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Orthopedic Pathology, specifically tumors of bone and related conditions, has a reputation as a diagnostically difficult area of practice. The reasons for this are multiple and probably include the reality that such lesions are quite rare (representing <1% of all cases seen in typical community practices) so the “average” pathologist may have limited experience in dealing with such cases and may...
There are many lesions that are associated with reactive new bone formation; this chapter predominantly covers those in which deposition of osteoid/bone matrix represents the primary pathological process. The key in recognizing these lesions is the identification of osteoid or woven bone (vs. lamellar bone) on the frozen section slide. Osteoid is the organic nonmineralized matrix of bone and, being...
Tumors that produce a chondroid matrix are traditionally grouped together regardless of their histogenesis. There are three types of cartilage: hyaline cartilage, fibrocartilage, and elastic cartilage. In the adult, hyaline cartilage is present in the joints; fibrocartilage is mostly found in the spine; and elastic cartilage is seen in the external ear, epiglottis, and a few other places. The vast...
Most tumors of fibrous and fibrohistiocytic origin generally produce collagen but do not form a mineralizing matrix, whereas high-grade tumors may have little to no matrix. Fibro-osseous lesions [fibrous dysplasia (FD) and osteofibrous dysplasia (OFD)] are composed of large volumes of fibrous connective tissue, principally collagens type I and III, as well as osseous areas. Fibrous and fibrohistiocytic...
Although almost all bone tumors contain giant cells, giant cell-rich lesions of bone encompass a number of entities in which the giant cells are an essential diagnostic component, chief among these are giant cell tumor (GCT) of bone, giant cell reparative granuloma (GCRG), and aneurysmal bone cyst (ABC). These lesions may have overlapping histomorphologic features, yet each possesses its own unique...
Lesions considered in this chapter include traditional “small blue round cell” neoplasms, specifically Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) and lymphomas, solitary plasmacytoma/multiple myeloma, and other lesions that tend to be composed of a mixed population of rounded cells without epithelial differentiation or significant extracellular matrix deposition. These latter lesions...
Since aneurysmal bone cyst has already been covered with other giant cell-containing lesions, the other cystic lesions that will be discussed in this chapter have been limited to simple bone cyst and intraosseus ganglion. Given the rarity of true vascular lesions of the bone only hemangioma, hemangioendothelioma, and angiosarcoma are referenced.
Although metastatic carcinoma represents the commonest epithelial lesion that can arise in bone, there are at least two primary bone neoplasms, namely adamantinoma and chordoma, that one should always consider these before making a diagnosis of metastatic carcinoma.
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