Name: Eslam Abokhalil Mohamed

ID: 201800575

Under supervision

Dr/ Malak
Zohier
 Osteosarcoma Osteoclastoma
Is a malignant Tumor of Locally aggressive neoplasm of
mesenchymal origin in which .bone
the neoplastic cells produce
Definition . osteoid and/or bone
Excluding multiple myeloma,
osteosarcoma is the most
common primary malignant
. Tumor of bone
Primary Osteosarcoma.1 Giant Cell Tumor of Bone=
Osteoclastoma
Age It occurs during the second Occurs in adults 20-40 years
.decade of life
Sex Males are more affected than .slight female predominance
females
Sites It arises in the -1 . Arises in epiphysis of long bones -1
metaphyseal ends of long Over 50% occur around knee joint -2
bone, around knee joint .(distal femur and proximal tibia)
(proximal tibia and distal Also found in proximal humerus -3
femur) . and distal radius
arises de novo from a -2
previously normal bone

Morphology Tumor is present at -1 Usually solitary, rarely multiple or -1

)Grossly( .metaphyseal end of long bone .multicentric
Is fusiform, fading on the -2 appears as large red brown mass -2
shaft giving a "mutton leg" containing large areas of necrosis and
appearance. Is gray-white, .cystic changes
often showing haemorrhage Remnants of residual bone are found -3
.and cystic softening .traversing the necrotic tissue
Bone necrosis associated -3 .No new bone formation is noticed-4
with new bone formation
especially noticed in the
.subperiosteal area
behavior Osteosarcoma is highly
aggressive, it destroys the
cortex extending in wards
into the medullary cavity
and outwards into the
adjacent soft tissue. It
rarely involves the joint
cavity, usually the
. epiphysis is spared

Microscopically Tumor cells are either spindle :composed of 2 elements

shaped and uniform, or Mononuclear Multinucleated
pleomorphic with bizarre, cells giant cells
hyperchromatic nuclei and the -1 The reactive -1
.frequent mitotic figures neoplastic component of the
 Giant cells sometimes component .neoplasm
mistaken for osteoclasts are of the They-2
often seen. Tumor cells .neoplasm closely resemble
produce osteoid which is They are -2 osteoclasts, contain
marked by trapping of the round to a huge number of
malignant cells within a spindle- .vesicular nuclei
homogeneous pink osteoid shaped )or more 100(-3
matrix and is surrounded by a cells, and and are evenly
. rim of malignant osteoblasts have distributed in the
vesicular neoplasm. Stroma
.nuclei of the
tumor is scanty and
contains areas of
haemorrhage,
necrosis, and
haemosiderin
pigments
Radiologically when the neoplasm penetrates large, lytic, "soap-bubble" lesion, -1
the cortex, it lifts the .erodes into the subchondral bone plate
periosteum producing the so
called "Codeman's triangle". Overlying cortex is destroyed and -2
This triangle is the angle bulging soft tissue mass appears
between the plane of outer delineated by a thin shell of reactive
surface of the cortex and the .bone
. elevated periosteum
It is characteristic but not
pathognomonic of
.osteosarcoma
new bone formation is
patchy in the form of fine
spicules of bone radiating
out from the central mass
of Tumor tissue, giving
."sun ray" appearance

Clinical features Progressive enlarging painful Pain, tenderness, functional

mass, usually seen after a .disability, occasional fracture
.fracture of the bone involved
Aggressive tumor metastasizes
early by blood reaching the
. lungs and other sites
Lymph node metastasis is
. unusual
Diagnosis Depends on age, site, size, and
raised serum alkaline
phosphatase. X-ray radiograph
revealing mass at metaphyseal
end of long bone, showing
Codeman’s triangle, sun ray
appearance of new bone,
extraosseous radiodensities
 (due to penetration of cortical
bone and extension in soft
tissue)
Biopsy from such soft tissue
extensions is necessary to
confirm diagnosis
Prognosis It depends on the size and
.histologic type of the Tumor
Fibroblastic osteosarcoma has
the best prognosis
N.B Secondary Osteosarcoma Histogenesis of giant cell Tumor is
It occurs in older age -1 unknown. The current opinion
than the conventional suggests that giant cells are reactive
type, usually above 40 cells derived from macrophages,
.years and proliferating mononuclear cells
arises as a -2 .are the neoplastic component
complication of a pre-
existing bone lesion e.g.
Paget's disease, bone
infarct, and a previously
irradiated bone and rarely
in patients with fibrous
dysplasia and chronic
.osteomyelitis
It is a highly aggressive -3
.tumor
responds less favorably -4
to treatment than does
conventional
.osteosarcoma
N.B Biologic behavior
Is unpredictable. Majority of
recurrences are common after
simple curettage sarcomatous
change may occur and occasionally
. metastases to the lung may occur