|
|
(18 intermediate revisions by 3 users not shown) |
Line 1: |
Line 1: |
| '''Chondro-osseous tumours''' occasionally cross the desk of the pathologist. They are grouped together as [[bone]] may develop from [[cartilage]]. | | [[Image:Osteosarcoma - very high mag.jpg|thumb|250px|right|A chondro-osseous tumour ([[osteosarcoma]]). [[H&E stain]].]] |
| | '''Chondro-osseous tumours''' occasionally cross the desk of the pathologist. They are grouped together as [[bone]] may develop from [[cartilage]]. |
|
| |
|
| Primary bone tumours are rare; the most common bone tumour is [[metastases]].<ref name=Ref_WMSP632>{{Ref WMSP|632}}</ref> | | Primary bone tumours are rare; the most common bone tumour is [[metastases]].<ref name=Ref_WMSP632>{{Ref WMSP|632}}</ref> |
Line 61: |
Line 62: |
| | ? | | | ? |
| | no stains / may be assoc. with [[FAP]] | | | no stains / may be assoc. with [[FAP]] |
| | Image (???) | | | [[Image:Osteoma -- intermed mag.jpg |thumb|center|150px| Osteoma. (WC)]] |
| |- | | |- |
| | [[Osteoid osteoma]] | | | [[Osteoid osteoma]] |
| | osteoblastic rimming | | | osteoblastic rimming |
| | anastomosing bony trabeculae | | | anastomosing bony trabeculae |
| | <= 1.5 cm, metaphysis | | | must be <2 cm,<ref name=pmid25224389>{{Cite journal | last1 = Yalcinkaya | first1 = U. | last2 = Doganavsargil | first2 = B. | last3 = Sezak | first3 = M. | last4 = Kececi | first4 = B. | last5 = Argin | first5 = M. | last6 = Basdemir | first6 = G. | last7 = Oztop | first7 = F. | title = Clinical and morphological characteristics of osteoid osteoma and osteoblastoma: a retrospective single-center analysis of 204 patients. | journal = Ann Diagn Pathol | volume = 18 | issue = 6 | pages = 319-25 | month = Dec | year = 2014 | doi = 10.1016/j.anndiagpath.2014.08.006 | PMID = 25224389 }}</ref> metaphysis |
| | painful, NSAIDs remove pain, young | | | painful, NSAIDs remove pain, young |
| | IHC / other | | | IHC / other |
Line 74: |
Line 75: |
| | osteoblastic rimming | | | osteoblastic rimming |
| | anastomosing bony trabeculae | | | anastomosing bony trabeculae |
| | > 1.5 cm, metaphysis | | | must be >1 cm,<ref name=pmid25224389/> often >=2 cm, metaphysis |
| | not painful | | | not painful |
| | IHC / other | | | IHC / other |
Line 308: |
Line 309: |
| =Cartilage= | | =Cartilage= |
| ==Chondroma== | | ==Chondroma== |
| ===General===
| | {{Main|Chondroma}} |
| *Benign thingy.
| |
| *Usual legs and feet.
| |
| *May be difficult to separate from [[chondrosarcoma]].
| |
| *Multiple chondromas = ''enchondromatosis''; three distinct syndromes:<ref name=emed_enchondroma>URL: [http://emedicine.medscape.com/article/389224-overview http://emedicine.medscape.com/article/389224-overview]. Accessed on: 25 December 2010.</ref>
| |
| **Ollier disease.
| |
| **Maffucci syndrome - with [[hemangioma]]s, increased risk of [[chondrosarcoma]].<ref name=omim166000>{{OMIM|166000}}</ref>
| |
| **Metachondromatosis - autosomal dominant.
| |
| *''Enchondroma'' = chondroma in the marrow space.
| |
| | |
| Clinical:<ref name=emed_enchondroma>URL: [http://emedicine.medscape.com/article/389224-overview http://emedicine.medscape.com/article/389224-overview]. Accessed on: 25 December 2010.</ref>
| |
| *Pain.
| |
| | |
| ===Radiology===
| |
| Features:<ref name=emed_enchondroma>URL: [http://emedicine.medscape.com/article/389224-overview http://emedicine.medscape.com/article/389224-overview]. Accessed on: 25 December 2010.</ref>
| |
| *Lytic lesion.
| |
| *Usual close to a growth plate.
| |
| | |
| Important suspicious findings that favour malignant:<ref name=pmid23041161>{{Cite journal | last1 = Choi | first1 = BB. | last2 = Jee | first2 = WH. | last3 = Sunwoo | first3 = HJ. | last4 = Cho | first4 = JH. | last5 = Kim | first5 = JY. | last6 = Chun | first6 = KA. | last7 = Hong | first7 = SJ. | last8 = Chung | first8 = HW. | last9 = Sung | first9 = MS. | title = MR differentiation of low-grade chondrosarcoma from enchondroma. | journal = Clin Imaging | volume = 37 | issue = 3 | pages = 542-7 | month = | year = | doi = 10.1016/j.clinimag.2012.08.006 | PMID = 23041161 }}</ref>
| |
| *Cortical destruction.
| |
| *Soft tissue component.
| |
| | |
| Note:
| |
| *High-grade chondroid lesions (high-grade chondrosarcoma) can usually be separated radiologically from low-grade ones.<ref name=pmid22696998>{{Cite journal | last1 = Berber | first1 = O. | last2 = Datta | first2 = G. | last3 = Sabharwal | first3 = S. | last4 = Aston | first4 = W. | last5 = Saifuddin | first5 = A. | last6 = Briggs | first6 = T. | title = The safety of direct primary excision of low-grade chondral lesions based on radiological diagnosis alone. | journal = Acta Orthop Belg | volume = 78 | issue = 2 | pages = 254-62 | month = Apr | year = 2012 | doi = | PMID = 22696998 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Ctyologically benign cells is spaced nests.
| |
| | |
| DDx:
| |
| *Low-grade [[chondrosarcoma]] - should be considered, correlation with radiology essential.
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Enchondroma_-_intermed_mag.jpg | Enchondroma - intermed mag. (WC)
| |
| Image:Enchondroma_-_very_high_mag.jpg | Enchondroma - very high mag. (WC)
| |
| </gallery>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| TISSUE ("CHONDROMA"), LEFT COSTAL MARGIN, EXCISION:
| |
| - CHONDROMA.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show spaced small cells in a pale matrix with a light-blue tinge. No nuclear atypia is appreciated. No mitotic activity is apparent. Degenerative changes are seen focally.
| |
| | |
| A small focus of cholesterol clefts with giant cells is present. Benign bone, bone marrow and skeletal muscle are present.
| |
|
| |
|
| ==Chondroblastoma== | | ==Chondroblastoma== |
| ===General===
| | {{Main|Chondroblastoma}} |
| *Growth plate lesion.
| |
| *Sclerotic margin.
| |
| *"Young" = growth plates open.
| |
| *Typically painful.<ref name=Ref_PCPBoD8_625>{{Ref PCPBoD8|625}}</ref>
| |
| | |
| ===Gross===
| |
| *Well-defined lesion.
| |
| | |
| Image:
| |
| *[http://www.flickr.com/photos/35441329@N05/4052875138/in/set-72157622681280610 Chondroblastoma (flickr.com/humpath)].
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_WMSP_642>{{Ref WMSP|642}}</ref>
| |
| *Abundant extracellular material - pink on [[H&E stain]] - looks vaguely like cartilage.
| |
| *Chondroblasts:
| |
| **Nuclear morphology variable: ovoid, folded or grooved.
| |
| **Moderate-abundant eosinophilic cytoplasm.
| |
| *+/-Calcification surrounds the cell nests ("chickenwire" appearance) - '''classic feature'''.
| |
| **Cell nests have a thin pale blue rimming.
| |
| *+/-[[Giant cells]].
| |
| **May lead to confusion with ''[[giant cell tumour of bone]]''.
| |
| | |
| DDx:
| |
| *[[Giant cell tumour of bone]].
| |
| *[[Chondroma]].
| |
| *Well-differentiated [[chondrosarcoma]].
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Chondroblastoma_-_intermed_mag.jpg | Chondroblastoma - intermed. mag. (WC)
| |
| Image:Chondroblastoma_-_very_high_mag.jpg | Chondroblastoma - very high mag. (WC)
| |
| </gallery>
| |
| www:
| |
| *[http://img.medscape.com/pi/emed/ckb/orthopedic_surgery/1230552-1254949-996.jpg Chondroblastoma (medscape.com)].<ref name=emed_chondroblastoma>URL: [http://emedicine.medscape.com/article/1254949-diagnosis http://emedicine.medscape.com/article/1254949-diagnosis]. Accessed on: 31 December 2010.</ref>
| |
| *[http://img.medscape.com/pi/emed/ckb/orthopedic_surgery/1230552-1254949-997.jpg Chondroblastoma with "chickenwire" appearance (medscape.com)].<ref name=emed_chondroblastoma>URL: [http://emedicine.medscape.com/article/1254949-diagnosis http://emedicine.medscape.com/article/1254949-diagnosis]. Accessed on: 31 December 2010.</ref>
| |
| *[http://path.upmc.edu/cases/case494/images/fig2a.jpg Chondroblastoma (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case494.html http://path.upmc.edu/cases/case494.html]. Accessed on: 24 January 2012.</ref>
| |
| | |
| ===IHC===
| |
| Features:<ref name=Ref_WMSP_642>{{Ref WMSP|642}}</ref>
| |
| *S100 +ve.
| |
| *Vimentin +ve.<ref name=emed_chondroblastoma>URL: [http://emedicine.medscape.com/article/1254949-diagnosis http://emedicine.medscape.com/article/1254949-diagnosis]. Accessed on: 31 December 2010.</ref>
| |
|
| |
|
| ==Chondromyxoid fibroma== | | ==Chondromyxoid fibroma== |
| ===General===
| | {{Main|Chondromyxoid fibroma}} |
| *Benign.
| |
| *Teenagers or young adults.
| |
| | |
| ===Gross===
| |
| *Metaphyseal lesion.
| |
| *Well-circumscribed.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_WMSP642>{{Ref WMSP|642}}</ref>
| |
| *Spindle cells or stellate cells in a myxoid or chondroid stroma.
| |
| | |
| Images:
| |
| *[http://www.webpathology.com/image.asp?n=7&Case=331 Chondromyxoid fibroma - low mag. (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?case=331&n=8 Chondromyxoid fibroma - high mag. (webpathology.com)].
| |
|
| |
|
| ==Chondrosarcoma== | | ==Chondrosarcoma== |
Line 423: |
Line 322: |
| =Bone= | | =Bone= |
| ==Osteoma== | | ==Osteoma== |
| ===General===
| | {{Main|Osteoma}} |
| *Benign.
| |
| *May be associated with [[familial adenomatous polyposis]].
| |
| *Normal bone - unusual location/outgrowth.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Normal bone.
| |
|
| |
|
| ==Osteoid osteoma== | | ==Osteoid osteoma== |
Line 449: |
Line 341: |
| =Other= | | =Other= |
| This section collects stuff that doesn't neatly fit into the ''bone'' or ''cartilage'' category. | | This section collects stuff that doesn't neatly fit into the ''bone'' or ''cartilage'' category. |
| ==Osteochondroma==
| |
| ===General===
| |
| *Benign.
| |
| *Very common.
| |
| *Abnormal outgrowth of bone and cartilage - associated with growth plate.
| |
| *Usually present before age 20.<ref name=pmid12873205>{{Cite journal | last1 = Parkin | first1 = B. | last2 = Bennett | first2 = JC. | last3 = Zaher | first3 = A. | title = Pathologic quiz case: an iliac mass in a 25-year-old woman. Osteochondroma. | journal = Arch Pathol Lab Med | volume = 127 | issue = 8 | pages = e355-6 | month = Aug | year = 2003 | doi = 10.1043/1543-2165(2003)127e355:PQCAIM2.0.CO;2 | PMID = 12873205 | URL = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282003%29127%3Ce355:PQCAIM%3E2.0.CO;2}}</ref>
| |
|
| |
|
| ===Gross=== | | ==Notochordal tumors== |
| Features:
| | Notochordal tumors arise from notochordal remnants and thus are seen in the clivus or sacrum. |
| *Metasphyseal lesions.<ref name=medpath>URL: [http://www.medpath.info/MainContent/Skeletal/Bone_07.html http://www.medpath.info/MainContent/Skeletal/Bone_07.html]. Accessed on: 18 September 2012.</ref>
| | {{Main|Chordoma}} |
| **Often distal femur, proximal humerus or proximal tibia.<ref name=pmid12873205/>
| |
| **Occasionally iliac mass.<ref name=pmid22217414>{{Cite journal | last1 = Kokavec | first1 = M. | last2 = Gajdoš | first2 = M. | last3 = Džupa | first3 = V. | title = [Osteochondroma of the iliac crest: case report]. | journal = Acta Chir Orthop Traumatol Cech | volume = 78 | issue = 6 | pages = 583-5 | month = | year = 2011 | doi = | PMID = 22217414 }}
| |
| </ref>
| |
| *Mushroom-like shape - with broad or narrow base.
| |
|
| |
|
| Note:
| | ==Osteochondroma== |
| *Very unusual in craniofacial bones.<ref name=pmid12873205/>
| | {{Main|Osteochondroma}} |
| | |
| ===Microscopic=== | |
| Features:<ref name=pmid12873205/>
| |
| *Bone - forms base of "mushroom".
| |
| *Cartilage - layer usu. thinner in older individuals.
| |
| **Lobular arrangement<ref name=upmc_case341>URL: [http://path.upmc.edu/cases/case341/dx.html http://path.upmc.edu/cases/case341/dx.html]. Accessed on: 19 September 2012.</ref> - clusters of 3-12 lacunae (separated by stroma).
| |
| **May have mild atypia.
| |
| **Nuclear enlargement - up to 5x normal.
| |
| *[[Perichondrium]] - covers the cartilage.
| |
| **Thin layer of cells - higher cellular density than cartilage.
| |
| ***Bland spindle cells in a fibrous (eosinophilic) stroma.
| |
| | |
| Notes:
| |
| *Benign cartilage - one chondrocyte per lacuna, small and round nucleus, no binucleation.
| |
| | |
| DDx:
| |
| *[[Chondrosarcoma]] - esp. in older individuals.
| |
| | |
| Images:
| |
| *[http://path.upmc.edu/cases/case341.html Super rare intracranial mesenchymal osteochondroma - several images (upmc.edu)].<ref name=upmc_case341/>
| |
|
| |
|
| ==Diffuse tenosynovial giant-cell tumour== | | ==Diffuse tenosynovial giant-cell tumour== |
| *[[AKA]] ''tenosynovial giant-cell tumour, diffuse type''. | | *[[AKA]] ''tenosynovial giant-cell tumour, diffuse type''. |
| *Previously known as ''pigmented villonodular synovitis'' (PVNS).<ref>{{Ref PBoD8|1247}}</ref> | | *Previously known as ''pigmented villonodular synovitis'' (PVNS).<ref>{{Ref PBoD8|1247}}</ref> |
| | | {{Main|Diffuse tenosynovial giant-cell tumour}} |
| ===General===
| |
| *Course: benign.
| |
| **Occasionally malignant.<ref name=pmid22827766>{{Cite journal | last1 = Kondo | first1 = R. | last2 = Akiba | first2 = J. | last3 = Hiraoka | first3 = K. | last4 = Hisaoka | first4 = M. | last5 = Hashimoto | first5 = H. | last6 = Kage | first6 = M. | last7 = Yano | first7 = H. | title = Malignant diffuse-type tenosynovial giant cell tumor of the buttock. | journal = Pathol Int | volume = 62 | issue = 8 | pages = 559-64 | month = Aug | year = 2012 | doi = 10.1111/j.1440-1827.2012.02838.x | PMID = 22827766 }}</ref><ref name=pmid18301053>{{Cite journal | last1 = Li | first1 = CF. | last2 = Wang | first2 = JW. | last3 = Huang | first3 = WW. | last4 = Hou | first4 = CC. | last5 = Chou | first5 = SC. | last6 = Eng | first6 = HL. | last7 = Lin | first7 = CN. | last8 = Yu | first8 = SC. | last9 = Huang | first9 = HY. | title = Malignant diffuse-type tenosynovial giant cell tumors: a series of 7 cases comparing with 24 benign lesions with review of the literature. | journal = Am J Surg Pathol | volume = 32 | issue = 4 | pages = 587-99 | month = Apr | year = 2008 | doi = 10.1097/PAS.0b013e318158428f | PMID = 18301053 }}</ref><ref name=pmid10757395>{{Cite journal | last1 = Somerhausen | first1 = NS. | last2 = Fletcher | first2 = CD. | title = Diffuse-type giant cell tumor: clinicopathologic and immunohistochemical analysis of 50 cases with extraarticular disease. | journal = Am J Surg Pathol | volume = 24 | issue = 4 | pages = 479-92 | month = Apr | year = 2000 | doi = | PMID = 10757395 }}</ref>
| |
| *''[[Giant cell tumour of the tendon sheath]]'' is considered to be the soft-tissue counterpart of PVNS.<ref>URL: [http://emedicine.medscape.com/article/1253223-overview http://emedicine.medscape.com/article/1253223-overview]. Accessed on: 6 January 2011.</ref>
| |
| | |
| ===Gross===
| |
| *Typically knee or hip.<ref name=pmid10524485>{{Cite journal | last1 = Frassica | first1 = FJ. | last2 = Bhimani | first2 = MA. | last3 = McCarthy | first3 = EF. | last4 = Wenz | first4 = J. | title = Pigmented villonodular synovitis of the hip and knee. | journal = Am Fam Physician | volume = 60 | issue = 5 | pages = 1404-10; discussion 1415 | month = Oct | year = 1999 | doi = | PMID = 10524485 | URL = http://www.aafp.org/afp/1999/1001/p1404.html }}</ref>
| |
| *May be extra-articular.<ref name=pmid10757395/>
| |
| | |
| ===Microscopic===
| |
| Features:<ref>URL: [http://www.wheelessonline.com/ortho/pigmented_villonodular_synovitis http://www.wheelessonline.com/ortho/pigmented_villonodular_synovitis].</ref>
| |
| *Subsynovial nodules composed of cells with:
| |
| **Abundant cytoplasm.
| |
| **Pale nuclei.
| |
| *Multinucleated giant cells.
| |
| *Hemosiderin-laden macrophages.
| |
| *Foam cells.
| |
| | |
| DDx - general for the site:<ref name=pmid17031677>{{Cite journal | last1 = Krenn | first1 = V. | last2 = Morawietz | first2 = L. | last3 = König | first3 = A. | last4 = Haeupl | first4 = T. | title = [Differential diagnosis of chronic synovitis]. | journal = Pathologe | volume = 27 | issue = 6 | pages = 402-8 | month = Nov | year = 2006 | doi = 10.1007/s00292-006-0866-6 | PMID = 17031677 }}</ref>
| |
| *[[Synovial chondromatosis]].
| |
| *[[Gout]].
| |
| *[[Pseudogout]].
| |
| *[[Storage disorders]].
| |
| *[[Granuloma|Granulomatous inflammation]].
| |
| *Degenerative changes ([[osteoarthritis]]).
| |
| *[[Rheumatic joint disease|Rheumatic disease]].
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Pigmented_villonodular_synovitis_low_mag.jpg | PVNS - low mag. (WC)
| |
| Image:Pigmented_villonodular_synovitis_high_mag.jpg | PVNS - high mag. (WC)
| |
| </gallery>
| |
| www:
| |
| *[http://path.upmc.edu/cases/case251/micro.html PVNS - several images (upmc.edu)].
| |
| *[http://www.webpathology.com/image.asp?case=357&n=2 PVNS (webpathology.com)].
| |
| | |
| ===Molecular===
| |
| *Clonal.<ref name=pmid22849738>{{Cite journal | last1 = Lucas | first1 = DR. | title = Tenosynovial giant cell tumor: case report and review. | journal = Arch Pathol Lab Med | volume = 136 | issue = 8 | pages = 901-6 | month = Aug | year = 2012 | doi = 10.5858/arpa.2012-0165-CR | PMID = 22849738 }}</ref>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| RIGHT FEMORAL HEAD AND JOINT CAPSULE, EXCISION:
| |
| - DEGENERATIVE JOINT DISEASE.
| |
| - DIFFUSE TENOSYNOVIAL GIANT-CELL TUMOUR (PIGMENTED VILLONODULAR SYNOVITIS).
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The soft tissue sections show nodules with abundant hemosiderin-laden macrophages and multinucleated giant cells. Nuclear atypia is not identified. Mitotic activity is not apparent.
| |
|
| |
|
| ==Giant cell tumour of tendon sheath== | | ==Giant cell tumour of tendon sheath== |