The document discusses various primary bone tumors classified by their histological type as either benign or malignant. The most common benign tumor is osteochondroma, while the most common malignant tumors are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Osteosarcoma most often occurs in adolescents around the knee and is the most common primary malignant bone tumor. Chondrosarcoma develops in mid to late adulthood and involves the trunk, limb girdles, and proximal long bones. The document provides details on the classification, characteristics, morphology, and clinical features of specific bone tumors including osteoma, osteoid osteoma, osteoblastoma, osteosarcoma, osteochondroma, ch
El sarcoma de Kaposi es una enfermedad por la que se forman tumores malignos (cancerosos) en la piel, las membranas mucosas, los ganglios linfáticos y otros órganos.
Para detectar (encontrar) y diagnosticar el sarcoma de Kaposi se utilizan pruebas que examinan la piel, los pulmones y el tubo digestivo.
Después de que se diagnostica un sarcoma de Kaposi, se realizan prueban para determinar si las células cancerosas se diseminaron a otras partes del cuerpo.
Ciertos factores afectan el pronóstico (probabilidad de recuperación) y las opciones de tratamiento.
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
El sarcoma de Kaposi es una enfermedad por la que se forman tumores malignos (cancerosos) en la piel, las membranas mucosas, los ganglios linfáticos y otros órganos.
Para detectar (encontrar) y diagnosticar el sarcoma de Kaposi se utilizan pruebas que examinan la piel, los pulmones y el tubo digestivo.
Después de que se diagnostica un sarcoma de Kaposi, se realizan prueban para determinar si las células cancerosas se diseminaron a otras partes del cuerpo.
Ciertos factores afectan el pronóstico (probabilidad de recuperación) y las opciones de tratamiento.
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Pathology of gastrointestinal tract
Pathology of Oesophagus
Clinical importance on oesophagus pathology
Oesophagus
Oesophagus pathology
Pathological study of oesophagus
Swollen lymph nodes usually occur as a result of infection from bacteria or viruses. Rarely, swollen lymph nodes are caused by cancer. Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin.
In some cases, the passage of time .Hard, swollen or tender lymph nodes
Itchy skin, Lump, or mass that can be felt beneath the skin, Rash
Redness, warmth or selling immune system disorders
Lupus — a chronic inflammatory disease that targets your joints, skin, kidneys, blood cells, heart and lungs
Rheumatoid arthritis — a chronic inflammatory disease targeting the tissue that lines your joints (synovium)
Cancers
Lymphoma — cancer that originates in your lymphatic system
Leukemia — cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system
Other cancers that have spread (metastasized) to lymph nodes
Pathology of gastrointestinal tract
Pathology of Oesophagus
Clinical importance on oesophagus pathology
Oesophagus
Oesophagus pathology
Pathological study of oesophagus
Swollen lymph nodes usually occur as a result of infection from bacteria or viruses. Rarely, swollen lymph nodes are caused by cancer. Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin.
In some cases, the passage of time .Hard, swollen or tender lymph nodes
Itchy skin, Lump, or mass that can be felt beneath the skin, Rash
Redness, warmth or selling immune system disorders
Lupus — a chronic inflammatory disease that targets your joints, skin, kidneys, blood cells, heart and lungs
Rheumatoid arthritis — a chronic inflammatory disease targeting the tissue that lines your joints (synovium)
Cancers
Lymphoma — cancer that originates in your lymphatic system
Leukemia — cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system
Other cancers that have spread (metastasized) to lymph nodes
The exact cause of primary bone cancer is not fully understood but the researchers believe that it is caused by over-activity of the bone cells. Studies have shown that there is a much higher risk of bone cancer in those persons, who had taken radiotherapy or chemotherapy with alkylating anticancer drugs during their childhood. Pain and swelling are the most common symptoms of bone cancer.
For more information: www.cancertame.com
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. BONE TUMORS
• Benign lesions are more common than malignant.
• The most common benign tumour of bone is
osteochondroma.
• All bone forming tumors occur between the ages
of 10-20yrs except osteoma which occurs in
older age group (40-50ys).
• Metastatic bone tumors > Primary bone T.
• Common tumor sites giving bone metastasis are:
prostate and breast .
5. BONE TUMORS cont…..
• Malignant bone tumors, the most common are
osteosarcoma followed by chondrosarcoma, and
Ewing’s sarcoma.
• Osteosarcoma occur in adolescence and affect bone
around the knee in ½ of cases.
• Chondrosarcoma develop in the mid to late adulthood
involve the trunk, limb girdles, proximal long bones.
• Chondroblastoma and giant cell tumor occur in the
epiphysis of long bone.
• Ewing’s sarcoma arise in diaphysis.
• Diagnosis of bone tumors requires clinical history, X-
ray, gross and microscopic examination.
9. OSTEOMA
• Osteoma are benign lesions of bone, developmental
or reactive growths rather than true neoplasms.
• Common in head, neck, paranasal sinuses, and facial
bone.
• Osteomas are localized, usually solitary, hard
exophytic growths attached to the surface of the
bone.
• More common in males, any age, middle age.
11. OSTEOMA cont…..
• Histologically, are composed of a
mixture of woven and lamellar bone,
similar to normal bone, might have
bone marrow elements.
• Do not undergo malignant
transformation.
• When multiple + intestinal polyposis
+ soft tissue tumors (Gardner’s
syndrome)
DDX: Reactive bone induced by
infection, trauma, or hemangioma
simulate osteoma.
12. OSTEOID OSTEOMA AND
OSTEOBLASTOMA
• Osteoid osteomas and osteoblastomas are benign
neoplasms
• Have very similar histologic features.
• Different in size, and site of origin and symptoms.
13. OSTEOID OSTEOMA AND
OSTEOBLASTOMA
Osteoid Osteomas
• Arise in proximal femur and tibia, on the cortex.
• Second to third decades of life.
• Males > females, 2:1 ratio.
• Cause pain, severe at night, relieved by aspirin.
• Measure less than 2 cm in greatest dimension.
• Treatment with local excision.
14. OSTEOID OSTEOMA AND
OSTEOBLASTOMA
Osteoblastoma
• Are larger.
• Cause dull achy pain, not relived by aspirin.
• Occur in vertebral column,& long bone.
• Affect 20-30 y, M>F.
• Treatment local excision , may recur.
15. Osteoid osteoma & Osteoblastoma
• Radiographically:
Are well-circumscribed lesions, involve cortex.
The central area called the nidus, radiolucent
surrounded by rim of sclerotic bone in both types.
• Gross:
round oval mass of hemorrhagic gritty tan tissue.
• Microscopically:
both are well circumscribed and composed of
trabeculae woven bone surrounded by
Osteoblast. The stoma is made up of loose,
vascular connective tissue, and contains number
of giant cells.
16. This is the central nidus of an osteoid osteoma.
Radiographically, there is a small round central lucent area
variably mineralized in the metatarsal bone cortex
surrounded by sclerotic bone.
17. This is the central nidus of
an osteoid osteoma
composed of irregular
reactive new bone.
Osteoid osteomas usually
occur in the axial skeleton
(especially tibia and
femur) in bone cortex of
young males in the second
decade of life. An
osteoblastoma is just a big
osteoid osteoma in the
vertebra&rarely have well
formed nidus .
18.
19. OSTEOSARCOMA
(OSTEOGENIC SARCOMA)
• Osteosarcomas are malignant mesenchymal
neoplasms in which the cancerous cells produce
bone matrix.
• Osteosarcoma 20% of all primary bone tumors.
• It is the most common malignant primary bone
tumor.
20. Osteosarcoma cont….
Occur:
in 10-20 years of age.
Affect:
Male > female.
Second peak in elderly who have had Pagets disease
or bone infarction.
Site
in metaphysis (60-70% around the knee, distal femur
and proximal tibia). Any bone can be involved. Flat
bone (jaws and pelvis) and long bone are involved
equally after age 25 years.
21.
22. Osteosarcoma cont…..
Morphology:
Several subtypes are described, and grouped according to:
1.The anatomic location in the bone (intramedullary,
intracortical or surface).
2.Degree of differentiation.
3.Multicentrecity (synchronous, metachronous).
4.Primary or secondary (arising on preexisting disease such
benign tumors, Paget’s disease, infarcts…….)
5.Histological variants (osteoblastic, chrondroblastic,
fibroblastic, telangiectatic, small cell, and giant cell).
23. Osteosarcoma cont……..
• The most common type is osteosarcoma arising in the
metaphysis of long bone.
• It is solitary.
• Poorly differentiated and produce large bony matrix.
24. Osteosarcoma cont…….
Grossly:
• are large, fleshy ill-defined, in medullary cavity of
metaphyseal end of the bone
• areas of necrosis and haemorrhage.
• areas of bone and cartilage formation present.
• The tumor destroys the cortex and frequently the
T.extends inwards in marrow cavity and outwards
into soft tissues.
• Invasion of epiphyseal plate uncommon.
25.
26. Osteosarcoma cont…..
Microscopically:
• The hallmark of osteosarcoma is the formation of
osteoid by malignant osteoblast.
• Island of bony trabeculae hugged by a rim of
malignant osteoblasts.
• Cartilage also be present.
• Neoplastic mesenchymal cells between osteoid are
spindle or pleomorphic, with frequent mitotic figures.
• Giant cells, either many or few.
27.
28. Osteosarcoma cont….
X-ray:
Tumor is destructive breaks the cortex, elevates the
periosteum result in reactive new bone deposition.
Give the so-called Codman’s triangle on radiographs.
29.
30. The most common subtype is osteosarcoma that arises in the
metaphysis of long bones; is primary, solitary, intramedullary,
and poorly differentiated; and produces a predominantly bony
matrix
31. Osteosarcoma cont……
• Clinical Features
• Early
give progressively enlarging, painful masses with
limited joint movement.
• Late
cause weight loss, anaemia and fracture of the
involved bone.
Fracture can be the presenting symptom.
32. Osteosarcoma cont…..
Spread of osteosarcomas:
• Metastasize via the bloodstream to the lung.
• 20% of pt. have pulmonary spread at diagnosis.
• Direct spread to the soft tissue.
Prognosis:
• 5 years survival rate is 5-20%.
• Improved prognosis, advanced surgical techniques,
combined with radiation and chemotherapy.
33.
34. Assessment
-The most common primary malignant
neoplasm of bones under the age of 20 years is:
a. Osteosarcoma
b. Giant cell tumor of bone
c. Chondrosarcoma
d. Metastasis
38. Osteochondroma
• Osteochondromas, exostoses are benign,&
common.
• Are malformation rather than neoplasm.
• Most common benign bone tumors under age 21
(10-30).
• M:F is 3:1.
• Occur as solitary lesion, sporadic can be multiple in
familial exostosis which have the risk of rare (1%)
sarcomatous transformation .
• Are outgrowth attached to the skeleton by bony
stalk & covered by cartilage cap.
39. Osteochondroma cont……
• Clinically : are asymptomatic, cause deformities.
• Site : arise from the metaphysis near the growth
plate of long tubular bones (about the knee) rare
in short tubular bone of hands and feet.
• Gross : Mushroom shaped with broad-base,
anchored to the cortex of the adjacent bone, the
outer layer of the head is composed of benign
hyaline cartilage and from 1-20 cm in size .
• Microscopically : are proliferations composed of
mature bone and cartilaginous cap. They stop
growing once the normal growth of the skeleton is
completed.
40. This is an osteochondroma cut into three sections. A bluish-
white cartilagenous cap overlies the bony cortex. These are
probably not true neoplasms, but they are a mass lesion
that extends outward from the metaphyseal region of a long
bone.
41. The microscopic appearance of an osteochondroma displays
the benign cartilagenous cap at the left and the bony cortex at
the right. This bone growth, though benign, can sometimes
cause problems of pain and irritation that leads to removal
surgically.
42. CHONDROMA
(ENCHONDROMA)
*Chrondromas are benign lesions composed of
mature hyaline cartilage.
Site: small bones of hands and feet.
Age: 20-40y, occur at any age.
Clinical: solitary or multiple, well-circumscribed.
Occur in metaphysis of tubular short bone of the
hand and feets.
if within the medullary cavity of the bone (called
enchondroma).
if on surface of the bone (called subperiosteal
chondromas).
43. CHONDROMA cont……
Ollier’s disease is multiple chondromas involving
one side of the body.
Maffucci’s syndrome is multiple chondromas
associated with benign vascular tumors (angiomas)
and brain gliomas.
Pathogenesis : Develop in enchondral bone.
arising from rests of growth plate cartilage.
X-ray : give O ring sign, unmineralized nodule
surrounded by rim of radiodense bone.
44.
45. CHONDROMA cont……
Gross : are usually smaller than 3 cm , gray-blue
translucent with nodular configuration.
Microscopically : are composed of mature,
hypocellular benign hyaline cartilage .
Clinically : can be painful or cause pathological
fracture.
If multiple result in deformities and recur if
incompletely excised.
Prognosis : solitary are benign.
Chondrosarcomas may develop in patients with
multiple chondromas.
47. CHONDROBLASTOMA
Rare benign neoplasm
affected age is 10-20 years
male > female.
Site : Epiphyseal region of long bone, femur,
humerous, tibia (around the knee).
less common in pelvis, ribs, skull, small bone of
feets and in vertebrae.
Gross : Round oval soft gray pink, with
calcification, hemorrhage, necrosis and cystic
changes.
48. CHONDROBLASTOMA cont…..
Micro : Uniform small round chondroblasts.
calcification (chicken wire pattern),
multinucleated giant cells,
mitosis and necrosis present.
Clinically : are painful, cause effusion in joint and
motion restriction.
Recurrence is common after excision or curettage.
Metastasis occur if the lesions fracture or after
repeated curettage.
X-ray : well-defined lucency with spotty calcification
DDX : giant cell tumor.
49.
50.
51. CHONDROSARCOMA
**Chondrosarcomas are malignant neoplasms.
**Second to osteosarcoma in frequency.
Incidence : Males 2x > females.
Age : older patients, with a peak incidence in the
60y
Site : Central portions of skeleton, shoulder area,
pelvis, proximal femur, and ribs, around the
knee, these tumors may occur anywhere.
*Most primary chondrosarcomas arise de novo.
*Secondary occur in patients with multiple
enchondromas or osteochondromas.
52. CHONDROSARCOMA cont…
MORPHOLOGY:
*Cells in chondrosarcomas do not form osteoid.
*Chondrosarcoma arises centrally within the
medullary cavity of the bone
*Rarely on the surface of the bone (peripheral,
subperiosteal).
Gross: large, gray-white glistening mass, with
spotty calcification;
central necrosis and cyst formation.
erodes the cortex and extend into soft
tissue.
53. A chondrosarcoma
arising in the pelvis.
Note the extensive
nodules of white to
bluish-white
cartilagenous tumor
tissue eroding and
extending outward
from the bone at the
lower right. Many of
them are slow
growing .
54. CONDROSARCOMA cont…
Histology
• Malignant cells infiltrates the marrow and surrounds
bony trabeculae.
• Well differentiated T. have little atypia.
• Poorly differentiated T. have pleomorphic cells with
many mitosis. Two or more chondroblasts in one
lacuna.
• 10% of low grade chondrosarcoma transform into
high grade sarcoma and called dedifferentiated
chondrosarcoma.
55. This high power microscopic appearance of a chondrosarcoma
demonstrates pleomorphic chondrocytes that are piled together
in a haphazard arrangement.
56. CHONDROSARCOMA cont…
Clinical Features
*Most of chondrosarcomas are indolent
(grade1&2).
*progressively enlarging mass.
*painful masses involving the central portions
of the skeleton.
*poorly differentiated T. behaves in a more
aggressive fashion (grade 3 ).
*Large chondrosarcoma (>10 cm ) are more
aggressive.
*Chondrosarcomas metastasize via blood, to
lungs and skeleton.
57.
58. MISC. TUMORS of BONE
• EWING sarcoma
• GIANT CELL TUMOR
• METASTASES
59. EWING’S SARCOMA
Ewing’s sarcoma is a primitive malignant small
round cell tumor of bone and soft tissues.
Accounts for 6-10% of primary malignant bone
tumors.
Is a common malignancy of bone in children,
second to osteosarcoma.
It is the third most common malignant bone
tumor, exceeded only by osteosarcoma and
chondrosarcoma.
60. EWING’S SARCOMA cont…
Age: Children and adolescents.
Peak incidence younger than 20 years.
M > F more in whites.
Site of origin:
Can be skeletal or extra skeletal in the soft tissues
61. EWING’S SARCOMA cont…
Gross
Soft, tan-white expansile mass with areas of necrosis
and hemorrhage.
Site Diaphysis region in the medullary cavity of long
tubular bone as femur, tibia, and pelvis are favored sites of
origin
Extends to the cortex and periosteum & produce soft
tissue mass.
X-ray:
Destructive lytic tumor.
Give periosteal reaction with lamellae of reactive bone
deposited in an onion-skin pattern.
62. EWING’S SARCOMA cont…..
Microscopy
*Ewing’s sarcoma is composed of sheets of
primitive small round blue cells .
*Have uniform nuclei and little cytoplasm.
*The cytoplasm contains glycogen( seen with
periodic acid-Schiff (PAS) stains or by electron
microscopy ).
63.
64. EWING’S SARCOMA cont….
CLINICAL FEATURES
*Presents with pain as local inflammation with
fever.
*The diagnosis requires biopsy.
Prognosis: is bad but recent advances in treatment,
the 5-year survival rate close to 75%.
Spread: Via blood.
65. Giant Cell Tumor of Bone
*Giant cell tumor of bone, known as
osteoclastoma.
*neoplasm that contains large numbers of
osteoclast-like giant cells admixed with
mononuclear cells.
Incidence relatively uncommon tumors and locally
aggressive, 20% of all benign tumors of the bone.
66. Giant Cell Tumor of Bone
Site:
*In adult involve the epiphyses and metaphysis
*in adolescent are confined to growth plate.
*55% around the knee, the distal femur, proximal
tibia, proximal humerus, and distal radius, sacrum,
pelvis, and small bones of hand and feets.
Age: 20 and 40, female > male.
Histogenesis
Is incompletely understood.
The giant cells are reactive ( are macrophages).
The accompanying mononuclear cells are neoplastic.
67. Giant Cell Tumor of Bone
Grossly
Are dark brown due to abundant vascularity.
Areas of necrosis, hemorrhage and cystic
change.
The cortex either thinned or eroded due to
tumor expansion.
68. Here is a giant
cell tumor of
bone. The
proximal
femur has
been
amputated and
cut in half to
reveal an
irregular dark
red-black
hemorrhagic
mass in the
epiphyseal
region. Giant
cell tumors are
lytic on
69. Giant Cell Tumor of Bone
Histologically are composed of two major cell populations:
• Large multinucleated giant cells ,resemble
osteoclasts, have 100 nuclei identical to the
mononuclear cells.
• Neoplastic component is made up of round to
spindle-shaped mononuclear cells, contains a
number of mitotic figures.
• Rare occasions malignancy may develop.
• Necrosis, hemorrhage, hemosiderin and reactive
bone formation are common.
72. METASTASES
• Metastatic bone tumors are more common
than primary malignant bone tumors
• Common tumor sites giving bone metastasis
are: prostate and breast .
• Some metastatic deposits are osteolytic ,
others are osteoblastic and most of them
induce a mixed lytic and blastic reactions
73. Here is a closer view of bone metastases. Virtually all bone
metastases are from carcinomas. The primary sites of
carcinomas that commonly go to bone are: breast, prostate,
kidney, thyroid, lung. Renal cell carcinomas tend to be
osteolytic (they destroy the bone) whereas prostatic
adenocarcinomas tend to be osteoblastic (they initiate new
bone formation).
74. At high magnification, metastatic infiltrating ductal carcinoma of
breast is seen within bone and filling the marrow cavity. There is
reactive new bone with pale pink osteoid being laid down next to a
bony spicule at the upper left.
75. Assessment
• A 37 year old lady with a known history of
breast carcinoma presents with a fracture of
the neck of femur. The most likely cause is :
a. Trauma
b. Osteoporosis
c. Osteomyelitis
d. Pathological fracture due to metastasis
Editor's Notes
Ewing's sarcoma is one of the "small round blue cell" tumors histologically.
GCT occurs in patients, 20s-40-s, and GCT has a MACROPHAGE lineage, as most multinucleated giant cells do. Histologically, giant cell tumors of bone as seen here are composed of multinucleated giant cells in a sea of round to oval mononuclear cells