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| '''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]]. |
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| 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> |
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| | ? | | | ? |
| | 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 |
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| | 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 |
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| =Cartilage= | | =Cartilage= |
| ==Chondroma== | | ==Chondroma== |
| ===General===
| | {{Main|Chondroma}} |
| *Benign thingy.
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| *Usual legs and feet.
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| *May be difficult to separate from [[chondrosarcoma]].
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| *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>
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| **Ollier disease.
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| **Maffucci syndrome - with [[hemangioma]]s, increased risk of [[chondrosarcoma]].<ref name=omim166000>{{OMIM|166000}}</ref>
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| **Metachondromatosis - autosomal dominant.
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| *''Enchondroma'' = chondroma in the marrow space.
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| 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>
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| *Pain.
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| ===Radiology===
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| 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>
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| *Lytic lesion.
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| *Usual close to a growth plate.
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| 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>
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| *Cortical destruction.
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| *Soft tissue component.
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| Note:
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| *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>
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| ===Microscopic===
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| Features:
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| *Ctyologically benign cells is spaced nests.
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| DDx:
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| *Low-grade [[chondrosarcoma]] - should be considered, correlation with radiology essential.
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| ====Images====
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| <gallery>
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| Image:Enchondroma_-_intermed_mag.jpg | Enchondroma - intermed mag. (WC)
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| Image:Enchondroma_-_very_high_mag.jpg | Enchondroma - very high mag. (WC)
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| </gallery>
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| ===Sign out===
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| <pre>
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| TISSUE ("CHONDROMA"), LEFT COSTAL MARGIN, EXCISION:
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| - CHONDROMA.
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| </pre>
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| ====Micro====
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| 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.
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| A small focus of cholesterol clefts with giant cells is present. Benign bone, bone marrow and skeletal muscle are present.
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| ==Chondroblastoma== | | ==Chondroblastoma== |
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| ==Chondromyxoid fibroma== | | ==Chondromyxoid fibroma== |
| ===General===
| | {{Main|Chondromyxoid fibroma}} |
| *Benign.
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| *Teenagers or young adults.
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| ===Gross===
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| *Metaphyseal lesion.
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| *Well-circumscribed.
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| ===Microscopic===
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| Features:<ref name=Ref_WMSP642>{{Ref WMSP|642}}</ref>
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| *Spindle cells or stellate cells in a myxoid or chondroid stroma.
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| Images:
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| *[http://www.webpathology.com/image.asp?n=7&Case=331 Chondromyxoid fibroma - low mag. (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?case=331&n=8 Chondromyxoid fibroma - high mag. (webpathology.com)].
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| ==Chondrosarcoma== | | ==Chondrosarcoma== |
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| =Bone= | | =Bone= |
| ==Osteoma== | | ==Osteoma== |
| ===General===
| | {{Main|Osteoma}} |
| *Benign.
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| *May be associated with [[familial adenomatous polyposis]].
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| *Normal bone - unusual location/outgrowth.
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| ===Microscopic===
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| Features:
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| *Normal bone.
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| ==Osteoid osteoma== | | ==Osteoid osteoma== |
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| =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==
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| ===General===
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| *Benign.
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| *Very common.
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| *Abnormal outgrowth of bone and cartilage - associated with growth plate.
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| *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>
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| ===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/>
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| **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 }}
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| </ref>
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| *Mushroom-like shape - with broad or narrow base.
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| Note:
| | ==Osteochondroma== |
| *Very unusual in craniofacial bones.<ref name=pmid12873205/>
| | {{Main|Osteochondroma}} |
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| ===Microscopic=== | |
| Features:<ref name=pmid12873205/>
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| *Bone - forms base of "mushroom".
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| *Cartilage - layer usu. thinner in older individuals.
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| **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).
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| **May have mild atypia.
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| **Nuclear enlargement - up to 5x normal.
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| *[[Perichondrium]] - covers the cartilage.
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| **Thin layer of cells - higher cellular density than cartilage.
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| ***Bland spindle cells in a fibrous (eosinophilic) stroma.
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| Notes:
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| *Benign cartilage - one chondrocyte per lacuna, small and round nucleus, no binucleation.
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| DDx:
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| *[[Chondrosarcoma]] - esp. in older individuals.
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| Images:
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| *[http://path.upmc.edu/cases/case341.html Super rare intracranial mesenchymal osteochondroma - several images (upmc.edu)].<ref name=upmc_case341/>
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| ==Diffuse tenosynovial giant-cell tumour== | | ==Diffuse tenosynovial giant-cell tumour== |