GPR: 2020 - Week 41

From MGH Learn Pathology

Clinical history

42 yo woman at 36 weeks pregnant with a pathologic hip fracture following several weeks of gradually increasing hip and thigh pain.


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Carcinoma, metastatic to bone
  • Most common malignancy in the bone.
  • Most common primaries are lung, breast, prostate, kidney
  • Commonly in the red marrow of the skull, spine, ribs, pelvis, humerus, femur. When in the long bones, typically in the metaphysis.




  • >90% are intramedullary
  • Most develop in the 5th – 7th decades
  • Most commonly in pelvis and femur (although may arise in any bone derived from endochondral ossification)
  • Cut surface has gray-tan and glistening neoplastic cartilage with focal ossification and chalky mineralization



Chordoma, conventional type

  • Arises from remnants of the notochord
  • 1-4% of primary bone tumors
  • Most are found in the axial skeleton, intraosseous
  • Slow growing with late presentation (with extra-compartmental invasion) with back pain
  • Classic form shows chords of tumor cells and lobules with mucoid matrix
  • Gelatinous, tan-grey to chondroid cut surface




  • Most common malignant primary bone tumor (excluding hematopoietic intraosseous tumors)
  • Peak incidence in 2nd and 3rd decades
  • Most often located in the medullary cavity of the metaphysis of a growing long tubular bone
  • Mesodermal origin with osseous, chondroid or fibrous differentiation

  • Deshpande V, Rosenberg A, Nielsen G. Metastatic Tumors: Bone. ExpertPath. Oct 2020.
  • Klein MJ, Siegal GP. Osteosarcoma Anatomic and Histologic Variants. Am J Clin Pathol. 2006; 125:555-581. doi: 10.1309/UC6KQHLD9LV2KENN
  • Nielsen GP, Rosenberg AE. Conventional Chondrosacoma. ExpertPath. Elsevier. 24/5/2020.
  • Pillai S, Govender S. Sacral chordoma : A review of literature. J Orthop. 2018;15(2):679‐684. Published 2018 May 2. doi:10.1016/j.jor.2018.04.001

This week's Gross Pathology Roundup was presented by Caroline Hilburn, MD on Mon, Oct 05, 2020.