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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%)

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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

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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)

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Primary Primary neoplasms neoplasms of boneof bone

Means of identificationMeans of identificationMatrix morphologyMatrix morphologyImmunophenotypicalImmunophenotypical markersmarkersClinClin/ / radiologicradiologic correlation: a must!correlation: a must!

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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

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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

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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

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CartilageCartilage--forming Tumorsforming Tumors

Benign Benign Chondroma Chondroma Malignant Malignant ChondrosarcomaChondrosarcoma

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Tumors of fibroblastic originTumors of fibroblastic origin

BenignBenign NonNon--ossifying ossifying fibromafibroma

MalignantMalignant ..FibrosarcomaFibrosarcoma.Malignant fibrous.Malignant fibroushistiocytomahistiocytoma

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Tumors of unknown originTumors of unknown origin

Giant cell tumor of boneGiant cell tumor of boneEwing SarcomaEwing Sarcoma

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