Bone tumors can vary significantly in their size, features, and severity, ranging from innocuous to rapidly fatal. It is important to accurately diagnose, stage, and treat bone tumors based on the normal tissue they resemble. The two main categories are benign and malignant tumors. Benign tumors typically occur in younger people while malignant tumors are more common in the elderly. Some key bone tumors mentioned are osteosarcoma, Ewing sarcoma, and giant cell tumor. Osteosarcoma produces abnormal bone and often affects the long bones of teenagers and young adults. Ewing sarcoma is highly malignant and affects children and young adults. Giant cell tumor is usually benign but can be locally aggressive.

1. BONE TUMORS

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

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

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

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

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

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

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

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

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

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

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

15. osteosarcoma of upper end of tibia

16. Osteosarcoma- Femur

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

19. Osteosarcoma

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

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

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

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

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

26. Ewing sarcoma

27. Ewing sarcoma

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

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

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

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

32. Osteoclastoma

33. Osteoclastoma

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

35. Giant cell tumor - MRI

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