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Path II - Neoplastic bone pathology

Terms in this set (49)

t/f metastatic cancers are far more common than primary bone neoplasms
true
where are the usual neoplasms coming from when you have develop bone neoplasms like where did they metastasize from
prostate, breast, kidney, lung
what are the neoplasms that are common in the 1st decade of children?
neuroblastoma
retinoblastoma
rhabdomyosarcoma
what are the bone neoplasms associated with the diaphysis?
osteoid osteoma, fibrous dysplasia, ewing sarcoma
what are the bone neoplasms associated with the metaphysis
osteochondroma, enchondroma, and osteosarcoma
what are the bone neoplasms associated with the epiphysis?
chondroblastoma and giant cell tumor
if the bone tumor margin is geographic in nature what does this usually mean
neoplasm is benign
if the bone tumor margin is permeative in nature what does this usually mean?
neoplasm is malignant
what does a periosteal reaction suggest
rapidly growing lesion
What are the bone forming tumors?
osteoma
osteoid osteoma
osteoblastoma
osteosarcoma
Benign tumor located in the head and neck
slow growing; subperiosteal or endosteal, solitary
May be multiple in association with Gardner's syndrome
Osteoma
what will we see histologically of both osteoid osteoma and osteoblastoma?
well circumscribed
interconnected trabeculae of woven bone
rimmed by osteoblasts
Less than 2 cm in greatest dimension
2nd and 3rd decased
Femur and tibia most common: favor appendicular skeleton
painful but relieved by aspirin
Osteoid osteoma
Larger than 2 cm; most commonly found in the vertebral column
may be painful but it is not relieved by aspirin
osteoblastoma
what are the radiographic findings of osteoid osteoma?
well circumscribed
involves the cortex, not medulla
rim of sclerotic bone at edge
Nidus: radiolucent central area of tumor
what is the 2nd most common malignant tumor of bone
osteosarcoma
malignant mesenchymal neoplasm in which the neoplastic cells produce bone matrix
osteosarcoma
how does osteosarcoma metastasize
by hematogenous spread
where does an osteosarcoma most likely metastasize to?
lungs
what is the treatment of osteosarcoma?
amputation, radiation therapy and chemotherapy
how does secondary osteosarcoma usually arise from?
as a complication of a known underlying process like Paget's disease, history of radiation, osteochondroma
What is the distribution pattern of osteosarcoma?
bimodal (75% under the age of 20 years old and then a second smaller peak in elderly)
in an overall healthy young individual that has osteosarcoma what will the patient most likely present with?
pathologic fracture
where is the most common location for osteosarcoma?
knee
what is the morphology of osteosarcoma?
large, ill defined mass
metaphyseal location most commonly
elevates the periosteum (codman triangle)
osteoid produced by malignant cells
islands of bony trabeculae rimmed by malignant osteoprogenitor cells/osteoblasts
cartilage may be present
what are the cartilage forming tumors?
osteochondroma
chondroma
chondroblastoma
chondrosarcoma
benign tumor referred to as an exostoses
accounts for 1/3 of benign bone tumors
probably a malformation rather than a true neoplasm
usually solitary
osteochondroma
where does an osteochondroma arise from?
metaphysis
mature bone covered by hyaline cartilage; cortex is continuous
osteochondroma
benign
mature hyaline cartilage
most common location: small bones of hands and feet
3rd to 5th decades
Chondroma
what is characteristic of an enchondroma
well-circumscribed
usually located within medullary cavity
mature, hypocellular hyalin cartilage composed of bland chondrocytes
what is ollier disease?
AKA enchondromatosis
multiple chondromas
skeletal deformities
what is Maffucci syndrome
Multiple chondroma
associated with benign vascular soft tissue tumors, brain gliomas
rare, benign tumor
young patients, 2nd decade
Most common location: epiphysis of proximal humor and distal femur
Highly cellular
chondroblastoma
Malignant neoplasm which mesenchymal cells produce cartilaginous matrix
No osteoid production
chondrosarcoma
In what patients population would you find chondrosarcoma and where is the predominant skeletal distribution?
Males in 6th decade

shoulder, pelvis, proximal femur, ribs, vertebrae
what is the morphology of chondrosarcoma?
arises in medullary cavity, erodes cortex
glistening, blue-gray cut surface
Lacunae filled with 2 or more chondrocytes
what is the prognosis of a grade 1 chondrosarcoa
90% 5 year survival
where is the most common metastasis of chondrosarcoma?
lung
uncommon, benign
normal trabecular bone replaced by proliferation fibrous tissue and disorderly islands of malformed bone
localized developmental arrest of bone formation
Fibrous dysplasia
what is the most commmon type of fibrous dysplasia
monostotic (arises in adolescence, in the jaw, ribs, femur or tibia)
what is the morphology of fibrous dysplasia?
circumscribed, radiolucent
surrounded by thin layer of sclerotic bone
composed of irregular, curvilinear islands of woven bone surrounded by proliferating fibroblasts and collagen
benign but locally aggressive tumor
3rd to 5th decade
epiphyses of long bones: distal femur, proximal tibia
slight female predominance
Clinical: pain, swelling, pathologic fracture
Giant cell tumor
what is the morphology of Giant cell tumor
radiolucent lesion
solitary
may erode through cortex
composed of multinucleated giant cells and spindle shaped mononuclear cells
small round blue cell tumor
Ewing sarcoma
Arises within medullary cavity
Most common sites: femur, tibia and pelvis
arises in diaphysis of long bones
Clinical: painful, enlarging mass
"Onion skin" periosteal reaction
Ewing sarcoma
what is the 5 year survival of ewing sarcoma?
75%
what is the histology of ewing sarcoma/
sheets of uniform, small, round cells that are slighly larger than lymphocytes
cytoplasm is scant, contains glycogen
no osteoid productions
what will tell you the grade of the tumor
histopathologic examination
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