Bone 2

1. BONE TUMOURS

2. VARIOUS LESIONS OF BONES

3. • Osteo- bone
• Arthritis- inflammation of bone/joints
• Osteomyelitis- infection of bone
• Chondro- cartilage
• Sarcoma- malignant bone tumour

4. NORMAL MICROSCOPIC VIEW OF
BONE

5. CARTILAGE
BONE

8. SITE WISE DISTRIBUTION

10. BONE TUMORS
• BONE
• CARTILAGE
• FIBROUS
• MISC.
–Ewing’s “sarcoma”
–Giant Cell Tumor
–METASTASES

12. BONE FORMING TUMORS
Benign
• Osteoma- < 2CM.
• Osteoid osteoma
• Osteoblastoma
Malignant
• Osteogenic sarcoma- primary /secondary

13. OSTEOSARCOMA
(OSTEOGENIC SARCOMA)
LATE TEENS
KNEES
METAPHYSES
PAINFUL!!!

14. • Malignant tumours of bone which is
characterized by cancerous cells producing
osteoid matrix or mineralized bone.
• Most common primary malignant bone tumour.
• Bimodal age group.
• Metaphysial site
• ALWAYS PAINFUL

15. TYPES
• BASED ON THE PATHOGENESIS
1. PRIMARY – no underlying disease & younger age
2. SECONDARY –elderly + underlying bone disease
 Paget disease
 Bone infarcts
 Prior irradiation
 Chronic osteomyelitis

16. TYPES
• BASED ON THE LOCATION IN THE BONE
1. Intra medullary
2. Intra cortical
3. Surface
• BASED ON THE HISTOLOGY
1. Conventional
2. Chondroblastic
3. Fibroblastic
4. Telangiectatic
5. Small cell
6. Giant cell rich

17. PATHOGENESIS
• RB- gene germline mutation[ Sporadic
osteosarcoma]
• TP53 GENE MUTATION and association of L-
Fraumani syndrome.
• INK4a inactivation.

18. CLINICAL /XRAY FEATURES
CODMAN TRIANGLE (periosteal elevation)
Lytic and destructive lesion
Sun-ray appearance (new bone formation)
Patholgical fractures
Chest- canon ball appearance
Prognosis- surgery,, chemotheropy

21. GROSS
• Bulky tumours with gritty grey white with areas of
hemorrhage and necrosis with cystic degeneration.
• Frequently destroy surrounding tissues producing
hard masses.

24. MICROSCOPY
• Vary in size and shape with large hyperchromatic
nuclei with bizarre tumor giant cells with mitosis.
• Vascular invasion with necrosis
• Formation of bone by tumour with fine lace like
pattern is characteristic

27. Cartilage forming tumors

28. OSTEOCHONDROMA

29. • Varies in C/F pahthologically
Hyaline type
Clear cell type
Differentiated type
Mesenchymal type
• Second common malignant tumor of bone

30. • Mostly above 40 yrs
• Mesenchymal, clear cell type below 20 yrs
• M:F 2:1
• May develop with chondroblastoma,
Osteochondroma, pagets, pagets dysplasia

31. GROSS
• Large bulky tumors - nodules of glistening
gray-white, translucent cartilage
• Myxoid matrix can ooze from the cut surface.
• Spotty calcifications- typically present
• Central necrosis- cystic spaces.
• tumor spreads through the cortex into
surrounding muscle or fat- soft tissue mass

32. CHONDROSARCOMA

33. M/S
• Cartilage infiltrates the marrow space and
surrounds pre-existing bony trabeculae.
• Vary in cellularity, cytologic atypia, and mitotic
activity and are graded from 1 to 3.
• Grade 1 tumors - low cellularity, and the
chondrocytes have plump vesicular nuclei with
small nucleoli.
• Grade 3 chondrosarcomas - high cellularity,
extreme pleomorphism with bizarre tumor giant
cells, and mitoses

35. CHONDROBLASTOMA
• RARE, in teenagers
• M>>F
• KNEES, usually
• Epiphyses
• MUCH LESS matrix than a chondroma

36. BONE- FIBROUS TUMORS
• FIBROUS CORTICAL DEFECT/NON-
OSSIFYING FIBROMA
• FIBROUS DYSPLASIA
• FIBROSARCOMA/MALIGNANT FIBROUS
HISTIOCYTOMA

37. FIBROSARCOMA
• METAPHYSES of LONG BONES
• Pelvic flat bones
• Lytic
• Fractures
• Of course, sarcomatous metastasis

38. FIBROSARCOMA/MFH

39. GIANT CELL TUMOR/OSTEOCLASTOMA
• Destroy the overlying cortex producing bulging
soft tissue mass dilineated by a thin shell of
reactive bone
• Knee, wrist, phlanges
• Large brown mass undergo cystic degeneration
• SHEETS OF MONONUCLEAR CELLS PROFUSION
OF MULTI NUCLEATE OSTEOCLAST TYPE GIANT
CELLS
• More than 50 to 100 nuclei in each cell-
Monocyte macrophage lineage
• Ephiphysis n metaphysis
• Locally aggressive

40. • Stromal cells are mononuclear cells and are
the real tumour cells and their histologic
appearance determines the biologic behaviour
of the tumour.
• Typically, they are uniform, plump, spindle-
shaped or round to oval cells with numerous
mitotic figures.

43. GCT

44. EWINGS SARCOMA/PNET
• EWING’S SARCOMA AND PRIMITIVE
NEUROECTODERMAL TUMOUR (ES/PNET
• Highly malignant small round blue cell
tumour
• age of 5 and 20 years with predilection for
occurrence in females

45. Pathogenesis.
• (11;22) (q24;q12) translocation generating
in-frame fusion of the EWS gene on
chromosome 22 to the FLI1 gene.

46. • Cell of origin have been
Endothelial
Pericytic
Bone marrow
Osteoblastic
Mesenchymal

47. • currently it is settled for origin from
primitive neuroectodermal cells
• 3 variants:
• i) classic (skeletal) Ewing’s sarcoma;
• ii) soft tissue Ewing’s sarcoma; and
• iii) primitive neuroectodermal tumour
(PNET).

48. • Clinical features include
pain,
tenderness and
swelling of the affected area accompanied by
fever, leucocytosis
Elevated ESR

49. • X-ray examination reveals a predominantly
osteolytic lesion with patchy subperiosteal
reactive bone formation
• producing characteristic ‘onion-skin’
radiographic appearance.

50. • located in the medullary cavity & produces
expansion of the affected diaphysis (shaft) or
metaphysis, often extending into the adjacent
soft tissues.
• greywhite, soft and friable

52. THANK YOU