Bone Tumor

Ass.Prof.Dr. Hanan Hosny

• The most common tumor of bone is
Metastatic carcinomas (secondary
tumor); that come from other sites.
• The most frequent tumor that
metastasize to bone in adults are
carcinoma of lung, prostate, breast.
 Benign Tumor of Bone
Osteoma
Benign neoplasm present as solitary, attached to
bone that frequently involve skull and facial
bone.
Osteoid Osteoma
Benign bone tumor that arises
from osteoblasts
commonly occur between 10-20 yrs
Favored site: proximal femur, tibia and
humerus (long bones)
X-Ray: central radiolucency
surrounded by sclerotic rim.
 Osteochondroma (Exostoses)
• It is the most common Benign tumor
• Affecting : Metaphysis near the growth
plate capped with cartilage.
• Common in male adolescent
Enchondroma
• Benign cartilaginous tumor usually
affect the bones of hands and feet.
• Well- circumscribed lesion arise from
medullary cavity of bone as a single and
asymptomatic lesion
Malignant Tumors of Bone
1-Osteosarcoma
❖Most Common primary malignant tumor
of bone.
Clinical features:
❖Teenager (10-25),more common in male
❖Bony mass with or without pain.
❖May present with fracture(as the first symptom)
❖Tend to occur at the sites of bone growth.
Clinical picture:
Localized pain and swelling
 Pathology:
• It is an aggressive malignant neoplasm
• Often involve the metaphysis of bones.
• Most common site :around the knee
(Pathological changes of osteomylitis).
• Mass with area of necrosis and
hemorrhage
Microscopically:
• Anaplastic cell with high mitotic rate
• production of osteoid and bone
 X-ray findings
• Sunburst pattern (hair on end) periosteal reaction
• Destruction of bone (osteolytic)
• Codman’s triangle: area of sub periosteal new bone
formation
Prognosis:
• Poor
• Hematogenous spread to lung is
common
 Secondary Osteosarcoma

• Old age
• Associated with
–Paget Disease
– Chronic osteomyelitis
• Highly aggressive and less
respond to treatment
 2-Chondrosarcoma
• Malignant tumor of Chondroblasts
• It may arise de novo or secondary
eg.: paget’s disease.
• Age: 40-60, Male < female
Pathology:
• Large destructive mass with a characteristic
translucent whitish appearance.
• Typically involves the pelvic bone, spine and
shoulder girdle.

Microscopically:
Atypical chondrocyte and chondroblast ,often
with multiple nuclei in a lacuna.
 Chondroblasts (metabolically active, large
nuclei and prominent nucleoli, L= lacuna=
space due to fixation. Chondrocytes (smaller,
dense nuclei, less cytoplasm, low activity)
3-Giant cell Tumor
• Uncommon benign but locally
aggressive, with tendency to
recurrence.
Clinical picture:

• The typical location of these tumors near joints

frequently causes arthritis-like symptoms.
• Occasionally, they present with pathologic fractures.
• Age: 20-40yrs.
• More common in female
• These are large, red-brown tumors that frequently
undergo cystic degeneration
• High recurrence rate
X-ray:
• Lytic mass traversed by thin sclerotic line
( soap bubble appearance)
• Microscopically:
Numerous osteoclast-like multinucleated
giant cells
4- Ewing Sarcoma
• Primary Malignant tumor
• the youngest average age at
presentation, since most affected are 10
to 15 years old.
• Arising in the medullary cavity, which
expand and destroys the medullary
cavity, cortex and surrounding structures
Ewing Sarcoma
• Microscopically:
– It is composed of sheets of uniform
small, round cells that with small
amounts of clear cytoplasm.
– The presence of Homer-Wright rosettes
(tumor cells arranged in a circle about a
central fibrillary space)
X-Ray:
• Destructive lesion in diaphysis,
infiltrating the cortex from
within(onion skin) .
 Can you
differentiate
between the 4
Malignant bone
type?????
 Osteosarcoma Chondrosarcoma Giant cell Ewning
Sarcoma

Age- sex

site

Gross

Microscopic

X-ray
 4-Codman’s
1-Homer- triangle
Wright
rosettes

5-Sunburst
2- soap pattern
bubble
3-Affecting
appearance chondroblas
t ,often with
multiple
nuclei