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Classification of Primary Bone Tumors

Predominant cell
Histological type

Form

Benign

Malignant

Osteoblast

Bone forming tumors, show active ossification

- Osteoid osteoma
- Osteoblastoma

- Osteosarcoma
 

Chondroblast

Chondrogenic, i.e. show active cartilage formation

Osteochondroma
Chondroma Chondroblastoma
Chondromyxoid fibromaQ

Chondrosarcoma

Fibroblast

Fibrogenic i.e. show active collagen formation.

- Non ossifying fibroma (fibrous cortical defect)
- Fibrous dysplasia
- Metaphyseal fibrous defect (fibroma)

- Desmoplastic fibroma
- Fibrosarcoma

Histiocytic

- Fibrous histiocytoma

Malignant fibrous histiocytoma

Osteoclast (Uncertain)

Osteoclast arises from coalescence of stromal cell, which is of non-bone forming connective tissue origin. Tumor show lytic bone lesions.

- Osteoclastoma
- Aneurysmal bone cyst
- Admantinoma

Malignant osteoclastoma

Notochordal remnants

 

-

Chordoma

Hematopoietic (40%) arising from bone marrow

- Multiple myeloma is malignant B- cell lymphoproliferative disorder of marrow with plasma cell predominating
- Ewing’s sarcoma arise from endothelial cells in bone marrow
- Like Ewing’s , reticulum cell sarcoma is round cell tumor of reticulo- endothelial system.

 

- Multiple myeloma (plasmacytoma)
- Reticulum cell sarcoma (non-Hodgkin’s lymphoma)
- Malignant Hodgkin’s lymphoma
- Ewing’s sarcoma
- Lymphosarcoma

 

Diagnosis of bone tumor depends on:

  • Site
  • Location in bone
    • Diaphysis
    • Metaphysis
    • Epiphysis
  • Type of destruction
    • Geographic bone destruction
    • Moth eaten bone destruction
    • Permeative bone destruction
  • Amount of reactive bone formation
  • Matrix of tumor:bony,chondroid,fibrous

 

Most Common Site of Primary Bone Tumors

  1. Epiphyseal
    1. Chondroblastoma (before physeal closure)
    2. Osteoclastom/Giant cell tumor (after physeal closure in adults)
    3. Articular osteochondroma
  2. Metaphyseal
    1. Chondrosarcoma
    2. Enchondroma
    3. Osteochondroma
    4. Osteoblastoma
    5. Bone cyst
    6. Osteosarcorna
    7. Osteoclastoma (in children)
    8. Osteomyelitis mostly starts in metaphysi
  3. Diaphyseal
    1. Round cell lesions: Ewing’s sarcoma/Multiple myeloma /Reticulum cell sarcoma
    2. Admantinoma
    3. Osteoid osteoma

 

Bone Tumor

Most Common Site

Unicameral/Solitary/Simple Bone cyst

Metaphysis of proximal humerus > femur

Aneurysmal Bone cyst

Lower Limb

Enchondroma

Metaphysis of small bones of hands (& feet)

Osteochondroma (Exostosis, m.c. benign bone tumor)

Distal femur > upper tibia > proximal humerus

Osteoid osteoma

Femur> tibia (diaphysis)

Osteosarcoma

Distal femur > Upper tibia (metaphysis)

Ewing’s sarcoma

Femur> Tibia (diaphysis)

Fibrous dysplasia

Upper end femur (22%) > Tibia (21%) > lower femur (12%)

Chordroma

Sacrum (most comnmon) > sphenooccipital region (clivus)> anterior vertebral body i.e. involves only axial skeleton

Ivory osteoma or compact or Eburnated Osteoma

Frontal sinus

Adamantinoma

Tibia (MC lone bone)

Multiple myeloma

Vertebrae

 

Age predilection

 

Tumor

Age Range years)

Ewing’s tumor

5-15

Non ossifying fibroma
Simple (unicameral) bone cyst

2-20

Aneurysmal bone cyst

5-20

Osteogenic sarcoma

10-20

Osteoclastoma (GCT)

20-40

Multiple myeloma
Metastasis

> 40

 

 

  a.   

b.   

c. 

 

 

a.Benign geographic

b. Likely malignant moth eaten

c. Aggressive Permeative

A. 

B. 

C.

D.

  1. Solid: Osteoid Osteoma
  2. Sunburst: Osteosarcoma
  3. Onion skin Ewings
  4. Codman triangle: Osteosarcoma

DON’T TOUCH LESION (Features are so suggestive of beginin disease that these lesion should not undergo biopsy)

A.

B.

C.

  1. Healing NOF (non osifying fibroma)
  2. Fibrous cortical defect
  3. CMF (Chrondro myxoid firboma)





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