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.
Malignant bone tumors- clinical presentation, epidemiology, pathological findings, radiological findings, cases
Includes osteosarcoma, Ewing's sarcoma, and chondrosarcoma in detail.
In this presentation, radiological characteristics of different bone tumors has been explained in detail including MRI, CT scan, Bone scan, and plain radiography.
Malignant bone tumors- clinical presentation, epidemiology, pathological findings, radiological findings, cases
Includes osteosarcoma, Ewing's sarcoma, and chondrosarcoma in detail.
In this presentation, radiological characteristics of different bone tumors has been explained in detail including MRI, CT scan, Bone scan, and plain radiography.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. Introduction
• Bone tumors are diverse in their gross and morphologic
features
• Innocuous to the rapidly fatal.
• Critical to diagnose these tumors correctly, stage them
accurately and treat them appropriately
• Affected patients should survive and maintain optimal
function of the affected body parts.
• Most bone tumors are classified according to the normal cell
or tissue type they arise from.
4. • Most frequent benign tumors - Osteochondroma
and fibrous cortical defect.
• Most common malignant tumor – Osteosarcoma
followed by chondrosarcoma and Ewing sarcoma
(excluding malignant neoplasms of marrow origin
such as myeloma, lymphoma and leukemia)
5. • Precise incidence of specific bone tumors is not
known
• Relatively infrequent
• Great diversity
• Occur at all ages / any part of body
• Certain tumors target particular age group and sites
• Diagnosis requires integration of
• Clinical history
• Radiographic appearance
• Histopathology
6. Age and location
• Most develop during the first several decades
of life and have a propensity to originate in the
long bones of the extremities.
• Location of a tumor provides important
diagnostic information.
8. Clinical presentation of Bone tumors
• Pain
• Slow-growing mass
• Sudden pathologic fracture
• Radiologic imaging studies - Important role in
diagnosing these lesions. In addition to
– Provides exact location
– Tumor extent
– Aggressiveness of the tumor
10. Bone Tumours
Sites of Occurrence
Giant cell tumour
Chondroblastoma
Ewing’s
Osteosarcoma
11.
12. BONE-FORMING TUMORS
• Production of bone by the neoplastic cells.
• The tumor bone is usually deposited as woven
trabeculae (except in osteomas) and is variably
mineralized.
• Benign – Osteoma, Osteoid Osteoma and
Osteoblastoma
• Malignant - Osteosarcoma
13. Osteoma
1. Benign, Often craniofacial in
location
2. Hamartomatous / reactive &
not true tumor.
3. Histologically dense
lamellar bone (closely
resemble normal bone).
4. Gardner Syndrome:
Autosomal Dominant
condition associated with
multiple, Osteoma,
Osteochondroma, GIT
polyps, skin tumors. Colon
Cancer may occur
14. Osteoid Osteoma
1. Osteoid osteoma are less than 2 cm in greatest dimension
and usually occur in patients in their teens and twenties. 90%
of patients are teens or in their 20’s.
2. Osteoid osteomas can arise in any bone but 50% of cases
involve the femur or tibia, affecting mainly the cortical bone
(diaphysis or metaphysis)
3. Osteoid osteomas are characteristically painful at night. The
pain is caused by excess prostaglandin E2 (due to
proliferating osteoblasts) and is relieved by aspirin.
15. Osteoid Osteoma
X-Ray: This is the central nidus of an
osteoid osteoma.
Radiographically, there is a small
round central lucent area in the
femoral cortex surrounded by
sclerotic bone.
Micro: the central nidus of an osteoid
osteoma is composed of irregular
reactive new woven bone
dispersed in a highly vascular
stroma
X-Ray & Microscopy
17. Microscopy of Osteoid osteoma
Osteoid osteoma composed of haphazardly interconnecting trabeculae of woven bone
that are rimmed by prominent osteoblasts. The intertrabecular spaces are filled by
vascularized loose connective tissue
18. Osteoblastoma
• Osteoblastoma is larger than 2 cm and
involves the spine more frequently
• The pain is dull, achy, and unresponsive to
salicylates
• Tumor usually does not induce a marked bony
reaction.
19. Osteosarcoma
• Osteosarcoma is a malignant mesenchymal tumor in
which the cancerous cells produce bone matrix.
• Most common primary malignant tumor of bone
• Occurs in all age groups but has a bimodal age
distribution
– 1st peak - 75% occur in persons younger than 20 years of
age
– 2nd peak occurs in the elderly – Predisposing conditions -
Pagets disease, bone infarcts and prior irradiation
• Men are more commonly affected than women
20. Major sites of origin of osteosarcoma
Usually arise in the metaphyseal region of the long bones of the extremities, and almost 50%
occur about the knee
21. Pathogenesis
• 70% of osteosarcomas have acquired genetic
abnormalities such as ploidy changes and
chromosomal aberrations
– RB, the retinoblastoma gene, a critical cell cycle
regulator
– p53, a gene whose product regulates DNA repair and
certain aspects of cellular metabolism. Li-Fraumeni
syndrome
• Abnormalities in INK4a, which encodes p16 (a cell
cycle regulator) and p14 (which aids and abets p53
function), also are seen in osteosarcoma
22. Morphology
• Site of origin (intramedullary, intracortical, or
surface)
• Degree of differentiation
• Multicentricity (synchronous, metachronous)
• Primary (underlying bone is unremarkable) or
secondary to preexisting disorders such as benign
tumors, Paget disease, bone infarcts, previous
irradiation
• Histologic features (osteoblastic, chondroblastic,
fibroblastic, telangiectatic, small cell, and giant
cell).
24. Osteosarcoma
• Typically present as painful and
progressively enlarging
masses. Sometimes a
sudden fracture of the bone is
the first symptom.
1. Classic X ray findings:
a) Codman’s triangle
(periosteal elevation)
b) Sunburst pattern
c) Bone destruction
Clinical & X-ray findings
Codman Triangle
Sunray
appearance
Sunray
appearance
25. Gross
• Big bulky tumors that are gritty, gray-white, and
often contain areas of hemorrhage and cystic
degeneration.
• Destroy the surrounding cortices and produce soft-
tissue masses. They spread extensively in the
medullary canal, infiltrating and replacing the
marrow surrounding the preexisting bone trabeculae.
26. Osteosarcoma of the upper end of the tibia. The tan-white tumor fills most of the medullary
cavity of the metaphysis and proximal diaphysis. It has infiltrated through the cortex, lifted the
periosteum, and formed soft-tissue masses on both sides of the bone.
27.
28. Microscopy
• Tumor cells vary in size and shape and frequently
have large hyperchromatic nuclei.
• Bizarre tumor giant cells are common along with
mitoses.
• The formation of bone by the tumor cells is
characteristic.
• Neoplastic bone usually has a coarse, lace-like
architecture
• When malignant cartilage is abundant, the tumor is
called chondroblastic osteosarcoma.
• Vascular invasion and necrotic areas are present.
29. Coarse, lacelike pattern of neoplastic bone produced by anaplastic malignant tumor cells.
Note the mitotic figures.
30.
31. Metastasis, Treatment and Prognosis
• Highly aggressive neoplasms
• Hematogenous mode of spread
• 90% have metastases to the lungs, bones, brain and
elsewhere.
• Treated with a multimodality approach that includes
chemotherapy
• 5-year survival rate – 20%
32. CARTILAGE-FORMING TUMORS
• Characterized by the formation of hyaline or myxoid
cartilage
• Benign – Osteochondroma, Chondroma,
Chondroblastoma, Chondromyxoid fibroma
• Malignant - Chondrosarcoma
33. Osteochondroma
• Also known as an exostosis
• Benign cartilage-capped tumor that is attached to the
underlying skeleton by a bony stalk.
• Most common benign bone tumor; about 85% are
solitary
• Multiple hereditary exostosis syndrome, which is an
autosomal dominant hereditary disease. Hereditary
exostoses are caused by germline loss-of-function
mutations in either the EXT1 or EXT2 genes
34. • Solitary osteochondromas are usually first diagnosed
in late adolescence and early adulthood, but multiple
osteochondromas become apparent during
childhood.
• Men are affected three times more often than
women
• Develop only in bones of endochondral origin and
arise from the metaphysis near the growth plate of
long tubular bones, especially about the knee
• Incidental finding or presents as slow growing
masses
35. Osteochondroma
1. Hereditary (multiple) or sporadic (single)
2. Benign bone growths capped with
cartilage
3. affects children/ adolescent males; may
be asymptomatic or cause pain,
producing deformity
4. hereditary type can undergo malignant
transformation (Chondrosarcoma )
Exostosis
36. Morphology
• Sessile or mushroom shaped
• Range in size from 1 to 20 cm.
• The cap is composed of benign hyaline cartilage
varying in thickness and is covered peripherally by
perichondrium. The cartilage has the appearance of
disorganized growth plate and undergoes enchondral
ossification, with the newly made bone forming the
inner portion of the head and stalk.
37.
38. A, X-ray of an osteochondroma arising off the posterior surface of the tibia. B, Axial
CT scan shows continuity of the cortex of the bone and the center of the
osteochondroma. The fibula is adjacent to the mass. C, Gross specimen of sessile
osteochondroma composed of a cap of hyaline cartilage undergoing enchondral
ossification. D, The cartilage cap has the histologic appearance of disorganized growth
plate-like cartilage.
39. Chondromas
• Benign tumors of hyaline cartilage that usually
occur in bones of enchondral origin.
• Enchondromas - Arise within the medullary
cavity.
• Subperiosteal or juxtacortical chondromas -
Surface of bone.
• Age – 20s to 40s
40. Enchondroma
• Benign
• Single or multiple sites
• Often involves small bones of hands and
feet.
• Well demarcated, mature cartilage.
• Hereditary – multiple enchondromatosis.
Usually over one side of the body.
(Ollier’s disease).
• Maffucci's syndrome - multiple bone
chondromas and hemangiomas of soft
tissue
• Increased risk for chondrosarcoma
Chondroma
41. Morphology
• Enchondromas are usually smaller than 3 cm
and grossly are gray-blue and translucent
• Composed of well-circumscribed nodules of
cyto logically benign hyaline cartilage
42. Enchondroma with a nodule of hyaline cartilage encased by a thin layer of reactive
bone
43. Enchondroma of the phalanx with a pathologic fracture. The radiolucent nodules of
hyaline cartilage scallop the endosteal surface.
44. Chondrosarcoma
• Production of neoplastic cartilage
• Subclassified according to site as central
(intramedullary) and peripheral (juxtacortical and
surface).
• Histologically, they include conventional (hyaline
and/or myxoid), clear cell, dedifferentiated, and
mesenchymal variants.
• Age > 40 years
• Men
• 15% of conventional chondrosarcomas arise from a
preexisting enchondroma or osteochondroma.
45. • Commonly arise in the central portions of the
skeleton, including the pelvis, shoulder, and ribs
• Present as painful, progressively enlarging masses.
• Slow-growing, low-grade tumor causes reactive
thickening of the cortex, whereas a more aggressive
high-grade neoplasm destroys the cortex and forms a
soft-tissue mass
46. Morphology - Gross
• Large bulky tumors are made up of nodules of
gray-white, somewhat translucent glistening
tissue
47.
48. Microscopy
• Tumors vary in degree of cellularity, cytologic
atypia, and mitotic activity. Presence of anaplastic
chondrocytes
– Grade 1, 2 and 3
49. Metastasis and Prognosis
• Direct correlation between the grade and the
biologic behavior of the tumor
• 5-year survival rates were 90%, 81%, and 43%
for grades 1 through 3, respectively
• Spread preferentially to the lungs and skeleton
• Treatment of conventional chondrosarcoma is
wide surgical excision
50. Miscellaneous tumors of bone
• GIANT-CELL TUMOR
• EWING SARCOMA/PRIMITIVE
EUROECTODERMAL TUMOR
• ANEURYSMAL BONE CYST
51. Giant cell Tumour of Bone
• Known as osteoclastoma
• Common tumour – 20% of all benign bone
tumors
• Age - 20 -40 years
• Slight female preponderence
• Histogenesis – not known
52. • Epiphysis of long bones affected
• Radiolucent lesion involving end of long bones
• Almost always solitary
• Grossly dark brown - due to abundant
vascularity
• Areas of necrosis and cystic change present
54. Magnetic resonance image of a giant-cell tumor that replaces most of the
femoral condyle and extends to the subchondral bone plate.
55. Morphology
• HPE - 2 major population of cells
• Multinucleated giant cells - reactive component
• Neoplastic component – round to spindle shaped
mononuclear cells
• Large number of osteoclast likes giant cells with
mononuclear cells.
58. • Clinical features
• Local pain – mistaken for arthritis
• Wide variety of bone disorder may contain
multinucleated giant cells
– Brown tumor
– Aneurysmal bone cyst
• Unpredictable behaviour
• Recurrence common after curettage
59. Ewing’s Sarcoma
• Most common form of bone tumour in children / adolescent
• Peak incidence 2nd decade
• Highly aggressive tumour
• Must be differentiated from other small blue cell tumours.
• Translocation involving the EWS gene on chromosome 22
and a gene encoding an ETS family transcription factor; the
most commonly involved ETS gene is FLI1
60. • Present as painful enlarging masses
• Tender, warm, and swollen.
• Some affected individuals have systemic findings,
including fever, elevated sedimentation rate, anemia,
and leukocytosis, which mimic infection.
• Plain radiograms show a destructive lytic tumor that
has permeative margins and extension into the
surrounding soft tissues.
• The characteristic periosteal reaction produces
layers of reactive bone deposited in an onion-skin
fashion.
61. Morphology
• Arise in medullary cavity
• Soft, expansive mass
• Site – femur, tibia, pelvis – diaphysis
commonly affected
• Extends beyond medullary cavity
64. • HPE
• Sheets of small round cells
• Small, fairly uniform nuclei
• Scant cytoplasm
• Cytoplasm contain glycogen (PAS stain)
• Produce reactive bone / not osteoid
• Presence of Homer-Wright rosettes
(tumor cells arranged in a circle about a
central fibrillary space) is indicative of
neural differentiation
67. • Immunohistochemical study needed
to distinguish from
• Neuroblastoma
• Rhabdomyosarcoma
• Lymphoma
• EWS express neural marker
68. • Clinical features
• Pain and local inflammation
• Fever is common
• Biopsy needed for diagnosis
• Recent advances in treatment
improved outlook of patients
• 5 year survival rate is 75%
69. ANEURYSMAL BONE CYST
• Benign tumor of bone characterized by
multiloculated blood-filled cystic spaces that may
present as a rapidly growing expansile tumor
• First 2 decades of life and has no sex predilection
• Metaphyses of long bones and the posterior
elements of vertebral bodies
• Most common signs and symptoms are pain and
swelling
72. Aneurysmal bone cyst with blood-filled cystic space surrounded by wall containing
proliferating fibroblasts, reactive woven bone, and osteoclast-type giant cells.
73. Metastatic tumors to bone
• Pathways of spread
– Direct extension
– Lymphatic or hematogenous dissemination
– intraspinal seeding (via the Batson plexus of veins)
• Adults more than 75% of skeletal metastases
originate from cancers of the prostate, breast,
kidney, and lung.
• In children, metastases to bone originate from
neuroblastoma, Wilms tumor, osteosarcoma, Ewing
sarcoma, and rhabdomyosarcoma.