Histopathology 2: Neoplastic Bone Disorders Flashcards
X-ray: Codman’s Triangle at end of long bones
Histology: Malignant mesenchymal cells
Diagnosis?
Osteosarcoma
X-ray: Lytic lesions with fluffy calcification
Histology: Malignant chondrocytes
Diagnosis?
Chondrosarcoma
X-ray: Onion skinning of periosteum
Histology: Sheets of small round cells
Karyotype: shows t(11;22)
Diagnosis ?
Ewing’s sarcoma
X-ray: Lytic appearance in the epiphysis of knee
Histology: Giant cells look like osteoclasts, spindle/ovoid cells
Diagnosis?
Giant cell tumour
X-ray: Soap bubble osteolysis, Shepherd’s crook deformity
Histology: Chinese letters
Diagnosis ?
Associated syndrome ?
Fibrocystic dysplasia
Albright syndrome
List the triad of features Albright syndrome?
- Polyostotic dysplasia
- cafe au lait spots
- Precocious puberty
X-ray: Mushroom protuberance from Bone
Histology: Cartilage capped bony outgrowth
Diagnosis?
Osteochondroma
X-ray: popcorn calcification
Histology: Proliferation of cartilage
Diagnosis ?
Enchondroma
X-ray: Bulls eye appearance of radioleucent nidus with sclerotic rim
Histology: normal bone arising from osteoblasts
Diagnosis ?
Osteoid Osteoma
Which benign bone tumour causes pain at night which is relieved by Aspirin ?
Osteoid osteoma
In which syndrome do you get Osteomas, GI polyps and epidermoid cysts ?
Gardner syndrome
Which bone tumour shows speckles mineralisation and is similar to osteoid osteoma ?
Osteoblastoma
Parts of the bone
long part = diaphysis
end part = epiphysis
outside - inside = periosteum - cortex - medulla
list 5 tumour- like condition
fibrous dysplasia metaphysial fibrous cortical defect/ non-ossifying fibroma reparative giant cell granuloma ossifying fibroma simple bone cyst
Features of fibrous dysplasia
F>M
ribs and proximal femur common
‘soap bubble osteolysis’ on x-ray
McCune Albright syndrome - associated with endocrine problems and cafe au lait spots
mutation in G protein
Chinese letters - marrow replaced with fibrous stroma
fibrous dysplasia in femoral head = shepherd’s crook
microfractures lead to a change in shape
name 3 cartilagenous bone tumours
osteochondroma
echondroma
chondroblastoma
name 3 bone forming benign bone tumours
osteoid osteoma
osteoblastoma
osteoma
features of osteochondroma
ends of long bones
young
males
cartilagenous surface overlying normal trabecular bone
features of echondroma
cartilagenous proliferation within the bone
hands and feet
rarely ends of long bones
popcorn calcification
two key macroscopic features of benign bone tumours
well demarcated
may erode through the cortex of the bone but does not burst through the cartilagenous surface
features of giant cell tumours
site = epiphysis with metaphysial extension
20-40 yrs
F>M
lytic on x-ray
osteoclasts on a background of spindle/ovoid cells
what adult cancers commonly spread to the bone
breast prostate lung kidney thyroid
what child cancers commonly spread to the bone
neuroblastoma wilm's tumour osteosarcoma ewing's sarcoma rhabdomyosarcoma
3 types of malignant bone tumour
1 - osteosarcoma - forms bone
2 - chondrosarcoma - forms cartilage
3 - ewings sarcoma/ PNET - undifferentiated mesenchymal
features of osteosarcoma
age 10-30 end of long bones jaw of older patients M>F most common bone sarcoma X ray - metaphysical, lytic, permeatuve, elevative periosteum (Codman's triangle) histology: malignant mesenchymal cells with or without bone and cartilage formation poor prognosis
features of chondrosarcoma
produces cartilage
>40yrs
axial skeleton, pelvis, proximal femur, proximal tibia
x-ray - lytic with fluffy calcifications
malignant chondrocytes on hist.
features of ewings sarcoma (PNET)
highly malignant small round cell tumour
<20 yrs
diaphysis/metaphysis of long bones, pelvis
x-ray - onion skinning of the periosteum, lytic or without sclerosis
hist - sheet of small round cells
11;22 chr translocation
list types of soft tissue tumours
liposarcoma
spindle cell sarcoma
pleomorphic sarcoma
features of liposarcoma
myxoid appearance
how can we diagnose soft tissue tumours
immunohistochemistry EM cytogenetics FISH M-FISH
benign vs malignant bone disease
benign:
- no periosteal reaction
- thick endostial reaction
- well developed bone formation
- intraosseous and even calcification
malignant:
- acute periosteal reaction - codmans triangle, onion skin, sunburst
- borad border between lesion and mortal bone
- varied bone formation
- extra osseous and irregular calcification
