Property of Department of Orthopaedics, Faculty of Medicine, University of Zagazig

1. Bone TumorsBone Tumors

2. Long Bones:
Description
• Epiphysis
• Metaphysis
• Diaphysis
• Metaphysis
• Epiphysis

3. Long Bones: Description
• Bone
– Periostium
– Cortical bone
– Cancelleous bone
• Medullary cavity (CANAL)
• Bone marrow
• Blood supply
• Nerve supply

4. Bones: Structure
• Organic
– Cells
– Collagen
– Mucopolysaccharides
– Water
• Inorganic
– Mineral-based components

5. Bone cells: Tissues
• Bony
– Osteoblasts
– Osteoclasts
– Osteocytes
• Cartilaginous
- chondroblasts
- chondrocytes
• Fibrous
- Fibroblasts
- fibrocytes

6. Classification:
Benign:
Osteoma.
Osteoid osteoma.
Osteochondroma
Chondroma.
Benign giant-cell tumors.
Malignant :
Osteosarcoma.
Chondrosarcoma.
Malignant giant-cell tumors.
Fibrosarcoma.
Ewing's Tumor.
Reticulum-cell sarcoma.
Plasma cell tumor or multiple myeloma.
Metastatic tumors.

7. Tissue of origin: Bone , Cartilage, Fibrous Others.
Benign Malignant
Bone - Osteoma - Osteosarcoma
- Osteoblastoma
Cartilage - Chondroma - Chondrosarcoma
- Chondroblastoma
- Osteochondroma
- chondromyxoid fibroms
Fibrous Fibroma Fibrosarcoma
Others GCT? Ewing’s
Myeloma

8. Tumour-like conditions of bone
• Bone cysts
– Simple bone cyst
– Aneurysmal bone cyst
• Fibrous-osseous lesions
– Fibrous dysplasia
• Eosinophilic granuloma (Langerhans histiocytosis)
• Osteochondroma - ?hamartoma

9. OSTEOMA
IVORY
OSTEOMA

10. It arises from membranous bone of Skull .
Small
Sessile
Smooth surface
Slowly growing
Simulating ivory (Compact & dense bone)
6.S

11. OSTEOMA
• Benign, Often craniofacial in location
• Hamartomatous / reactive not true tumor.
• Histologically are woven and lamellar
bone (closely resemble normal bone).
• Never turn malignant .
• Gardner Syndrome: multiple, Osteoma,
osteochondroma, GIT polyps, skin tumors.
Autosomal Dominant, Colon Cancer.

12. IVORY OSTEOMA
Sites:
Outer table of Skull
disfigurement
Inner table  pressure
on brain
Orbit  interfere with
eye movements
Paranasal sinus 
sinusitis
Auditory meatus 
prevent hearing
Neck of mandible 
interfere with jaw
movements
Treatment : Excision
biopsy.

13. Osteoma Lateral radiograph of the skull (a) and axial CT scan (b)
demonstrate an ossific nodule (arrow) arising from the outer table of
the skull

14. Benign painful
lesion arises from
osteoid
mesenchyme
Reparative bone
lesion ? .
Age: 10-30 Ys
Site : Long
bones( shaft of femur,
tibia ) [every bone
expect mandible].
Pain
Few months
duration
↑ by night
Nagging ( like
toothache)
Referred to
neighboring joint
Relieved by
salicylate.

15. Examination:Localized tenderness –
palpable thickening of a superficial bone
like tibia
X-ray :
• Radiolucent area;
• Circumscribed.
• In one side of cortex.
• ˂ 1 cm in diameter.
• Surrounded by dense bone
sclerosis .
• Nidus (small dense shadow
of calcified Osteoid) inside
tumor.

16. OSTEOID OSTEOMA
MACROSCOPICALLY

17. Radiographic Features

19. Nidus

21. D . D
Sclerosing Ch. O.M of Garre
Benign Bone cyst.
Brodie’s absces
Osteogenic sarcoma
Eosinophilic granuloma
Ewing’s sarcoma
Non ossifying fibroma
N.E: Nodule: Reddish; firm; small.
M.E: Vascular osteoblastic tissue -
uncalcified matrix - central calcified area

23. Treatment :
= surgical excision after
exact radiographic
localization.
= Radiofrequency ablation

24. OSTEOBLASTOMA
• Clinically similar to osteoid osteoma
(large)
• Also known as giant osteoid osteoma.
• Common location -- vertebral column
• Histology similar – but rare nidus.
• Can be locally aggressive
• Therapy - curettage/resection with bone
graft.

26. T. derived from cartilage forming
C.T. ( chonroid + myxoid ).
Age: < 20 Ys.
Site: metaphysis of long bones.
S&S: mild pain & mass.
X-ray : Eccentric well demarcated;
radiotranslucent lesion.
Surrounded with slight sclerosis.

28. N.E: Rubbery tissue (not
mucinous); Whitish; Firm.
M.E:
Cells: Stellate,
spindle shaped.
Matrix: Fibrous
& chondroid.
Treatment
Curettage
& bone
grafting.

29. Osteochondroma

30. OSTEOCHONDROMA
(osteo-cartilagenous exostosis)
The commonest
B.T
Pedunculated
[ cartilage-capped
exostosis]
Sessile

31. Pedunculated
[ cartilage-
capped
exostosis]
Sessile

32. • Age: 10-25 Ys
• Site:
Metaphysis of
long bones.
• S & S: Painless
swelling
Origin ?:
Displaced
part of the
epiphyseal
cartilage
Perverted
activity of
periosteum.

33. •Osteochondromas are mushroom shaped and range in size from 1 to 20 cm.
•The outer layerouter layer of the head of the osteochondroma is composed of benign
hyaline cartilage varying in thickness
•Newly formed bone forms the inner portioninner portion of the head and stalk, with the
stalk cortex merging with the cortex of the host bone.

34. Pain may be due to:
Pressure on Nerve;
Tendon, muscle
Adventious bursitis
Fr. Of the stalk
Malignant changes

35. OSTEOCHONDROMA
Bony swelling;
Well defined
Over the
surface of the
bone
Continuous
with the outer
cortex of the
mother bone
A cauliflower
mass
X-ray:

36. OSTEOCHONDROMA
N.E:
Stalk; of cortical
& cancellous
bone
Cap; of growing
cartilage
Base; directed
away from
epiphysis
Base
Cap
Stalk

37. OSTEOCHONDROMA

39. Osteochondroma

40. Osteochondroma:

41. OsteochondromaOsteochondroma
A cauliflower massA cauliflower mass

42. Complications:
1. Sarcomatous changes ( chondrosarcoma):
Pain
Rapid growth
Invasion of the mother bone
Recurrence after excision.
2. Fracture of the Pedunculated Osteochondroma
3. Bursitis
4. Compression of Nerve
5. Hitching of a tendon
6. Bony block to the joint

43. Treatment:
Excision & Biopsy
non symptomatizing tumors may
be left alone and observed by
repeated clinical and radiological
examination.

45. Osteochondroma microscopy:Osteochondroma microscopy:

46. 2-Hereditary or multiple
Osteochondroma (Metaphyseal
Aclasis):
It is a developmental disease of bone commonly affecting
the bones of the forearm and leg. The bones may be
deformed with irregular broad ends and the stature may
be stunted. Only those tumors causing; pain or
dysfunction are removed.
Malignant change is liable to occur (5-15%).
The three characteristic features of the disease are:
Multiple osteochondromata
Stunted stature.
Lack of remodeling of the metaphysis.

47. PedunculatedSessile
OSTEOCHONDROMA

48. Multiple Hereditary
Exostosis

49. ChondromChondrom
aa

50. B.T of cartilage tissue.
Age: 10- 50 Ys.
Site: Short bones of hands
& feet.
Metaphysis of long bones
Ribs, pelvic bone & scapula.
S &S : Swelling , mild pain ±
Path. Fr.
CHONDROMA

51. X-ray: Well defined
radiotransclucent area
Enchondroma
(centrally situated)
→ little or no
expansion
Ecchondroma
(eccentric growth)
→ cortical
expansion EnchondromaEcchondroma

52. Enchondroma

53. Ecchondroma

55. • N.E:
Bluish white
Circumscribed
Gritty feeling.
• M.E:
lobules of hyaline cartilage
+ fibrous partitions
± areas of calcifications; ossification
& mucoid degeneration

56. Pathological fracture
Sarcomatous
change (Long
bones & Flat
bones)
Rapid growth
Pain
Recurrence after
excision

57. •Curettage
•+ Bone Graft

58. Multiple chondromatosis
Failure of remodeling
Unilateral dwarfism
Deformities

60. Multiple
chondromatosis
Multiple soft
tissue
haemangioma

62. Uncommon T.
Chondroblastoma is
a benign neoplasm
arising from
immature,
cartilaginous cells
(chondroblasts).
Epiphysial

63. Origin: chondroblast
Age : 10 – 20 Ys.
MaleFemale; 3:1
Site: epiphysis ( Around
knee, upper humerus,
upper femur)
Clinical Picture.
1. Joint pain , stiffness.
2. Swelling & effusion.
3. Limping.

64. • An epiphyseal
oval or rounded
area of
radiotranslucency.
• Flecks of
calcification.
• Thin overlying
cortex.
X-ray

65. Pathology
N.E:
Brownish,
sand-like
and gritty
lesion.
N.E

66. M.E: Rounded
or polyhedral
chondroblasts. +
scattered giant
cells
+{ Area of focal
necrosis and
calcification }.
M.E

67. D.D :
Giant cell tumor
Chondroma
Chondrosarcoma .
Treatment:
Curettage + bone
graft.

70. CT Scan
`MRI
Femoral head

72. Radiograph of epiphyseal lesion (hip).

73. Giant cell tumorGiant cell tumor
(Osteoclastoma(Osteoclastoma))

74. Pathology
Incidence:
age --- between 20 and 30 Years.
Site ---originates in the fused epiphysis and involves the
metaphysis by extension.
Commonest sites are the lower end of the femur,
upper end of the tibia and lower end of the
radius. It may also occur in other bones, as the humerus, the
ulna, the fibula and occasionally in the small bones of the hands and
feet.
This bone tumor is composed of a fibroblastic stroma and
multi-nucleated giant cells.

75. Gross appearance:
The tumor causes expansion of the bone and the cortex is
greatly thinned out. Bone trabeculae may be left behind and
these give the tumor the soap bubble appearance in the X-
ray film. The cut section shows a soft dark red, hemorrhagic
mass causing expansion of the end of the bone.
Microscopic appearance:
Two types of cells are encountered:
Spindle shaped or oval cells which are the basic
tumor cells.
Multinucleated giant cells of the osteoclastic
type. In determining the degree of malignancy
more attention must be paid to the stromal cells
and not the giant cells.

77. Pathological types: 3 grades of the tumor can be
identified,
grade I tumors have a benign course (98%),
grade III tumors are frankly malignant whereas
grade II tumors show an intermediate.
Malignant tumors are characterized by frequent
mitosis and predominance of anaplastic cells,
whereas in benign tumors mitosis is infrequent and
numerous giant cells are observed.

78. Clinical Features:
•The common feature is a dull aching pain
over the affected site, associated with the
appearance of slowly growing tumor of the
extreme end of the bone,
•IN big Tumor egg-shell crackling may be
detected over it. The nearby joint may be
painful, limited mobility and with effusion
•The patient may present with a pathological
fracture and this may be the result of trivial
trauma..

79. Expansion of the extreme end of the bone.
(At the fused epiphysis).
1. Soap bubble appearance.
2. The joint line is not invaded except very
late
3. Sharp limitation of the tumor from the
surrounding bone and soft tissues. There is
always some sclerosis between the tumor and
the shaft (operculum or medullary plug).
4. Pathological fracture is a frequent
radiological finding.
X-ray features:

82. Giant cell T. Chondroblastoma
Age <20Ys 10–20Ys
X-ray -Large translucent area
– in fused epiphysis.
-No calcification or
Ossification
-Extends to metaphysis
-Small translucent area.
-Areas of ossification
M.E -Spindle cell Stroma
–many Giant cells
-Polyhedral cells + focal
necrosis & calcification +
-few giant cells
Behavior Aggressive Benign

83. •For definitive diagnosis and
•For grading the tumor.
•The neoplastic part of the
tumor is the mesenchymal cells
rather than the giant cell element.
Biopsy:

84. Treatment:
•Benign Tumors:
i.Resection if not disturbing the function of the part, e.g.
tumor of the fibula.
ii. If the tumor is found in a main bone it is treated by
curettage and bone grafting.
iii.This form of treatment carries the risk of recurrence in 40%.
If recurrence occurs, biopsy is performed again, if malignancy
is found the bone is resected and replaced by an allograft or
synthetic prosthesis.
•Malignant Tumors: Whether primary or secondary
they should be treated by amputation.
•Inaccessible Tumors: Such as tumors of the spine
are treated by irradiation.

86. OsteosarcomaOsteosarcoma

87. •This is the most common and
most malignant bone tumor.
•Age -- between 10-20 years
-- after the age of 50 years, it
may occur on top of Paget's
disease )
•Site in bone : in the metaphysis,
•bones affected in order of
frequency are the femur, tibia,
humerus, pelvis and fibula.

88. Pathology:
Predisposing factors:
Trauma; although a history of trauma is common there
is no proof that trauma predisposes to bone sarcoma.
The tumor was found common in children exposed to
radio-active materials.

89. Gross appearance:
At first the disease is confined to the bone giving rise to a
fusiform mass which gradually fades into the shaft.
The consistency of the tumor varies as there is bone
formation as well as bone destruction. Therefore, the
mass may be soft in areas, while it is firm or hard in other
areas.
The usual colour is grey but owing to a great liability to
haemorrhage, necrosis and cystic formation, the colour varies
much.
The periosteum is raised . Deposition of fine specules of
bone around the stretched blood vessels between the raised
periosteum and the cortex gives the characteristic Sun Ray
Appearance in the x-ray. In late cases the periosteum is
invaded and the soft tissues are infiltrated.

92. Microscopic appearance:
The characteristic appearance is pleomorphism, the cells vary
widely, some are spindle shaped or spheroidal and giant cells
are frequent.
The stroma also varies widely; it may be hyaline and fibrous,
cartilagenous, myxomatous, osteoid or osseous.
The nature of the stroma may give different names to the
tumor, thus it may be called osteolytic when bone formation is
scanty or absent, sclerosing when bone formation is great and
telangiectatic when it is greatly vascular.
The blood vessels of an osteogenic sarcoma are thin walled,
and ill developed and in. some areas tumor cells form the walls
of blood sinuses and this explains the early spread by the blood
stream.

94. Clinical Features:
Pain:
Pain is the initial complaint and usually precedes the
appearance of the swelling by weeks or months it is due to
early involvement of the periosteum as usually there is a history
of trauma which precipitates the discomfort, although in some
cases the pain comes gradually and there is no relation to
trauma.
Swelling:
There is a tender fusiform mass arising at the region of the
metaphysis and gradually fading into the shaft. The swelling
increases rapidly in size with marked deterioration in general
health. The mass usually feels warm, there may be dilated
veins on the surface and some sympathetic effusion in nearby
joint.

96. Diagnosis: x-ray:
Bone destruction which starts in the medulla of the metaphyseal
part of the bone and then affects the cortex.
a. Irregular bone formation which may be in the form of Sun Rays.
Subperiosteal deposition at the angle between the raised periosteum
and the shaft (Codmann's triangle), or scattered areas of new bone.
b. Soft tissue mass due to early extra osseous extension of the
tumor.
c. The epiphyseal plate resists the invasion by the tumor.
d. Pathological fracture may be seen in the osteolytic variety; bone
destruction is the main feature while bone formation is scanty or
absent. However, the shadow of the shaft (Ghost of the bone) can
always be seen inside the tumor.
Open biopsy: Confirms the diagnosis

99. Management:
The classic treatment: which was applied for many years
ago, was the complete amputation. As the tumor always
infilterates along the medulla of the bone, the whole bone
affected should be amputated. For example, above knee
amputation should be done for tumor affecting the upper
end of tibia.
The recent approach for management : Done in 3 steps
Neo-adjuvant chemotherapy : pre-operative chemotherapy.
Operation : done as a salvage procedure , as the complete
excision of the lesion only or radical excision of the
compartment containing the tumor . Followed by
reconstructive procedures like replacement of the removed
part by bone graft.
Adjuvant chemotherapy: Post-operative chemotherapy

100. Prognosis:
-- extremely grave,
-- survival period is not more than 12 months
This is due to early invasion of the blood vessels
and the development of pulmonary metastases. At
the time the tumor is diagnosed, tumor cells are
growing and the lung is usually affected, even if a
chest radiogram appears normal.
-- The 5 y. survival rate is about 20%,
-- it may increase to 60% after amputation.
--- recently survival rate improved to 70 %

101. CHONDROSARCOMACHONDROSARCOMA

102. It is a slowly growing tumor arising from
chondroblasts.
It is usually of 2 types:
Primary chondrosarcoma: usually occurs
between the ages of 30-60 y.
Secondary chondrosarcoma: which arises 2ry
to a pre-existing chondroma.
Chondrosarcoma is common in pelvis, and in bones
developed from cartilage. But it may also affect long
bones (in metaphysis).

104. Clinically:Clinically:
It presents with dull aching pain associated with the
development of a slowly growing swelling usually firm and not
tender.
In the X-ray film the tumor appears as a large area of
translucency with scattered spots of calcification and a varying
degree of destruction of the cortex.
Metastases to distant sites particularly to the lungs occur later
than in the case with most other bone sarcomas.
Treatment:Treatment:
Complete local excision. Amputation may be needed for
tumors of the limbs especially if big or if they recur after local
excision.

106. Ewing's TumourEwing's Tumour

107. This forms about 10% of all malignant bone tumors.
between the ages of 5 and 15 years.
History of trauma is common.
Pain, fever and tender swelling follow and the condition may be
easily mistaken for osteomyelitis for the following reasons:
1. General constitutional disturbances.
2. The severe pain and local tenderness.
3. The rapid appearance of the swelling which may be
warm as in osteomyelitis.
4. The occasional appearance of leucocytes. A soft
necrotic cellular material is obtained by biopsy and the
pathologist may even mistake it for pus.

108. The following points may help the diagnosis:
A very high leucocytic count is in favour of
osteomyelitis.
Osteomyelitis usually responds rapidly to antibiotic
therapy.
Ewing tumor responds quickly to irradiation but
recurs rapidly.

109. Gross Appearance:
Bones affected are tibia, humerus, femur, iliac bone
but no bone is exempt.
It affects the metaphysis and also the diaphysis.
The tumor is formed of necrotic brain like material
which invades the bone and leads to bone destruction
and formation of successive layers of new bone giving
rise to the characteristic Onion Peal Appearance in the
X-ray.
New bone formation may also obliterate the medullary
cavity and for this reason pathological fracture is rare.

112. Microscopic Appearance:
It is a round cell sarcoma
arranged in columns or
sheets
but may be grouped around
blood vessels and give rise
to an angiotheliomatous
appearance.

114. Spread of the tumor:
Local in the bone both longitudinally and
transversely, the bony canals are full of
tumor cells.
Blood spread to lungs and other bones. It
is the only bone tumor which gives
secondaries in bones. (Multiple myeloma
is generalized from the start).
Lymphatic spread to the local lymph
nodes.

115. Treatment:
•The accepted treatment is irradiation &
• chemotherapy followed by
amputation.
•Although it is highly sensitive
recurrence is the title and the prognosis
is bad.
•Combination of radiation and multiple
drug chemotherapy has improved the 5
years survival rate to 60%.

116. Multiple MyelomaMultiple Myeloma

117. This is a diffuse tumor of the whole skeleton
arising in the bone marrow and its cells may
resemble plasma cells.
Occasionally a solitary myeloma is described.
The tumor is characterized by over-production of
monoclonal immunoglobulins, which are excreted in
urine as Bence Jones protein. And forms myloma
band in plasma elctrophoresis

119. Clinical Features:
Common between 40 and 60 years of age
and more frequent in males.
General weakness, weight loss and
backache.
Tenderness on palpation or percussion of the
affected bone.
Superficial bones may be felt tumefied.
A pathological fracture may be the first
presentation,

120. Radiological findings:
X-ray shows multiple punched out areas of radio-
translucency. These are common in the skull.
The diagnosis should be suspected when lytic
lesions are found in a patient with anaemia and
elevated sedimentation rate and elevated serum
Calcium.
Diagnosis
Serum and urine electrophoresis and
immunophoresis shows elevated M protein
(Immunoglobulins or Bence Jones protein).
Biopsy of bone marrow.

123. Treatment
Measures to relieve pain as rest and
sedatives.
General supportive measures as diet, Blood
transfusion and anabolic drugs.
Measures to control the growth of the tumor
as chemotherapy and radiotherapy.
Surgical fixation of pathological fractures to
improve quality of life.

124. Metastatic Carcinoma

125. Bone secondaries are more commonly seen than the primary
bone tumors .
•The skeleton is a common site for metastatic carcinoma.
•The common sites for the primary are the thyroid, the
breast, the lung, the kidney, the adrenal and the prostate.
•Secondaries commonly affect the skull, the sternum, the
spine the pelvic bones and the limbs above the knee and
elbow. They are very rare in the bones of the forearm, hand
and foot.
•Most of the secondaries are osteolytic in nature, but
secondaries from a prostatic carcinoma are usually
Osteosclerotic (Rarely the breast may give osteosclerotic
secondaries).

126. Clinical pictures:
Sometimes secondaries in bone may be the first presentation
of the primary which remains silent for a variable time.
Metastatic carcinoma in bones usually gives rise to anaemia,
bone pains, pathological fracture and sometimes bony
mass.
A mass is common with hypernephroma and thyroid
carcinoma .
Compression paraplegia may occur due to secondaries in the
spine.

127. Renal cell carcinoma

131. Investigations:
X-ray a secondary appears as a round well defined area of
radiotranslucency
Bone scan with 99m TcHDP, which is of a great value for
detection of the silent secondaries.
The Treatment: is palliative and may be in the form of
radiotherapy, hormonal therapy, antimitotic drugs or radioactive
isotopes according to the nature of the primary lesion.
Surgical fixation of a long bone is indicated when there is a
pathological fracture, and prophylactic fixation of long bones with
metastatic lesions is indicated when the lesion involves more than
half of the circumference or when the length of the tumor is
greater than the bone diameter .

132. FibrosarcomaFibrosarcoma
This is a rare malignant tumor of bone. The tumor is solid, firm
and whitish in colour and it may affect any bone. It may
occur in any part of the bone. The commonest sites are
the distal femur and proximal tibia and have two types:
Periosteal type: Develops from the periosteum and grows on
the surface. It causes erosion of the cortex producing a
concave defect in the bone and some reactive bone may
develop at the ends of the tumor.
Medullary or central type: Arises from the interior of the
bone causing bone destruction and without biopsy it is
difficult to diagnose.

133. Histological structure:
Similar to fibrosarcoma of the soft tissues with different
grades of differentiation.
Treatment:
Wide local excision may be sufficient for highly differentiated
tumors, but anaplastic tumors need amputation as the
recurrence rate after local excision is high. Irradiation and
chemotherapy are ineffective. The 5 years survival rate is 30-
35%.

134. BONE
CYSTS

135. Simple (Unicameral ) bone cyst.
Aneurysmal bone cyst.
Parathyroid osteodystrophy
(osteitis fibrosa cystica)
Hydatid cyst.

136. Simple (Unicameral ) Bone
cyst)
Unilocular fluid filled
cyst.
Age: <15 Ys. M > F
Site: Ends of long
bones abutting on
E.P.(active); away of
E.P. (latent).
S&S: Pain swelling
Pathological Fr.

137. Radiolucent
area
Oval;
Central
Metaphyseal
near E.P.
Thin cortex ±
Path. Fr.

139. Calcaneus

140. Treatment:
Curettage
&
Bone grafting

141. Tumor-like ; non pulsating
bone lesion.
The bone is expanded
(Ballooned).
Age: <20 Ys.
Site: Metaphysis of long bone.;
Vertebra ( arch & transverse
process).
S&S: pain & swelling.
Spine : signs of compression

142. An expansile cystic lesion
2nd
decade of life.
Any bone in the body.
Although benign, the ABC can be
locally aggressive and cause
extensive weakening of the bony
structure and impinge on
surrounding tissues.
ABC

143. • ABC is consisting of
blood-filled spaces
separated by
connective tissue
septa containing
trabeculae or osteoid
tissue and osteoclast
giant cells.
• Although benign, the
ABC can be a rapidly
growing and
destructive bone
lesion.

144. The expansile nature of the lesions
can cause:
Pain .
Swelling .
Deformity.
Disruption of growth plates.
Neurologic symptoms (depending on
its location).
Pathologic fracture.

145. X-ray : Eccentric;Expansile;
translucent area. Clearly defined
margin; sclerosed edge. Thin cortex

151. Aneurysmal Bone Cyst
• N.E: Cavity
filled with
few thin
shreds &
blood.

152. • M.E
• Fibroblastic
spindle cells
• + few giant cells
• Blood filled
spaces
M.E

153. Treatment
Curettage & Bone
grafting.
Prognosis:
Recurrence.

154. • Treatment:
Intralesional curettage; however,
recurrence is not uncommon.
En bloc resection
Selective arterial embolization.
Curettage with locally applied
adjuvants such as liquid nitrogen
or phenol.

155. FIBROUS DYSPLASIA
• Etiology is unknown.
• Dysplastic proliferation of fibrous
tissue & bone tissue in localized
area(s) of skeletal bone
• Three Types:
– monostotic,
– polyostotic,
– polyostotic with endocrinopathies.

156. Polyostotic with endocrinopathies
• 3 to 5% of cases
• café au lait spots and
precocious sexual development
(McCune-Albright syndrome)
• Associated with other
endocrine disorders.

157. Fibrous Dysplasia:

158. Fibro-osseous tissue – dysplastic

159. THANK YOU