1 CPMC Bone Tumors Bone Tumors May May Parisien Parisien , M.D. , M.D. Columbia University, New York Columbia University, New York Classification Classification Secondary Secondary (metastases) (metastases) (95%) (95%) Primary (5%) Primary (5%)
1
CPMC
Bone TumorsBone Tumors
May May ParisienParisien, M.D. , M.D. Columbia University, New YorkColumbia University, New York
ClassificationClassification
Secondary Secondary (metastases)(metastases) (95%)(95%)Primary (5%)Primary (5%)
2
Secondary tumorsSecondary tumors
Malignancies originating from distant Malignancies originating from distant (primary) organs(primary) organs
most frequent: carcinomasmost frequent: carcinomas/ malignant / malignant epithelial tumors of visceraepithelial tumors of viscerarare: sarcomas /malignantrare: sarcomas /malignantmesenchymal mesenchymal tumors)tumors)
Secondary Tumors of BoneSecondary Tumors of BoneMost frequent primariesMost frequent primaries
LungLungBreastBreastProstateProstate
GastroGastro--intestinalintestinalKidneyKidneyThyroidThyroid
3
Secondary Tumors of BoneSecondary Tumors of BoneMechanism of transportMechanism of transport
Paravertebral Paravertebral venous plexusesvenous plexusesretrograde access of tumor cells to retrograde access of tumor cells to
bonebonebypass of bypass of portoporto--caval caval venous venous
drainage drainage
Primary Primary neoplasms neoplasms of boneof bone
Definition:Definition: tumors oftumors of mesenchymalmesenchymalorigin arising in boneorigin arising in boneRoutes of spread: Routes of spread: hematogenous hematogenous (lung, liver, bone)(lung, liver, bone)
4
Primary Primary neoplasms neoplasms of boneof bone
Means of identificationMeans of identificationMatrix morphologyMatrix morphologyImmunophenotypicalImmunophenotypical markersmarkersClinClin/ / radiologicradiologic correlation: a must!correlation: a must!
5
Primary Tumors of BonePrimary Tumors of BoneClassificationClassification
BoneBone--formingformingCartilageCartilage--formingformingFibrous tumorsFibrous tumorsTumors of unknown originTumors of unknown origin
BoneBone--forming tumorsforming tumors
BenignBenign Osteoid osteomaOsteoid osteomaOsteoblastomaOsteoblastoma
MalignantMalignant OsteosarcomaOsteosarcoma
6
7
Malignant Tumors of BoneMalignant Tumors of BoneOsteosarcomasOsteosarcomasCentralCentralLow Grade Low Grade High Grade High Grade
SurfaceSurfaceLow Grade Low Grade High Grade High Grade
OsteosarcomasOsteosarcomas
DefinitionDefinitionMalignant neoplasm of boneMalignant neoplasm of bone
malignant malignant mesenchymal mesenchymal cellcellmalignant bone matrixmalignant bone matrix
8
9
10
OsteosarcomasOsteosarcomas
MesenchymalMesenchymal cellcell is is multipotentialmultipotentialMalignant Malignant osteoid osteoid essential for essential for recognitionrecognition
OsteosarcomaOsteosarcomaHistologic typesHistologic types
OsteoblasticOsteoblasticChondroblasticChondroblasticFibroblasticFibroblasticTelangiectaticTelangiectatic
Small cell typeSmall cell typeGiant cell richGiant cell richOsteoblastomaOsteoblastoma--likelike
11
CartilageCartilage--forming Tumorsforming Tumors
Benign Benign Chondroma Chondroma Malignant Malignant ChondrosarcomaChondrosarcoma
12
13
Tumors of fibroblastic originTumors of fibroblastic origin
BenignBenign NonNon--ossifying ossifying fibromafibroma
MalignantMalignant ..FibrosarcomaFibrosarcoma.Malignant fibrous.Malignant fibroushistiocytomahistiocytoma
14
Tumors of unknown originTumors of unknown origin
Giant cell tumor of boneGiant cell tumor of boneEwing SarcomaEwing Sarcoma
15
16
17
18