6. GIANT CELL TUMOR
Age: 20-40.
Epiphyseometaphyseal in adults -
Metaphyseal in adolescents.
Common location: around knee (50%),
distal radius
Xray: Geographic lytic lesion, thinned &
ballooned out cortex.
Gross pathology:
Large red - grey - brown tumor
Soft & friable
Areas of cystic degeneration / necrosis &
blood filled cavities
7. HISTOPATHOLOGY:
•Uniform oval mononuclear stromal
cells : mesenchymal origin; neoplastic
•Appear to grow in a syncytium
•Numerous osteoclast-type giant
cells: reactive
•Necrosis, hemorrhage, hemosiderin
deposition and reactive bone
formation
•Relatively few mitotic figures in
relation to the dense cellularity of the
tumor
8. GIANT CELL VARIANTS
Includes the tumors which show giant cells in histology-
A. ABC
B. Brown tumor
C. Chondromyxoid fibroma, chondroblastoma
D. Desmoplastic fibroma
E. Epulis – Giant cell reparative granuloma
F. Fibrous dysplasia, non ossifying fibroma
G. Giant cell rich osteosarcoma
H. Benign fibrous histiocytoma
10. OSTEOSARCOMA
Bimodal age distribution: Primary 10-20, secondary 50-70.
75% around knee
Bone forming tumor arising from bone
Several subtypes –
By location (Central or Juxtacortical)
Multicentricity
Degree of differentiation: well to dedifferentiated
Histologic variance:
osteoblastic/chondroblastic/fibroblastic/telangictatic/small cell
Associated with Retinoblastoma (rb gene), Li Fraumeni
syndrome (p53 gene), Rothmund Thomsen syndrome.
11. GROSS PATHOLOGY:
Metaphyseal
Tan-white solid tumor fills
most of the medullary cavity
of the metaphysis and
proximal diaphysis
Expanding & infiltrating
through the cortex, lifts the
periosteum (Codman’s
triangle) and forms soft tissue
masses on the side of the bone
Areas of hemorrhage and
central necrosis.
12. HISTOPATHOLOGY:
Pleomorphic and anaplastic cell
population- large hyperchromatic
nuclei, mitotic figures
Abundant fibrous/ chondroid
matrix
Formation of pink homogenous
osteoid by neoplastic cell:
characteristic.
The neoplastic bone has a coarse,
lacelike architecture but is also
deposited in broad sheets or as
primitive trabeculae.
Osteoblastic, chondroblastic or
fibroblastic types
Osteoclast-like giant cells may
be present
13. CHONDROSARCOMA
Age: 30-60
Primary or Secondary ( Enchondromatosis [Ollier 50%,
Maffucci 100%], diaphyseal aclasis 20%, osteochondroma 0.25%)
Pelvis (30%), Femur (20%)
Types: Conventional, mesenchymal, clear cell,
juxtacotical, dedifferentiated
Most common malignant bone tumor of hand
14. GROSS PATHOLOGY:
Large bulky tumor
Made up of lobules of gray-white
/somewhat translucent glistening tissue.
Tumor permeating throughout the
medullary cavity, growing through the
cortex, and forming a relatively well-
circumscribed soft tissue mass.
At center – necrotic/liquefied/cystic.
Gelatinous appearance secondary to
myxoid changes in matrix.
May show calcification.
The adjacent cortex is thickened or
eroded, and the tumor grows with broad
pushing fronts into the surrounding soft
tissue.
15. HISTOPATHOLOGY:
• Tumor cells produce
cartilaginous matrix; well,
moderate or poorly
differentiated.
• May have only minor or
focal atypia
• Intracytoplasmic hyaline
globules common in low
grade tumors
16. EWING’S SARCOMA
James Ewing 1921
GROSS PATHOLOGY:
Diaphyseal in long bones;
also pelvis, rib, scapula
White tan grey mass like
brain; or red like red currant
gelly if hemorrhagic
With necrosis & hemorrhage
Cortical destruction
Invasion to soft tissue
around, no capsule
17. HISTOPATHOLOGY:
• Homogenous & densly
packed undifferentiated
small round blue cells like
lymphocytes; regular nuclei,
infrequent mitoses, scant
clear cytoplasm.
• Abundant glycogen: PAS +
diastase digestible
• Rare Homer- Wright
pseudorosettes (7-8 tumor
cells arranged in a circle
about a central fibrillary
space)
19. OSTEOCHONDROMA
GROSS PATHOLOGY:
Mushroom shaped
Cartilage-capped bony outgrowth
Cartilage cap usually regular and
thin
Sessile / Pedunculated
Pedunculated : attached to skeleton
by bony stalk; medullary cavity of
the osteochondroma and bone are
in continuity
Diaphyseal aclasis: multiple
heriditary exostosis
Trevor’s disease: Epiphyseal side
osteochondroma
20.
21. Painful osteochondroma:
Fracture
Bursitis
Malignant transformation: fluffy calcification in the
cartilage cap, thickness of cartilage cap > 1 cm.
22. CHRONIC OSTEOMYELITIS
Sequestrum is the necrotic
bone that is embedded in the
pus/infected granulation
tissue.
Involucrum is the new bone
laid down by the periosteum
that surrounds the sequestra.
Cloaca is the opening in the
involucrum through which
pus & sequestra make their
way out.
23. Types of sequestrum…..
Tubular: long bone
Annular: amputation stump
Ring: around pin tracts
Flake, coke, rice grain: tubercular
Button: histiocytosis
Feathery: syphilis
Match stick: sickle cell
Coloured: fungal
Black: gun shot
Bombay: exposed bone after open fracture
24. TUBERCULAR SPONDYLITIS (POTT’S)
SPINE
Paradiscal
Loss of height
of vertebra
Caseating
necrotic tissue
Bone necrosis;
sequestra
Sclerosis
28. • Granulomatous fungal disease; involve subcutaneous tissue
after traumatic inoculation; later spread to deep structures.
• Causes local tissue destruction including bone
Types:
• Actinmycetoma: Actinomadura sps, Nocardia
• Eumycetoma: Aspergillus sps,
• Discharge colored granules: Red (Actinomadura pelletieri),
white / yellow (Actinomadura madurae, Pseudoallescheria
boydii), black (Exophiala jeanselmei, Madurella mycematis)
• Pus contains sulfur granules, a tangled mass of branching
bacteria (Splendore Hoppelli body)