MS, DNB, MNAMSASSISTANT PROFESSOR
MAMC & SUSHRUTA TRAUMA CENTERNEW DELHI
DESCRIBING GROSS SPECIMENA: Identify the part: Knee / prox.
femur/ prox. tibia/ pelvis /scapula. Epiphyseal / Metaphyseal /
Diaphyseal. Physeal plate visible? Immature pt.
B:Describe the abnormality: Nature: solid / soft & friable
/cystic / varigated Matrix: bony / cartilaginous / fibrous
Secondary changes: central necrosis/ hemorrhage
/ cystic change Cortical destruction, periosteal elevation
Intramedullary spread Tumor margin / capsule: well defined /
illdefined Extension: into soft tissue / joint; invasion /
infiltration to surrounding tissue
C: Give provisional diagnosis.
Age: 20-40. Epiphyseometaphyseal in adults -
Metaphyseal in adolescents. Common location: around knee
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
GIANT CELL TUMOR
HISTOPATHOLOGY:Uniform oval mononuclear stromalcells :
mesenchymal origin; neoplasticAppear to grow in a syncytium
Numerous osteoclast-type giant cells: reactive
Necrosis, hemorrhage, hemosiderindeposition and reactive
Relatively few mitotic figures in relation to the dense
cellularity of the tumor
GIANT CELL VARIANTSIncludes the tumors which show giant cells in
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
Physiological: MegakaryocytePathological Langhans : fused
epitheliod cells. Peripherally arranged 7-21 nuclei. TB,
histoplasmosis, sarcoidosis, other mycobacteria
Foreign body: fused macrophages. Numerous nuclei scattered in
Aschoff : Rheumatic heart disease Reed Sternberg: Hodgkins
lymphoma Touton : xanthoma, xanthogranuloma, dematofibroma Viral:
Warthin Finkeldy (measles), resp syncitial virus, parainfluenza
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)MulticentricityDegree of differentiation: well to
cell Associated with Retinoblastoma (rb gene), Li Fraumeni
syndrome (p53 gene), Rothmund Thomsen syndrome.
GROSS PATHOLOGY: Metaphyseal Tan-white solid tumor fills
most of the medullary cavity of the metaphysis and proximal
Expanding & infiltrating through the cortex, lifts the
periosteum (Codmans triangle) and forms soft tissue masses on the
side of the bone
Areas of hemorrhage and central necrosis.
HISTOPATHOLOGY: Pleomorphic and anaplastic cell
population- large hyperchromaticnuclei, mitotic figures
Abundant fibrous/ chondroidmatrix
Formation of pink homogenous osteoid by neoplastic cell:
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
Age: 30-60 Primary or Secondary ( Enchondromatosis [Ollier
Maffucci 100%], diaphyseal aclasis 20%, osteochondroma
Pelvis (30%), Femur (20%) Types: Conventional, mesenchymal,
juxtacotical, dedifferentiated Most common malignant bone tumor
GROSS PATHOLOGY: Large bulky tumor Made up of lobules of
/somewhat translucent glistening tissue. Tumor permeating
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.
HISTOPATHOLOGY: Tumor cells produce
cartilaginous matrix; well, moderate or poorly
May have only minor or focal atypia
Intracytoplasmic hyaline globules common in low grade tumors
EWINGS SARCOMAJames Ewing 1921GROSS PATHOLOGY: Diaphyseal in
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
around, no capsule
Homogenous & denslypacked undifferentiatedsmall round blue
cells likelymphocytes; regular nuclei, infrequent mitoses, scant
Abundant glycogen: PAS + diastase digestible
Rare Homer- Wright pseudorosettes (7-8 tumor cells arranged in a
circle about a central fibrillaryspace)
D/D : Small Round Cell Tumor Ewings: mic2 overexpression -
CD99/013 . t(11;22)(EWS-FLI-1). NSE + PNET (Primitive
neuroectodermal tumor): CD99/013. S100,
chromogranin, synaptophysin; > 20% Homer Wright rosettes
Lymphoma (reticulum cell sarcoma, NHL): CD 45, LCA Small cell
carcinoma: keratin, synaptophysin, chromogranin Mesenchymal
chondrosarcoma Neuroblastoma: neurofilament. S100, chromogranin,
synaptophysin. Alveolar rhabdomyosarcoma: actin, desmin, vimentin,
OSTEOCHONDROMAGROSS PATHOLOGY: Mushroom shaped Cartilage-capped
bony outgrowth Cartilage cap usually regular and
thin Sessile / Pedunculated Pedunculated : attached to
by bony stalk; medullary cavity of the osteochondroma and bone
are in continuity
Diaphyseal aclasis: multiple heriditary exostosis
Trevors disease: Epiphyseal side osteochondroma
Painful osteochondroma: Fracture Bursitis Malignant
transformation: fluffy calcification in the
cartilage cap, thickness of cartilage cap > 1 cm.
CHRONIC OSTEOMYELITIS Sequestrum is the necrotic
bone that is embedded in the pus/infected granulation
Involucrum is the new bone laid down by the periosteumthat
surrounds the sequestra.
Cloaca is the opening in the involucrum through which pus &
sequestra make their way out.
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
TUBERCULAR SPONDYLITIS (POTTS) SPINE
Paradiscal Loss of height
of vertebra Caseating
necrotic tissue Bone necrosis;
Kyphotic deformity Internal gibbus Severe cord compression
Granuloma or LH giant cell is notpathagnomonic of TB!
Foreign body granuloma. Fat necrosis. Fungal infections.
Sarcoidosis. Crohns disease.
MADURA FOOT Foot looks like tumor Multiple nodules &
Multiple circumscribed abcesses; extensive granulation tissue
Granulomatous fungal disease; involve subcutaneous tissue after
traumatic inoculation; later spread to deep structures.
Causes local tissue destruction including boneTypes:
Actinmycetoma: Actinomadura sps, Nocardia Eumycetoma: Aspergillus
Discharge colored granules: Red (Actinomadura pelletieri), white
/ yellow (Actinomadura madurae, Pseudoallescheriaboydii), black
(Exophiala jeanselmei, Madurella mycematis)
Pus contains sulfur granules, a tangled mass of branching
bacteria (Splendore Hoppelli body)
Slide Number 1DESCRIBING GROSS SPECIMENSlide Number 3Slide
Number 4Slide Number 5GIANT CELL TUMORSlide Number 7GIANT CELL
VARIANTSGiant cellOSTEOSARCOMASlide Number 11Slide Number
12CHONDROSARCOMASlide Number 14Slide Number 15EWINGS SARCOMASlide
Number 17D/D : Small Round Cell TumorOSTEOCHONDROMASlide Number
20Painful osteochondroma:CHRONIC OSTEOMYELITISTypes of
sequestrum..TUBERCULAR SPONDYLITIS (POTTS) SPINESlide Number
25Slide Number 26MADURA FOOTSlide Number 28Slide Number 29Slide