Description on giant cell lesions

1. Giant Cell lesions of Bone
tumour of bone
Presenter: Dr Himachal Mishra
Giant Cell tumour of bone

2. Contents
1.Basics of giant cell
2.Classification
3.Approach
4.Detail Description of Lesions
5.Summary
6.References

3. NORMAL ANATOMY

4. • A giant cell is a cell that is larger in dimension than the cells
that are routinely encountered in histology.
• They are involved in many physiologic and pathological
processes.
• A multinucleated giant cell is formed by the union of several
distinct cells.
GIANT CELL

5. • In chronic inflammation, if macrophages fail to deal with
particles that has to be removed; fuse together and form
multinucleated giant cells.
• These cells sequester persistent pathogens and prevent
further spread of infection.
• Usually contain 10 to 20 nuclei per cell and are found on
• bone surfaces
• on the endosteal surfaces within the haversian
system
• on the periosteal surface beneath the periosteum

6. Formation of multinucleated giant cells

7. Types of Giant cells

8. REACTIVE BENIGN MALIGNANT
Brown tumor GC Tumor Osteosarcoma
Giant Cell reparative
granuloma
Aneurysmal Bone Cyst Clear cell
chondrosarcoma
Myositis ossificans Chondroblastoma
Tubercular
osteomyelitis
Chondromyxoid Fibroma
Non ossifying Fibroma
Langerhans Cell
Histiocytosis
Benign fibrous
histiocytoma of bone
GCT of tendon sheath
Osteoid Osteoma
Giant cell lesion-Classification

9. Categorization

11. APPROACH

12. Age Group
(Yrs)
Tumors
10-20 Non Ossifying Fibroma, ABC,
Osteosarcoma, SBC
Osteoid osteoma
10-25 Chondroblastoma, Osteoblastoma
15-30 Myossitis Ossificans
20-40 Langhans cell Histiocytosis
Clear cell chondrosarcoma
GCT
>40 Osteosarcoma

13. Radiological information

14. Narrow Zone- Slow growth
Wide zone- sign of aggressive growth
Transition zone/margin

15. Location
.
.

16. An Approach
Look for stromal cell background
Brown Tumor
Mononuclear Plump cells
Uniformly distributed giant
cells+
Age>25 yrs
Epiphyseal lesion
-Soap bubble appearance
Giant cell Tumor(Benign)
Stromal cells –nuclear
pleomorphism, atypical mitosis
? Malignant Giant cell Tumor
Cells with polygonal nuclei
- Sharp border, nuclear groove
Chondroblastoma
Age<25 yrs
Iregular distribution of giant
cells, Calcifications+ ,S100 +
Site:Jaw PTH Level
Fibroblastic Stromal cells
Areas of Hemorhage,
hemosiderin, fibrosis,
Irregular distribution of
giant cells
Dilated blood filled spaces+
Age<25 yrs
USP & gene rearragement
Vertebra/long bone
Aneursymal Bone cyst
Giant cell rich lesions??
Age-20-40 yrs
Giant cell Granuloma

17. Reactive Giant cell Lesions

18. • Intraosseous proliferation characterized by aggregates of
giant cells in a fibrovascular stroma
• Site- Craniofacial, small bones of hands and feet
• Children and young adults
• Radiographic Features
Expansile, purely lytic lesion with cortical thinning
GIANT CELL REPARATIVE
GRANULOMA

19. GIANT CELL REPARATIVE GRANULOMA
Gross
• Curettage produces fragments
of reddish brown friable tissue
Microscopy
• Irregular distribution of giant
cells
• Spindle cells within
collagenous stroma and
multinucleated giant cells

20. D/D:
Lesions Differentiating Features
Brown tumor Elevated S. calcium and PTH levels
Giant Cell Tumor Greater numbers of evenly distributed
giant cells without clustering.
Aneursymal Bone
Cyst
In tumors of the hands and feet, presence
of solid foci of stromal & giant cells is
more consistent with giant cell reparative
granuloma

21. • Self-healing lesion, characterized by heterotopic ossification.
• Age: Adolescents and young adults, after trauma
• Site: Upper extremity flexors, quadriceps, thigh adductors,
gluteal muscles, soft tissues of hand
• Radiologically: zonal ossification pattern with a shell of
calcifications at the periphery of a well demarcated mass
MYOSITIS OSSIFICANS

22. MYOSITIS OSSIFICANS
well-circumscribed lesion with
peripheral calcification and
central lucency
well-circumscribed lesion
Central- hemorrhagic & surrounding firmer, YG tissue
Peripheral- rim of bone.

23. zoning phenomenon
gradual evolution in appearance from plump spindle cells through
immature woven bone to mature lamellar bone-
MYOSITIS OSSIFICANS

24. A
B C
Myositis ossificans
 cytological features:
Osteoblast-like cells
• Proliferating myofibroblasts
• Osteoclast-like multinucleated
giant cells
• Small calcifications

25. Extraosseous osteosarcoma:
Rare
>40 yrs
Malignant cytology
Atypical mitotic figures
Differential diagnosis

26. • Bone tumor composed of non neoplastic reactive tissue
that occurs in setting of hyperparathyroidism
• Age: 3rd & 4th decades
• Site- pelvis, ribs, clavicles, and extremities
• Severe Hyperparathyroidism- Increased bone cell activity,
peritrabecular fibrosis & cystic brown tumor-
• Known as Generalised osteitis Fibrosa Cystica
BROWN TUMOR OF
HYPERPARATHYROIDISM

27. Brown tumor
Gross-
Well-circumscribed, reddish-brown
hemorrhagic mass with lobular architecture
Thins and expands cortex
Radiology
• Expansile,
• Well circumscribed,
• Lytic lesion

28. Brown tumor
•Lobular pattern
• Groups and clusters of osteoclast-like multinucleated giant cells
•Vascular fibroblastic stroma
•Tunneling resorption of adjacent uninvolved bone

29. Brown tumor
Dispersed or clustered spindle cells.
variable amounts of osteoclast-like giant cells and haemosiderin-laden macrophages

30. Lesion Differentiating features
GCT Uniform distribution of giant cells.
Solid ABC USP6 gene rearrangement on FISH
Differential diagnosis

31. Benign Giant cell Lesions

32. • A benign but locally aggressive neoplasm composed of
uniformly distributed osteoclast-like giant cells
• Site:
Ends of long bones in the mature skeleton
occasionally –Metaphysis
• Age: 3rd- 5th decade
• Most common in female
GIANT CELL TUMOR

33. Pathogenesis
• 95% of giant cell tumors- H3-3A (H3F3A) gene mutations
Neoplastic cells are primitive osteoblast precursors
Express high level of RANKL
Proliferation highly destructive bone resorption of osteoclast

34. GCT
• Radiolucent lesion involving
epiphysis and metaphysis.
• Lesion- well circumscribed, lacks
surrounding reactive bone
• Cut surface- solid or friable
• Variegated red–brown and yellow
appearance

35. GCT
• Components -stromal & Giant
cells
• Giant cells- evenly dispersed
among mononuclear stromal
cells.
• Mitoses- prominent in stromal
cells

36. GCT
Abundant material,
A double cell population: mononuclear spindle cells and giant cells of osteoclastic type,
Giant cells are attached to the periphery of the clustered spindle cells.

37. MALIGNANCY IN GCT
• PRIMARY MALIGNANT GCT-
• Tumor that contains foci of GCT and pleomorphic
sarcoma at first diagnosis
SECONDARY MALIGNANT GCT-
• Initial tumor has appearance of classic GCT
Sarcomatous transformation:
after local recurrence/following RT

38. Differential diagnosis
Lesions Differentiating features
Giant cell–reparative
granuloma
• Lacks uniform distribution of giant
cells
• Stroma is more fibrotic and more
abundant hemosiderin and hemorrhage
• Stromal cells are spindle shaped rather
than round
Aneurysmal bone cyst • Not typically involve epiphyses
• Giant cells are arranged around cystic
spaces
Giant cells rich
Osteosarcoma
• Delicate strands of osteoid surrounding
aggregates of pleomorphic mononuclear
cells
• Atypical mitotic activity

39. • Destructive, expansile benign neoplasm of bone
characterized by multiloculated, blood-filled cystic spaces
• Age: 2nd and 3rd decade of life
• SITE-
• Metaphysis of long bones of upper and lower
extremities
• Posterior elements of vertebra
• Small bones of hands and feet
• Craniofacial skeleton
ANEURYSMAL BONE CYST

40. Pathogenesis
. Translocation, t(16;17)(q22;p13)
cytogenetic rearrangements of the USP6 gene at
chromosome band 17p13.2
Fusion of CDH11 with USP6
Upregulation of USP6 transcription
Regulates expression of metalloprotein
Cystic bone resorption

41. ABC
• Radiolucent lesion with
thin shell of reactive
periosteal bone.

42. Aneursymal bone cyst
• Spongy, hemorrhagic mass
• covered by a thin shell of
reactive bone.

43. ABC
• Large spaces filled with blood,
separated by cellular septa
• Septa- No true endothelial lining.
• Osteoclast-like giant cells- align
along the bloody spaces.

44. GENETIC TESTING-
• FISH using break-apart probe for USP6 can detect rearrangement
D/D:
Lesion Differentiating Features
GCT • Located in the epiphyses in skeletally mature bones
• Stromal mononuclear cells and numerous evenly spaced
multinucleated giant cells
Solitary bone
cyst
• Fibrous septa -hypocellular, with foci of occasional giant
cells
• Fibrous septa lack inflammatory cells, osteoid & chondroid
tissue
Telangiectatic
OS
• Uncommon in vertebrae, craniofacial bones, hands & feet
• Anaplastic tumor with production of tumor osteoid
• May show complex karyotypic abnormalities

45. • Age: 10-20 yrs
• Site: Distal femur, proximal tibia
Eccentrically in the metaphysis
• Associated syndrome: Neurofibromatosis type 1,
JaffeCam- Panacci syndrome
• Prognosis: Excellent
NONOSSIFYING FIBROMA

46. Pathogenesis
• Mutations in KRAS & FGFR1
• Neoplasms driven by
activated MAPK signaling.

47. 66
NONOSSIFYING FIBROMA
• Eccentric, sharply delimited
radiolucent lesions in the
metaphyseal cortex
• Granular and brown or dark red.

48. NONOSSIFYING FIBROMA
• Cellular masses of fibrous tissue arranged in a storiform pattern.
• Scattered osteoclasts with collections of foamy and hemosiderin-laden
macrophages

49. D/D-
Lesion Differentiating Features
GCT • Occurs in skeletally mature patients
• Located in the epiphysis
Benign fibrous
histiocytoma
Features of nonossifying fibroma are found in
ribs, vertebrae, or flat bones

50. BENIGN FIBROUS HISTIOCYTOMA

51. • Infiltration by Langerhans cell with variable admixture of
eosinophils, giant cells, neutrophils, foamy cells & areas of
fibrosis
• Site
• Skull>femur>pelvis>ribs
• Solitary bone involvement >>Multiple bone
• Multiple organ involvement:
Hand–Schüller– Christian, Letterer-Siwe disease
LANGERHANS CELL
HISTIOCYTOSIS

52. Pathogenesis
MAPK pathway activation -central role in LCH pathogenesis.
Pluripotent haematopoietic Tissue-restricted Local precursor level
High-risk multisystem Multifocal low-risk Unifocal LCH
Misguided myeloid differentiation
Disrupted cell migration and apoptosis inhibition
Tissue site accumulation

53. Langerhans Cell Histiocytosis
Well-circumscribed,
Punched out radiolucent lesions
“Hole in a hole”
Sharply circumscribed lesion
greenish brown color

54. Langerhans Cell Histiocytosis
• Dendritic cells and other inflammatory cells- eosinophils, giant cells, neutrophils,
foamy histiocytes, and accompanied by areas of fibrosis.
• Langerhans cells: Nuclei- lobulated or indented, longitudinal groove
Eosinophilic cytoplasm

55. Langerhans Cell Histiocytosis
• Dendritic cells and other inflammatory cells seen with areas of fibrosis

56. Differential diagnosis
lesions Differentiating features
Granulomatous osteomyelitis when a prominent number of
osteoclast-type giant cells are
present
Osseous manifestations of
Rosai-Dorfman disease
Emperipolesis
strongly immunoreactive for S-
100 protein

57. • Skeletally immature individuals, 10-25 years
• Site: Epiphyseal end of long bones
Distal end of the femur
• Proximal end of the humerus
• Proximal end of the tibia
CHONDROBLASTOMA

58. Pathogenesis
pLys36Met substitutions in H33B gene on chr 17
Mutation Inhibit H3K36 Mehyltransferases NSD2 and SETD2
Reduced Global H3K36 Mehylation
Block Mesenchymal differentatiation
Tumorogenesis

59. Chondroblastoma
• Well-defined eccentric lesions
with a thin sclerotic rim
• Soft to rubbery with gritty and
haemorrhagic areas

60. Chondroblastoma
• Composed of islands of
immature cartilage, mononuclear
chondroblasts & multinucleated
giant cells.
• Chondroblasts
sharply cytoplasmic borders.
Nuclei- vary, round to indented
& lobulated.
• Presence of small zones of
calcification

61. Chondroblastoma
• Fragments of chondroid matrix,
• Multinucleated osteoclast-like cells,
• Mononuclear, rounded cells with distinct cell borders and rounded nuclei
(chondroblasts).

62. Differential diagnosis
Lesion Differentiating features
Chondromyxoid
Fibroma
• Usually involves the metaphyses
• Lacks calcifications
• Prominent lobulated myxoid stroma
Giant Cell Tumor • Skeletally mature patients
• Stromal cells with nuclear grooves are absent
• Lacks chondroid matrix & calcification
Clear Cell
Chondrosarcoma
• Usually seen in older patients
• Composed of cells with clear-staining cytoplasm
• Chondrocytic cells with cytologic malignant features
• Heavily calcified than chondroblastoma
Chondroblastic
Osteosarcoma
• Rarely involve epiphyses & mimic chondroblastoma
• Contains tumor osteoid

63. • Site: Long bones
• Young adults- 2nd to 3rd decade oflife
Pathogenesis
CHONDROMYXOID FIBROMA
Recombination of the GRM1 gene with several 5' partner genes
Upregulated expression of GRM1 coding region---Driver event
High level in chondromyxoid fibroma.

64. Chondromyxoid fibroma
• Sharply defined
• Pronounced shell of surrounding
reactive bone.
• Located in the medullary portion
of the bone

65. • Solid and yellowish white or tan.
• Replaces bone
• Thins the cortex
Chondromyxoid fibroma

66. Chondromyxoid Fibroma
• Distinctly lobular.
• Lobules show paucicellular
myxochondroid matrix
• Matrix separated by intersecting
bands of highly cellular
fibroblast-like spindle cells and
osteoclast

67. D/D-
Lesions Differenting features
Chondroblast
oma
• Typically involves the epiphyses
• Calcifications - both radiographically &
histologically (chicken-wire appearance)
Medullary
Chondrosarco
ma
• Occur in older patients and in axial skeleton
• Radiographically-poorly circumscribed &
calcifications
• May cause a soft tissue mass

68. Simple Bone cyst
• Site: Proximal humerus, femur & tibia.
Small bones of hands & feet
• Age- 10-20 yrs
• Intramedullary, unilocular cystic bone lesion lined by a fibrous
membrane and filled with serous or Serosanguineous fluid

69. Simple Bone cyst
• Location- Metaphysis adjacent to
the growth plate.
• Growth plate grows away from the
lesion resulting in the appearance
that the cyst has migrated.
• Fallen fragment sign

70. Simple Bone cyst
• Clear or yellow fluid
• Lined by a smooth fibrous
membrane
• Fluid may be hemorrhagic if a
previous fracture has occurred.

71. Simple Bone cyst
• Cyst is lined by a thin fibrous
membrane.
• Well-vascularized connective
tissue containing hemosiderin
and cholesterol clefts.
• Fibrin deposits within the wall
gets calcified, resemble
cementum-like material

72. Cytology
Aspiration - colourless to amber fluid
Cellularity: Scant
Cells: histiocytes, chronic inflammatory cells & giant cells
D/D
Lesion Differenting features
Aneurysmal Bone
Cyst
• Hemorrhagic cyst contents contain osteoid and
chondroid tissue with fibromyxoid features & giant
cells
Giant Cell Tumor • Occurs in epiphyses of bones in skeletally mature
patients
• Composed of mononuclear stromal cells and more
giant cells.

73. Tenosynovial GCT
Age- young and middle aged
Site: hands. Fingers & feet
Localised or Diffuse
Pathogenesis
Reciprocal somatic Chromosomal translocation, t(1;2)p13;q37)
Fusion of type VI collagen a-3 promoter of MCSF gene
Tumor cell over express MCSF
Stimulate proliferation of macrophages similar to GCT

74. Tenosynovial GCT
GROSS
• Tumors are small circumscribed
Color : brown to yellowish
MICROSCOPY
• Tumors- mononuclear cells,
foamy histiocytes, and
multinucleated giant cells
containing hemosiderin
• Mitoses may be prominent, and
zones of hyalinization seen

75. Differential Diagnosis
Epithelioid sarcoma- Presence of granuloma-like formations
Necrosis
Invasiveness,
Epithelioid features
keratin immunoreactivity

76. Osteoid osteoma
Benign bone-forming tumour characterized by small size < 2 cm.
Site-Long bones, small bones of the hands and feet & spine.
Age group- children and adolescents
Pathogenesis:
Rearrangement of FOS gene
Resulting in nuclear immunoreactivity in the osteoblastic cell

77. Osteoid osteoma
• Radiolucent central nidus
<2 cm
• Nidus is surrounded by
peripheral sclerotic
reaction.

78. Osteoid osteoma
• Sharply delineated central nidus is
composed of calcified osteoid and
woven bone lined by plump
osteoblasts.
• Highly vascularized connective
tissue, without evidence of
inflammation

79. Osteoblastoma
Age group- 10–30 yrs
Site: Vertebrae, tibia, femur, humerus, pelvis, ribs
Medulla of metaphysis
Microscopy
• Irregular interlacing network
of osteoid with prominent
osteoblastic rimming
• Osteoid separated by
fibrovascular stroma containing
multinucleated osteoclast-like
giant cells

80. Differential diagnosis
Osteoid osteoma Osteoblastoma
Size < 2cm >2cm
pain Severe Less pain
Response to aspirin Relieved Not relieved
Central nidus Tiny osteoid islands
lined by osteoblasts
Less organised
osteoid pattern
Sclerotic bone Dense surrounds
nidus
less
Progressive growth No evidence Present
Lesion Features
GCT Epiphyses of long bones,
Rare in vertebra (Arch not involved)
ABC Reactive osteoid- small foci

81. MALIGNANT
GC LESIONS

82. • Age groups: bimodal
• Male>female
OSTEOSARCOMA
Site: Metaphyseal region of the long bones:-
• Lower end of femur
• Upper end of tibia
• Upper end of humerus

83. Several subtypes
• Site of origin (intramedullary, intracortical, or surface)
• Histologic grade (low, high)
• Primary (underlying bone is unremarkable) or
secondary: Paget disease, bone infarcts, radiation
• Subtype in the metaphysis of long bones:
primary, intramedullary, osteoblastic, and high grade

84. Pathogenesis
Syndromes- Li-Fraumeni syndrome, hereditary retinoblastoma
Genetics
Gains of chromosome arms 6p, 8q and 17p-50%
Mutated genes in TP53 and RB1 > 90%
• Inactivating mutations of TP53
Inability to mediate cell-cycle arrest, apoptosis, and cellular senescence
Errors in mitotic chromosome segregation
Affects chromosomal regions
• Chromothripsis and amplification
Result in the generation of cancer driver events- CDK4hz amplification

85. Osteosarcoma
Codman triangle or a
sunburst appearance

86. Often large (>5 cm),
fleshy or hard tumor,
centered within the metaphysis
Depending on predominant stromal component:
(1) Gray-tan & granular: osteoblastic
(2) Translucent bluish: chondroblastic
(3) Firm off-white mass: Fibroblastic
GROSS

87. Osteosarcoma
• Immature bone or osteoid by neoplastic cells
• Histological subtype of conventional osteosarcoma:
Osteoblastic,Chondroblastic ,fibroblastic- Common
• Less common-Giant cell rich, clear cell & Chondroblastoma
like
• Microscopic variants: Telangiectatic, small cell, low grade
central & Parosteal osteosarcoma

88. Osteosarcoma
Microscopic Features
• Defined as-Direct production of immature bone or osteoid by
neoplastic cells
• Conventional osteosarcomas- composed of a mixture of
osteoblastic, fibroblastic & chondroblastic foci.
• Telangiectatic osteosarcoma.- numerous blood-filled spaces
separated by septa containing highly pleomorphic mononuclear
and multinucleated giant cells accompanied by abundant mitotic
activity.

89. • Small cell osteosarcoma- composed of small, uniform, round or
spindled cells
• Low-grade central osteosarcoma- a fibroblastic osteosarcoma
with minimal cytologic atypia and minimal mitotic activity.
• Parosteal osteosarcoma -composed of bland fibrous stroma
containing disorganized, immature bone.
• Periosteal osteosarcomas are largely chondroblastic in
appearance

90. Osteosarcoma

91. CYTOLOGY-
• Variable cellularity
• Tumour cells-pleomorphic spindle, rounded, ovoid,
polygonal and often large, osteoblast like
• Multinucleated tumour giant cells.
• Strands of osteoid matrix between tumour cells in
clusters.
• Benign osteoclast-like giant cells are numerous in
giant-cell-rich osteosarcoma.

92. Osteosarcoma
Tumor cells are singly or small groups in a myxoid background matrix

93. IHC
Strong positive cytoplasmic staining
for ALP
Expression of osteonectin

94. D/D-
Lesions Differentiating features
Dedifferentiated
chondrosarcoma
• Low grade chondrosarcoma
• IDH1 Mutation
Fibro sarcoma • No production of tumor osteoid
Osteoblastoma • Lacks atypical mitoses
• Infiltrative pattern
• Destructive growth pattern

95. CHONDROSARCOMA
• Malignant tumor of chondroid differentiation
• Divided into 2 major categories on the basis of
microscopic criteria:-
Conventional chondrosarcoma
Chondrosarcoma variant-
 Clear cell chondrosarcoma
 Myxoid chondrosarcoma
 Dedifferentiated chondrosarcoma
 Mesenchymal chondrosarcoma

96. CENTRAL
CHONDROSARCOMA
PERIPHERAL
CHONDROSARCOMA
Location Medullary cavity of flat or
long bones
De novo or from cartilaginous
cap of a pre existing
osteochondroma
Radiogra
phy
Osteolytic lesion with
splotchy calcification
Ill defined margins Fusiform
thickening of the shaft
Perforation of the cortex
Large tumors with a Calcified centre
surrounded by a lesser denser
periphery with splotchy calcification
CONVENTIONAL

97. CLEAR CELL CHONDROSARCOMA
• A low-grade, cartilage-producing cells with
characteristic large, clear cytoplasm
• Younger patients
• SITE- Epiphysis of proximal femur, proximal
humerus, and distal femur

98. Pathogenesis
Loss or structural aberrations of chr 9 & gain of chr 20
CDKN2A alterations
Lacked expression of p16 (CDKN2A)

99. Clear cell chondrosarcoma
Diagnostic sign:
Ill-defined margins
Fusiform expansile remodeling of bone with endosteal scalloping
cortical destruction with a soft tissue mass

100. Clear cell chondrosarcoma
• Large cells with a clear or
vacuolated abundant cytoplasm
and a central or paracentral
nucleus.
• Myxoid background matrix

101. Gross-
• Large bulky tumors
• Pale blue matrix, softer than normal
hyaline cartilage
• Abundant gritty calcifications
• Larger tumors: destructive with
extensive soft tissue

102. Clear cell chondrosarcoma
• Tumor cells with an abundant
clear or ground glass cytoplasm.
• Sharply defined borders.
• Interspersed small trabeculae of
woven bone, numerous
multinucleated giant cells & foci
of cartilage

103. ELECTRON MICROSCOPY
•Ultrastructurally, neoplastic cells contain abundant
intracytoplasmic glycogen
GENETICS
• Lacks IDH1 and IDH2 mutations

104. D/D-
Lesions Differentiating feature
Chondroblastoma • Lacks prominent clear cells and bony trabeculae
Osteoblastoma • Lacks chondroid differentiation
Aneurysmal Bone
Cyst
• Clear cells and cartilaginous differentiation are absent
Intramedullary
Chondrosarcoma
• Multinucleated giant cells and reactive bony
trabeculae are absent

105. Summary
• Giant cell lesions are a group of diverse entities.
• These lesions are morphologically related due to
presence of multinucleated osteoclast like giant cells.
• For making a diagnosis, apart from from clinical and
histopathological, radiological data is equally
important.
• In ambiguous cases- diagnosis can be done by
additional studies like- IHC, FISH & sequencing.

106. REFERENCES
1. Unni K.K., Mertens F. (Eds.): World Health Organization Classification of
Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. 2020;5
:370-434.
2. Rosai, Juan, and Lauren Vedder Ackerman. Rosai And Ackerman's Surgical
Pathology.2018;11:1722-1764.
3. Fletcher C, Carrie Y. Inwards, André M. Oliveira. Diagnostic
histopathology of tumors. 2013: 1884-1890)
4. Field, Andrew S, and Svante R Orell. Orell & Sterrett's Fine Needle
Aspiration Cytology. 2015.;5: 412-427)
5. Kumar v,Abbas KA,Aster C J. Robbins and cotran pathological basis of disease.
2020; 10: 1171-1199.
6. Video Lecture by Dr Shantveer G Uppin on giant cell lesion of bone
7. Matcuk GR Jr, Chopra S, Menendez LR. Solid aneurysmal bone cyst of the
humerus mimics metastasis or brown tumor. Clin Imaging. 2018 Nov-
Dec;52:117-122. doi: 10.1016/j.clinimag.2018.07.020. Epub 2018 Jul 24. PMID:
30056289
8. Patricia J. Brooks, Glogauer M, McCulloch CA. An Overview of the Derivation
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Processes. The American Journal of Pathology, 2019; 189(6): 1145-115

107. THANK YOU

108. • Route- hematogenous
• More common than primary bone tumors
• Primary sites: lung, breast, prostate, kidney & thyroid
• Involved bones: skull, spine, ribs, pelvis, humerus & femur
• Prostatic adenocarcinoma- Blastic
• Kidney,lung,GIT &malignant melanoma- Lytic
METASTATIC TUMORS

109. Metastatic tumors
Histopathology
• Morphology: resembles primary lesion
• Osteoblastic metastasis shows abundant reactive woven bone
• Secondary changes: hemorrhage, fibrosis & osteoclast-type giant
cell reaction
Gross Finding
• Haemorrhagic and friable tissue -thyroid or kidney.
• Hard due to reactive bone sclerosis - Prostate and breast
• Dark, pigmented - Melanoma.