GPR: 2020 - Week 41

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.

Chondrosarcoma

>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

Osteosarcoma

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.