, irregular, microtrabecular woven
bone, lined by cytologically bland osteoblasts
and entrapped osteocytes. Note the vascular
stroma.
Microtrabecular array of woven bone surrounded by a
loose vascular stroma.

21. • Ultrastructural investigation of 5 cases of osteoid osteoma by Steiner has revealed
• the morphology of the osteoblasts to be similar to that of normal osteoblasts although
atypical mitochondria could be seen.
• The author concluded that his observations supported the idea that the osteoid osteoma
and the osteoblastoma are closely related lesions.
• Unlike in osteoblastoma, neural staining techniques reveal many axons throughout an
osteoid osteoma, which probably accounts for the pain (the nidus).
• Levels of prostaglandin E2 are markedly elevated in the nidus; this is presumably the
cause of pain and vasodilatation.

22. Treatment
• Surgical removal of the lesion.
• If the lesion is completely excised, recurrence is not to be
expected.
Differential diagnosis:
Osteoblastoma

23. Benign Osteoblastoma (Giant osteoid osteoma)
Clinical features
• Central bone tumor occurs - young persons, 75% under 20 years and 90% under 30 years.
(Does occur even in elderly adult).
• Males > Females
• Clinically charectarised by pain (generalized) and swelling at the tumor site.
• Duration - few weeks to a year or more., Less likely to be relieved by salicylates.
• Site - vertebral column and long tubular bones.
• Occurs in both the maxilla and mandible

24. Radiographic Features.
• The lesion is not distinctive but, on the
radiograph, appears rather well circumscribed.
• In some instances- shows bone destruction,
• in other cases there is sufficient bone formation to
produce a mottled, mixed radiolucent-radiopaque
appearance (Fig. 2-61).

25. Histologic Features.
Hallmark of the benign osteoblastoma consists of:
• The vascularity of the lesion with many dilated capillaries scattered throughout the tissue
• The moderate numbers of multinucleated giant cells scattered throughout the tissue,
• The actively proliferating osteoblasts which pave the irregular trabeculae of new bone (Fig. 2-
62).
Malignant osteoblastoma
• Schajowicz and Lemos on the basis of a histologically more bizarre pattern of cells: more
abundant and often plump hyperchromatic nuclei, greater nuclear atypia, and numerous giant

26. Osteoblastoma with
cartilaginous matrix Demarcated tumor Activated osteoblasts
Anastomosing
trabeculae
Central nidus of sclerotic
woven bone Degenerative atypia

27. Treatment :
• Conservative surgical removal
• Reoccurance in rare.
Differential diagnosis:
Osteosarcoma

28. Chondroma
• Benign central tumor composed of mature cartilage, well organized entity
in certain area of bony skeleton
• Uncommon in bone of maxilla and mandible
Clinical feature :
• Occur at any age
• No apparent gender predilction
• Arises as painless, slowly progressive swelling of jaw.
• Overlining mucosa is ulcerated
• In maxilla > seen particularly on midline lingula to or between central
incisor
• In mandible > occur posterior to cuspid tooth, involving body of the
mandible, coronoid / condylar proces.

29. Mature hyaline cartilage with
numerous chondrocytes

30. Radiographic feature :
• Irregular radiolucent / mottled area of the bone.
• Cause root resorption adjacent to it.

31. Histologic feature :
• It’s a mass of hyaline cartilage which may exhibit cartilage which may
exhibit areas of calcification / necrosis.
• Cartilage cells appear small, contain single nuclei and donot exhibit great
variation in size, shape and staining reaction.
enchondroma Periosteal chondroma

32. Treatment :
Surgical excision , since tumor is resistence to x-ray.
Differential diagnosis:
Chondroblastoma

33. Benign chondroblastoma:
(Epiphyseal chondromatous gaint cell tumor , codman’s tumor)
Named by jaffe and lichtensin in 1942
Described by ewing in 1928 and codman in 1931
Benign chondrosarcoma of bone
It’s a distinct entity usually involving long bone but somtimes occur in
cranial bone.
Reviewed by Al- Dewachi and co worker
13 cases- 9 ( temporal bone)
1 ( perietal bone )
2 ( mandible)
1 ( maxilla)

34. Clinical feature :
• Benign, primary central bone tumor
• Occur In young age
• 90% occur in 5- 25 yrs age
• M: F = 2: 1
• Majority involves long bone of upper and lower limb
• Mandibular condyle reported by Goodsell and Hubingen
• Anterior maxilla by Al -Dewanchi
• Extraskeletal chondroblastoma of ear by Kingsley and markel

35. Histological feature :
• Composed of relatively uniform closely packed, polyhydral cells, with
occasional foci of chondroid matrix
• Scattered multinucliated gaint cells.
• Usually associated with haemorrhage, necrosis / calcification of chondroid
material.
• Formation of bone and osteoid also occur.
The arrows indicate the characteristic "chicken wire"
calcification.

36. Figures 1/2: expansile and lytic lesion of proximal digit and articular surface
3: giant cells
4: chondroid-type matrix with chicken-wire, pericellular calcifications

37. Nuclei vary in size Neoplastic cells with
ovoid to spindled nuclei
Well-formed chondroid
matrix

39. Treatment :
• Conservative surgical excision
• Reocurance is un common
Differential diagnosis:
Chondromyxoid fibroma

40. Chondromyxoid fibroma :
• Uncommon bone tumor of cartilage derivative
• Described as an entity in 1964 by Jaffe and Lichtenstein
Clinical feature :
• Young person - 75% occur under 25 yrs age
• No definate gender predilection
• Majority occur in long bone but it also formed in small bone of hand
and feet.
• Pain is the charectaristic feature of this lesion.
• Evident swelling is uncommon but does occur.

41. Histological feature :
• Exhibits lobulated myxomatous area, fibrous area and areas having chondroid
appearance.
• Foci of calcifications are sometimes found.
Treatment :
• Conservative surgical excision
• Reocurrance is not common.

47. Ossifying fibroma
Central ossifying fibroma of bone :
(Central fibro- osteoma)
Odontogenic origin.
Clinical feature :
• Any age
• Common in young adult, Mean age = 33 yrs
• Either jaw may be involved : Mandible > Maxilla.
• Lesion is generally asymptomatic until growth produces a noticeble
swelling and mild deformity
• Displacement of teeth is a early clinical feature

48. Radiographic feature:
• Extremely variable radiographic appearance
depending upon stage of development
• Lesion is well circumcribed and demarkated
from surrounding bone.
• In early stage , it appears as a radiolucent
area with no evidence of internal
radiopacities.
• As tumor bone matures, there is an
increased calcifications
• Radiolucent areas become flacked with
opasities, ultimately the lesion appears as
uniform radiopaque mass.
• Displacement of adjasent teeth,
impringement upon other adjascent
structure.

49. Histological feature :
• Lesion composed of many delicate interlasing collagen fibers
• Arranged in discrete bundles, interspread by large numbers of active proliferationg
fibroblast.
• Mitotic activity , cellular pleomorphism may be present.
• Connective tissue present many small foci of irregular bony trabaculae.
• As lesion matures island of ossification increases in number, enlarges and ultimately
coalase
Treatment :
• Excised conservatively
• Reoccurance is rare.

50. BONE ISLAND
Definition and synonyms
• A solitary lesion composed of normal compact bone,
distinctly separated from surrounding cancellous bone;
probably developmental in origin (solitary enostosis)

51. Clinical features
Epidemiology
• Exact frequency is unknown; however, reports describe varying
frequency of 1% to 14%
•Common in adults, rare in children
•No sex or gender predilection
•Presentation
•• Often discovered incidentally on imaging for other reasons
•Asymptomatic
•Usually 1 to 2 mm in diameter, but occasionally can
•be as large as 1 cm or larger
•Prognosis and treatment
•• Benign lesions without associated morbidity or mortality
•• No treatment required if diagnosis can be made radiographically

52. Radiology
• Typically appears as sclerotic, round to
ovoid intramedullary focus or foci
• Long axis of bone island is aligned parallel
to long axis of bone
• Low signal intensity on MRI because of
cortical bone composition, both on T1- and
T2-weighted images
• Larger bone island can be irregular and may
appear spiculated

53. Histology
• Mature lamellar bone with well-
developed haversian and interstitial
lamellar systems resembling cortex
• Merges with surrounding cancellous
bone of the medulla
• Note that a variety of lesions
(osteopetrosis, osteopoikilosis,
melorheostosis) demonstrate compact
lamellar bone, so the histologic findings
are not pathognomonic

54. THANK YOU