ABSTRACT
OBJECTIVES: Our classic histopathologic study of aneurysmal bone cyst (ABC) revealed that "blue reticulated chondroid-like material" (BRC) is characteristic of ABC. METHODS: The light microscopic findings were retrospectively analyzed in 215 cases of ABC, including 101 primary and 114 secondary cases. In addition, 22 cases of telangiectatic osteosarcoma (TOS) were drawn from the same source and used as a control. RESULTS: We found the presence of typical BRC in 24 (23.8%) of 101 cases of primary ABC and in six (5.3%) of 114 cases of secondary ABC, with an overall incidence of 30 (14%). None of the cases of TOS showed BRC. BRC was significantly more common in primary ABC than in secondary ABC (P < .05) and in patients 19 years or younger than in those 20 years or older (P < .05). CONCLUSIONS: BRC appears to be a unique histopathologic feature of ABC, making it valuable to differentiate benign ABC from TOS. Simple H&E stain can be economically performed anywhere.
Subject(s)
Bone Cysts, Aneurysmal/diagnosis , Bone Neoplasms/diagnosis , Diagnosis, Differential , Osteosarcoma/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: To discuss the concept of pseudoanaplastic tumors of bone, which pathologically show hyperchromatism and marked pleomorphism with quite enlarged, pleomorphic nuclei, but with no to extremely rare, typical mitoses, and to propose guidelines for their diagnosis. DESIGN AND PATIENTS: From a database of 4,262 bone tumors covering from 1971 to 2001, 15 cases of pseudoanaplastic bone tumors (0.35% of total) were retrieved for clinical, radiographic and pathologic review. Postoperative follow-up after surgical treatment was at least 3 years and a maximum of 7 years. RESULTS: There were eight male and seven female patients. Their ages ranged from 10 to 64 years with average of 29.7 years. Pathologic diagnoses of pseudoanaplastic variants of benign bone tumors included: osteoblastoma (4 cases), giant cell tumor (4 cases), chondromyxoid fibroma (3 cases), fibrous dysplasia (2 cases), fibrous cortical defect (1 case) and aneurysmal bone cyst (1 case). Radiography of all cases showed features of a benign bone lesion. Six cases, one case each of osteoblastoma, fibrous dysplasia, aneurysmal bone cyst, chondromyxoid fibroma, giant cell tumor and osteoblastoma, were initially misdiagnosed as osteosarcoma. The remaining cases were referred for a second opinion to rule out sarcoma. CONCLUSIONS: Despite the presence of significant cytologic aberrations, none of our cases showed malignant behavior following simple curettage or removal of bony lesions. Our observation justifies the concept of pseudoanaplasia in some benign bone tumors as in benign soft tissue tumors, especially in their late evolutionary stage when bizarre cytologic alterations strongly mimic a sarcoma.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/pathology , Adolescent , Adult , Anaplasia/diagnosis , Bone Cysts, Aneurysmal/diagnostic imaging , Bone Cysts, Aneurysmal/pathology , Child , Diagnostic Errors , Female , Femur/diagnostic imaging , Femur/pathology , Fibrous Dysplasia of Bone/diagnostic imaging , Fibrous Dysplasia of Bone/pathology , Follow-Up Studies , Giant Cell Tumors/diagnostic imaging , Giant Cell Tumors/pathology , Humans , Humerus/diagnostic imaging , Humerus/pathology , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Male , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/pathology , Osteoblastoma/diagnostic imaging , Osteoblastoma/pathology , Osteosarcoma/diagnostic imaging , Osteosarcoma/pathology , Radiography, Interventional , Retrospective Studies , Sacrum/diagnostic imaging , Sacrum/pathologyABSTRACT
BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare disease of uncertain etiology usually affecting the synovium of weightbearing joints. METHODS: We retrospectively evaluated 11 patients who were diagnosed and treated for PVNS of the ankle and foot over a 13-year period with a minimum of 2-year followup. Four patients with ankle joint PVNS and one patient with PVNS of the fifth metatarsophalangeal joint were seen initially at our institution and were treated with surgery alone. Six patients with ankle joint PVNS were referred to our institution for recurrent PVNS lesions; two of these patients were treated with excision alone, and the other four patients had surgical excision followed by radiation therapy with dosages ranging from 3600-4000 cGy. RESULTS: No recurrence was noted at a mean followup of 9 years for primary lesions and 3.5 years for recurrent lesions. CONCLUSION: Based on these results, surgical excision of primary lesions and excision with postoperative radiation for recurrent lesions are recommended.
Subject(s)
Ankle Joint , Foot Joints , Synovitis, Pigmented Villonodular , Adolescent , Adult , Aged , Ankle Joint/pathology , Child , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Synovectomy , Synovitis, Pigmented Villonodular/pathology , Synovitis, Pigmented Villonodular/radiotherapy , Synovitis, Pigmented Villonodular/surgeryABSTRACT
Desmoid tumor of bone, also termed desmoplastic fibroma or aggressive fibromatosis, is a rare, locally aggressive fibroblastic tumor. We present a 16-year-old male with a huge desmoid tumor involving the iliac wing. It was associated with enchondromatous nodules mimicking malignancy. The tumor in this patient was mistaken for chondrosarcoma and hemipelvectomy was performed. To our knowledge, such a case has not previously been documented fully in the English literature. The radiographic and pathologic findings and a possible mechanism of enchondromatous nodule formation in fibrous bone tumors are discussed.
