Bone tumors: Pathology review
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Bone tumors: Pathology review
Musculoskeletal system
Pediatric musculoskeletal conditions
Radial head subluxation (Nursemaid elbow)
Developmental dysplasia of the hip
Legg-Calve-Perthes disease
Slipped capital femoral epiphysis
Transient synovitis
Osgood-Schlatter disease (traction apophysitis)
Musculoskeletal injuries and trauma
Rotator cuff tear
Dislocated shoulder
Radial head subluxation (Nursemaid elbow)
Winged scapula
Thoracic outlet syndrome
Carpal tunnel syndrome
Ulnar claw
Erb-Duchenne palsy
Klumpke paralysis
Iliotibial band syndrome
Unhappy triad
Anterior cruciate ligament injury
Patellar tendon rupture
Meniscus tear
Patellofemoral pain syndrome
Sprained ankle
Achilles tendon rupture
Spondylolysis
Spondylolisthesis
Degenerative disc disease
Spinal disc herniation
Sciatica
Compartment syndrome
Rhabdomyolysis
Bone disorders
Osteogenesis imperfecta
Craniosynostosis
Pectus excavatum
Arthrogryposis
Genu valgum
Genu varum
Pigeon toe
Flat feet
Club foot
Cleidocranial dysplasia
Achondroplasia
Osteomyelitis
Bone tumors
Osteochondroma
Chondrosarcoma
Osteoporosis
Osteomalacia and rickets
Osteopetrosis
Paget disease of bone
Osteosclerosis
Lordosis, kyphosis, and scoliosis
Joint disorders
Osteoarthritis
Spondylosis
Spinal stenosis
Rheumatoid arthritis
Juvenile idiopathic arthritis
Gout
Calcium pyrophosphate deposition disease (pseudogout)
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
Spondylitis
Septic arthritis
Bursitis
Baker cyst
Muscular disorders
Muscular dystrophy
Polymyositis
Dermatomyositis
Inclusion body myopathy
Polymyalgia rheumatica
Fibromyalgia
Rhabdomyosarcoma
Neuromuscular junction disorders
Myasthenia gravis
Lambert-Eaton myasthenic syndrome
Other autoimmune disorders
Sjogren syndrome
Systemic lupus erythematosus
Mixed connective tissue disease
Antiphospholipid syndrome
Raynaud phenomenon
Scleroderma
Limited systemic sclerosis (CREST syndrome)
Musculoskeletal system pathology review
Back pain: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
Seronegative and septic arthritis: Pathology review
Gout and pseudogout: Pathology review
Systemic lupus erythematosus (SLE): Pathology review
Scleroderma: Pathology review
Sjogren syndrome: Pathology review
Bone disorders: Pathology review
Bone tumors: Pathology review
Myalgias and myositis: Pathology review
Neuromuscular junction disorders: Pathology review
Muscular dystrophies and mitochondrial myopathies: Pathology review
Assessments
Bone tumors: Pathology review
USMLE® Step 1 questions
0 / 9 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Hemoglobin | 11.2 g/dL |
| Mean corpuscular hemoglobin | 90 fl |
| Creatinine | 2.3 mg/dL |
| Total protein | 9.5 |
| Albumin | 3.2 g/dL |
| Sodium | 132 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| Calcium | 12 mg/dl |
Radiograph of the spine reveals multiple areas of hyperlucency at the lumbar and thoracic regions. Which of the following is the most likely underlying cause?
Memory Anchors and Partner Content
Transcript
Content Reviewers
Yifan Xiao, MDContributors
Jung Hee Lee, MScBMC
Daniel Afloarei, MD
Kaylee Neff
Tanner Marshall, MS
While doing your rounds, you see two individuals. First is James, a 14-year-old boy who came in for chronic right knee pain, night sweats, and weight loss. He didn’t report falling or any other trauma to the region or any additional symptoms. On examination, his right knee is slightly larger than the left and, on palpation, a hard mass can be felt on the metaphysis of his right femur, close to the knee region. Then you see William, who’s 22 years old and complains of a 1-month history of bone pain along his left tibia, a problem which is worse at night. One interesting observation he made was that the pain responds well to Ibuprofen, a nonsteroidal anti-inflammatory drug. On examination, palpation reveals a bony mass on the anterior surface of the left tibial diaphysis. As expected, X-ray scans were obtained. They showed a distal sunburst appearance and Codman's triangle in James’ right femur, whereas William’s x-ray scans detected a small lesion under 2 centimeters with a radiolucent core on the anterior surface of his left tibia.
Now, both seem to have some type of bone tumor. But first, a bit of physiology. Even though the bones vary in size and shape, all bones are made of the same types of cells, and chief among them are osteoblasts which build up new bone, and osteoclasts which help with bone breakdown or resorption. Now in addition to these, there are some more primitive cells in the bone marrow called human mesenchymal stem cells and neuroectodermal cells, which can differentiate into many cell types including nerve, fat, bone, and cartilage cells. In terms of anatomy, looking at a long, bone like the femur, it has two epiphysis, which are the ends that contribute to joints with other bones. Between the two epiphyses, is the diaphysis, also called the bone shaft. In children and adolescents, there is an additional narrow portion between the epiphysis and the diaphysis called the metaphysis. The metaphysis contains the growth plate, the part of the bone that grows during childhood. In adults, the growth plate has ossified and fused with the diaphysis and the epiphysis.
Summary
Bone tumors can be either benign (non-cancerous) or malignant (cancerous), and can occur in any bone in the body. Bone tumors may be caused by several different factors, including genetics, infection, trauma, and exposure to radiation or certain chemicals.
Benign bone tumors include osteochondroma, giant-cell tumor, osteoid osteoma, and osteoblastoma. Malignant bone tumors include osteosarcoma, Ewing sarcoma, and chondrosarcoma
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "The WHO classification of bone tumors" Recent Results Cancer Res (1976)
- "Osteosarcomas of flat bones in adolescents and adults" Cancer (2000)
- "The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging" CA: A Cancer Journal for Clinicians (2017)
- "Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions." Q J Nucl Med (2001)
- "Principles and Practice of Pediatric Oncology" Lww (2015)
- "Benign tumours of the bone: A review" Journal of Bone Oncology (2015)
- "BENIGN BONE TUMORS AND TUMOR-LIKE BONE LESIONS: TREATMENT UPDATE AND NEW TRENDS" Revista Brasileira de Ortopedia (English Edition) (2009)
- "Malignant bone tumors" Instr Course Lect (2008)
- "Bone tumors: osteosarcoma and Ewingʼs sarcoma" Current Opinion in Pediatrics (2009)
- " Pathobiology and Diagnosis of Multiple Myeloma" Semin Oncol Nurs. (2017)
- "Multiple myeloma: from diagnosis to treatment" Aust Fam Physician (2013)
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