SymptomsLocalised Swelling Generalised body aches GCT Multiple Myeloma Osteosarcoma - Symtoms ignored for quite sometime Chondrosarcoma - Can be mistaken for Ewing’s sarcoma many other conditions with generalised body aches Osteoporosis/Osteomal acia, FMS etc.
Swelling May not be obvious Especially if the tumour is deep REST PAIN
Wasting of Muscles Disproportionate to Duration of disease Tuberculosis Malignancy Rheumatoid Disease
IMAGINGPLAIN Enneking`s four questionsRADIOGRAPHY 1. Where is the lesion? 2. What is the lesion doing to bone? Transition zone 3. How is the tissue responding to lesion? Reactive zone 4. Does anything suggest histology? Calcification, Ossification, Ground glass appearance Etc.
ALTRMCPS Age of Skeleton – - Mature or Immature Location Transitional zone Reactive zone Matrix Cortex Periosteal reaction Soft tissue swelling
Location ALTRMCPS Which Bone? Which Part of the Bone? - Epiphysis - Metaphysis - Diaphysis Eccentric or Concentric?
Zones of Transition A LT R M C P S Narrow - Sharp Sclerotic BENIGN - Sharp Lytic Wide - Ill-defined or hazy AGGRESSIVE / - Moth eaten MALIGNANT - permeative
Zone of Transition ALTRMCPS Narrow Non-ossifying Fibroma Sharp Sclerotic
Zone of Transition Narrow Giant Cell Tumour Sharp Lytic
Zone of Transition Wide Aggressive GCT Ill-defined or hazy
Zone of Transition Wide NH L Met Ca. Breast Moth eaten
Zone of Transition Wide Permeative Malignant Tumour
Problem – Histology 4ReactiveConditionsmistakenforTumours- Exuberant callus- Organisinghematoma- Myositisossificans
Problem – Histology 5Benign vsMalignant Secondary Chondrosarcoma arising from osteochondromatosis - Histology may be misleading – appears benign Aggressive Chondromyxoid Fibroma can be mistaken for low grade Chondrosarcoma Aggressive Osteoblastoma borderlines on Osteosarcoma Clinical picture & Radiology help to a great extent to differentiate
Problem – Histology 6Pathologicalfr. MistakenforTumour Needle Biopsy - Chondrosarco - Open Biopsy maTuberculosis
Problem – Histology 7Primary vs Met. Neuroblastoma orMetastases carcinoma vs Ewing’s – immunohistochemistry
Problem – Histology 8Tumour vsInfectionOSTEOMYELITISLow GradeINTRAMEDULLARYOSTEOSARCOMA
Problem – Histology 8Tumour vsInfection * Ewing’s Sarcoma & Osteomyelitis are confused with each other Clinically, Radiologically and even Histologically * “Culture a tumour & Biopsy an Infection”
“The gross anatomy asrevealed in radiographs isoften a safer guide to correctclinical conception thanvariable and uncertainnature of a small piece of 1922 EWINGtissue” Importance of Correlation of Histology & Radiology
Diagnosis of Bone Tumours Final Diagnosis CLINICAL IMAGEOLOGY PATHOLOGY (Radiology)
Prof. Dr. Walter PutscherOrthopedic Pathologist, Boston, USA“No Pathologist shall ever sign out a report without seeing the Radiograph
Prof. Peter G BulloughProfessor of Orthopedic PathologyHospital for Special Surgery,Cornell University,NEW YORK “If I were you, I will run to the Radiology department and get the x-ray films and make them available before the Histology slides are studied”
DICTUMThe Pathologist should receive the Clinical &Radiological findings while dealing with thediagnosis of Bone Tumours
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