1. Bone & Joint Tumors

4. Periostal reactions Response to RAPIDLY growing lesions
Spiculated "hair-on-end"
Onion-skinning

5. Codman's triangle

6. Periostal reactions Response to SLOW growing lesions
focal cortical thickening

7. I. Cartilaginous Tumors
Osteochondroma
Solitary Enchondroma
Chondrosarcoma

8. Osteochondroma Osteocartilaginous exostosis
Most common benign tumors or tumorlike lesions of bone,
In almost any bone preformed in cartilage, particularly long tubular bones,
Presents as a solitary cartilage-capped bony outgrowth protruding from the bone surface near the metaphysis.

9. The most common location of an osteochondroma is in the region of the knee,
particularly the lower metaphysis of the femur or the upper metaphysis of the tibia.
occasionally in a flat bone
such as a rib, clavicle, ilium, or vertebra.

10. Pathology
A sessile or stalked, cartilage-capped, bony protusion which extends from the metaphysial region
Microscopically
bony protusion
a cap of mature cartilage

12. bony protusion
a cap of mature cartilage

13. Solitary Enchondroma Central Chondroma
Composed of mature hyaline cartilage
Develops in the medullary cavity of a single bone
Third to sixth decades of life
average age : between 30 and 40 years.

14. The most common location is in the bones of the hand:
About one-third of all cases occur in the phalanges.
Sometimes:
the bones of the foot
long tubular bone (the humerus or femur)
pelvic bones
shoulder girdles.

15. Radiology:
A central, or slightly eccentric, well-circumscribed or "bubbly" radiolucent lesion,
finely or densely stippled with calcification.

17. Pathology:
Microscopically, small neoplastic cartilage cells with single small nuclei
May form lobules or facets
May be partially calcified

18. - lobules or facets
- partially calcified

19. Enchondromatosis
(Ollier’s Disease)

20. Chondrosarcoma A malignant cartilaginous tumor
The third to sixth decades of life (average age of 45 years)
Slightly more common in males than females

21. Chondrosarcoma may originate in the medullary cavity (central chondrosarcoma)
about 75% of cases or by malignant transformation of a preexisting enchondroma particularly in patients with enchondromatosis,
May originate in a juxtacortical location (peripheral chondrosarcoma) by sarcomatous change in the cartilage cap of an osteochondroma.

22. Location: flat bones of the pelvis the large limb bones the ribs
femur  25%
humerus
the ribs

23. Radiology: Radiolucencies (irregular or circular or bubbly)
Calcification (granular or lobular radiopaque areas)
Destruction of the inner cortex,
Enlargement of bone contours,
Focal periosteal reaction,
Penetration of the cortex.

24. Chondrosarcoma

25. Chondrosarcoma

26. Chondrosarcoma

28. Microscopy a lobular cartilaginous architecture, highly cellular,
more than one nucleated cell per lacuna,
occasionally reveals tumor giant cells or clear cells,
with increasing grades of malignancy, has marked variation in nuclear and cellular size and shape.

29. Chondrosarcoma

30. - Osteoid Osteoma II. Bone-Forming Tumors - Osteoblastoma
- Osteogenic Sarcoma

31. Osteoid Osteoma
A distinctive, small (<2 cm), solitary, benign, tumorlike lesion of bone
It is composed of osteoid tissue intermixed with woven bone and surrounded by reactive bony sclerosis.
Osteoid osteoma most often occurs in children and young adults.
A frequent presenting symptom of this condition is night pain, often relieved by aspirin, with localized tenderness in the painful area.

32. Osteoid osteoma is commonly located in a femur or tibia, Radiology:
A representative x-ray picture
An osteoid osteoma shows a well circumscribed, small, round or oval, radioluscent or radiodense lesion (the nidus)
May be located in or near the cortex and surrounded by densely sclerotic bone.

33. Osteoid Osteoma

34. Microscopy The nidus: surrounded by a sclerotic mature bone.
narrow trabeculae of osteoid or newly formed bone produced by osteoblasts + vascularized stroma
surrounded by a sclerotic mature bone.

35. Osteoid Osteoma

36. Osteoblastoma
Osteoblastomas are larger (> 2 cm) than osteoid osteomas
Mainly osteolytic
do not evoke reactive bone sclerosis
Higher recurrence rate (~10%)
Characterised by immature osteoid production
Commonly in the cancellous bone of the spine (posterior elements) and skull

37. Osteogenic Sarcoma Osteosarcoma: a malignant tumor of bone
Most common primary bone tumor after myeloma

38. In young people under 20 years of age Male / Female : 2/1
Peak beyond 40 years of age:
Secondary to preexisting disease
Paget's disease (Paget's sarcoma)
Previous radiation (irradiation sarcoma)
Other conditions

39. Osteosarcoma may occur in any bone
The most frequent location is near the knee (~50-60% of cases)
most commonly in the distal end of the femur
the upper end of the tibia,
upper end of the humerus,
pelvis,
upper end of the femur.
Bone-forming cells produce alkaline phosphatase
The serum alkaline phosphatase is markedly elevated in many patients with osteosarcoma.

40. Radiology of a long bone usually show a large, ill-defined tumor.
The bone-producing (osteoblastic) lesion is located in the medulla near the metaphysis
Lifts up the periosteum (periostal reaction)
often producing "Codman's triangle", an angle between the outer cortex and the elevated periosteum,
Sun-rays pattern
Less common :
destructive (osteolytic) lesions with a "moth eaten" appearance of the cortex.

41. Osteosarcoma

42. Osteosarcoma
Osteosarcoma

43. Osteosarcoma

45. Osteosarcoma: Lung mets

46. Microscopy
Proliferating malignant spindle- cell stroma
Osteoid or immature bone

47. Osteosarcoma

48. Osteosarcoma

49. III. Tumors of Other or Unknown Histogenesis
Ewing’s sarcoma
Giant Cell Tumor

50. Ewing's Sarcoma A malignant, small, round-cell tumor of bone
Composed of uniform, densely packed, tumor cells with round nuclei and indistinct cellular borders
The histogenesis of Ewing's sarcoma remains controversial

51. The most common presenting symptom of Ewing's sarcoma is bone pain,
Mainly in children
second decade of life
average age of years
Male/Female : 2/1
The most common presenting symptom of Ewing's sarcoma is bone pain,
swelling, tenderness, and heat in the affected part, slight fever, and elevated erythrocyte sedimentation rate, which all together may mimic osteomyelitis.

52. Ewing's sarcoma may occur in any bone but most frequently involves long bones.
Femur (27%), pelvic bones (18%), tibia and fibula (17%), humerus (10%), scapula (6%).
Radiology:
A mottled "moth eaten" destructive lesion in the diaphysis
periosteal reactive new bone
sometimes formed in concentric layers and producing an "onion skin" appearance, and often accompanied by a soft-tissue mass.

53. Ewing's sarcoma

54. Microscopically,
uniform, densely packed, tumor cells with a single, round or oval nucleus, indistinct cellular borders, and a size and appearance somewhat resembling lymphocytes (small round blue cells).
The tumor cell cytoplasm characteristically contains PAS-positive glycogen granules.
The tumor cells grow in sheets, sometimes with central necrosis, but without pattern, such as the rosettes typically formed by metastatic neuroblastoma.

56. Giant Cell Tumor An aggressive benign tumor Composed of :
well vascularized stroma
plump, spindly, and oval tumor cells
multinucleated tumor giant cells
Over the age of 20:
most commonly in the third decade of life
slight female preponderance

57. The skeletal location:
50% of cases occur near the knee
most commonly in the distal end of the femur or the upper end of the tibia.
The x-ray picture :
Large, eccentric, oval,
Radioluscent destructive lesion centered in the epiphysis,
Cortical erosion and thinning,
Expanding the bone contours without a border.

58. Giant Cell Tumor

59. Giant Cell Tumor

61. 1. plump, spindly, and oval stromal cells
Microscopy:
1. plump, spindly, and oval stromal cells
2. multinucleated tumor giant cells which are formed by fusion of the stromal cells
Differential diagnosis:
reparative granulomas
brown tumors of hyperparathyroidism
the lytic phase of Paget's disease
aneurysmal bone cyst

63. IV. Miscellaneous Tumors and Tumor-like Lesions of Bone
Multiple Myeloma
Chordoma
Myositis Ossificans

64. Multiple Myeloma Multiple myeloma is a malignant tumor of plasma cells
Characterized by
multiple lytic destructive lesions of bone,
immunoglobulin abnormalities (monoclonal gammopathy),
bone marrow failure,
recurrent infections,
hypercalcemia,
amyloid deposits,
renal insufficiency.

65. Over 40 years of age and with an average age of 60 years.
Multiple myeloma most often involves the vertebral column, ribs, and skull although virtually any, or all, bones can be affected.
The most common symptom is bone pain,
Other symptoms
bone marrow failure (anemia, bleeding),
recurrent infections,
serum hyperviscosity,
hypercalcemia,
renal failure of multifactorial pathogenesis (myeloma nephropathy, associated amyloidosis, nephrocalcinosis).

66. Radiology: Skull, ribs, or other affected bones
Multiple lytic "punched out" lesions.
Osteopenia/Osteoporosis

67. Multiple Myeloma

68. Microscopy: Bone marrow. Plasma cell tumor:
an eccentric, round, hyperchromatic nucleus sometimes with a "cartwheel" distribution of chromatin
frequent double or triple nuclei,
abundance of cytoplasm with a purple (basophilic) color and an occasional perinuclear "halo",
distinct cell borders.

69. Multiple Myeloma

70. Chordoma A malignant tumor of the notochord
Arises towards either end of the vertebral column, most often in the sacrococcygeal region but also in the spheno-occipital region.
Fifth to eighth decades of life,
average age : 50 years
slight female preponderance.

71. Clinical x-rays : Pathology large soft tissue mass
lytic destruction of the sacrococcygeal bone.
Pathology
Grossly,
large, soft, lobulated, gelatinous tumor
extends from the sacrum and expanding into the pelvic cavity.
Microscopically,
large and vacuolated, so-called physaliferous (bubbly/drop-like) cells.

72. Chordoma

73. Myositis Ossificans A nonneoplastic tumor-like lesion
Trauma to skeletal muscle  hemorrhage  distrophic calcification  heterotropic ossification
It must be distinguished from extraosseous osteogenic sarcoma.
Clinical x-rays:
peripherally calcifying (ossifying) lesion located in the soft tissues or next to bone.

74. Microscopically, newly formed bone
matures toward the periphery of the lesion,
whereas the center or interior of the lesion is cellular and poorly differentiated.
The presence of peripheral maturity and central immaturity of the lesion is called "zoning phenomenon" and is characteristic of myositis ossificans but lacking in osteogenic sarcoma.

75. Myositis Ossificans

76. Joint Tumors Synovial tumors Benign tumors Malignant tumors
Tenosynovial giant cell tumor
Localized tenosynovial giant cell tumor
Diffuse tenosynovial giant cell tumor (extraarticular pigmented villonodular synovitis, florid tenosynovitis)
Malignant tumors
Synovial sarcoma
Biphasic (fibrous and epithelial) synovial sarcoma
Monophasic (fibrous or epithelial) synovial sarcoma
Malignant giant cell tumor of tendon sheath

77. Misdiagnose  benign tumor
8-10% of all sarcomas
All ages
Location:
extremities
especially the lower extremities around the knees
Misdiagnose  benign tumor
small size, slow growth, and well-defined appearance

78. Synovial sarcoma in the anterior left upper thigh and/or inguinal region