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Full download Bone 2nd Edition G. Petur Nielsen file pdf all chapter on 2024
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Full download Bone 2nd Edition G. Petur Nielsen file pdf all chapter on 2024
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SECOND EDITION
NIELSEN | ROSENBERG
DESHPANDE • HORNICEK • KATTAPURAM • ROSENTHAL
ii
SECOND EDITION
G. Petur Nielsen, MD
Pathologist, Department of Pathology
Director of Electron Microscopy
Director of Bone & Soft Tissue Pathology
Massachusetts General Hospital
Professor of Pathology
Harvard Medical School
Boston, Massachusetts
Andrew E. Rosenberg, MD
Professor and Vice Chair
Director of Bone & Soft Tissue Pathology
Department of Pathology
Miller School of Medicine
University of Miami
Miami, Florida
iii
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details
on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
iv
Dedications
To my wife and family.
GPN
v
vi
Preface
The pathology of the skeleton is complex and is the morphologic expression of a broad spectrum of
diseases, including those caused by genetic (sporadic and inherited), malformative, inflammatory, metabolic,
circulatory, traumatic, iatrogenic, and neoplastic disorders. Bone tumors, including both neoplasms
and various conditions that may simulate them, are the focus of our book. This topic is one of the most
challenging areas in surgical pathology for several reasons: Bone tumors are uncommon, making it difficult
to acquire the necessary experience with their histological variants and mimics; the correct diagnosis usually
requires the careful integration of radiological imaging studies and clinical findings; the implications of a
diagnosis on a patient can be life changing; and medical schools and pathology training programs often have
insufficient expertise to provide medical students and young pathologists with the skills needed to diagnose
these lesions accurately and precisely.
This book reflects the philosophy and high standards practiced by the truly multidisciplinary team of
physicians at the Massachusetts General Hospital and University of Miami, who have diagnosed and surgically
treated tens of thousands of patients with bone tumors for many decades. Also important to acknowledge
are the contributions of the many fellows and residents who participated in the efforts of patient care.
The authors are subspecialized physicians who have dedicated their professional lives to the diagnosis and
surgical management of bone tumors. As a result, the figures include beautiful and classic examples and
unusual variants of many of the diseases discussed and are the product of painstaking correlations between
the clinical, imaging, macroscopic, histological, immunohistochemical, and molecular characteristics of bone
tumors. The text synthesizes the literature and our combined extensive experience, and the images have
been selectively culled from the patient files of the Massachusetts General Hospital, the University of Miami
Miller School of Medicine, and the private consultations of the authors. The book is constructed in a thematic
format with sections representing groups of related diseases and the chapters discussing individual entities
and their differential diagnosis.
Accordingly, this textbook serves as an excellent resource for medical students, residents, fellows, and
practicing physicians in the disciplines of pathology, radiology, and orthopedics. Medical and radiation
oncologists who treat bone tumors will also find it valuable. Our opportunity to participate in the care
of patients with bone tumors has been our call and honor, and we hope to do it justice by sharing our
experience with the medical community—our goal is to enhance diagnostic accuracy and to provide the
biological basis for optimal treatment.
G. Petur Nielsen, MD
Pathologist, Department of Pathology
Director of Electron Microscopy
Director of Bone & Soft Tissue Pathology
Massachusetts General Hospital
Professor of Pathology
Harvard Medical School
Boston, Massachusetts
Andrew E. Rosenberg, MD
Professor and Vice Chair
Director of Bone & Soft Tissue Pathology
Department of Pathology
Miller School of Medicine
University of Miami Hospital
Miami, Florida
vii
viii
Acknowledgments
Text Editors
Arthur G. Gelsinger, MA
Nina I. Bennett, BA
Lisa A. Gervais, BS
Karen E. Concannon, MA, PhD
Matt W. Hoecherl, BS
Megg Morin, BA
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Illustrations
Laura C. Sesto, MA
Richard Coombs, MS
Lane R. Bennion, MS
Lead Editor
Terry W. Ferrell, MS
Production Coordinators
Angela M. G. Terry, BA
Rebecca L. Bluth, BA
Emily C. Fassett, BA
ix
x
Sections
SECTION 1: Benign Bone-Forming Tumors
xi
TABLE OF CONTENTS
xii
TABLE OF CONTENTS
400 Leiomyosarcoma
SECTION 9: GIANT CELL-RICH TUMORS G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
256 Giant Cell Tumor 404 Myoepithelioma
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
270 Brown Tumor 410 Schwannoma
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
274 Giant Cell Reparative Granuloma 414 Myxopapillary Ependymoma
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD Vikram Deshpande, MD, G. Petur Nielsen, MD, and
Andrew E. Rosenberg, MD
SECTION 10: CYSTIC LESIONS OF BONE 416 Phosphaturic Mesenchymal Tumor
282 Intraosseous Ganglion G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
286 Unicameral Bone Cyst SECTION 14: METASTATIC TUMORS
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD 420 Metastatic Tumors
294 Aneurysmal Bone Cyst Vikram Deshpande, MD, Andrew E. Rosenberg, MD, and
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD G. Petur Nielsen, MD
306 Epidermoid Inclusion Cyst
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD SECTION 15: BONE TUMOR MIMICS
428 Bizarre Parosteal Osteochondromatous
SECTION 11: VASCULAR TUMORS
Proliferation and Related Lesions
310 Conventional Hemangioma G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD 434 Melorheostosis
318 Lymphangioma/Lymphangiomatosis G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD 438 Amyloidoma
320 Epithelioid Hemangioma G. Petur Nielsen, MD, Andrew E. Rosenberg, MD, and
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD Vikram Deshpande, MD
328 Pseudomyogenic Hemangioendothelioma 440 Gaucher Disease
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
334 Epithelioid Hemangioendothelioma
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
340 Angiosarcoma
G. Petur Nielsen, MD and Andrew E. Rosenberg, MD
xiii
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SECOND EDITION
NIELSEN | ROSENBERG
DESHPANDE • HORNICEK • KATTAPURAM • ROSENTHAL
This page intentionally left blank
SECTION 1
Bone Island/Osteopoikilosis 4
Osteoma 10
Osteoid Osteoma 16
Osteoblastoma 22
Bone Island/Osteopoikilosis
KEY FACTS
Benign Bone-Forming Tumors
4
Bone Island/Osteopoikilosis
ETIOLOGY/PATHOGENESIS CT Findings
• Small stellate medullary lesion with characteristics of
Neoplasm
cortical-type bone
• Cause of bone island is unknown
• Osteopoikilosis may be inherited in autosomal dominant Bone Scan
fashion • Can show some uptake of radionuclide
○ Associated with mutations and loss of function in LEMD3
located on 12q14 MACROSCOPIC
General Features
CLINICAL ISSUES
• Hard, solid, and tan-white; periphery blends into
Presentation surrounding trabeculae, which accounts for irregular
• Incidental radiographic finding and asymptomatic spiculated margins
○ Large bone islands may be painful
• Uncommon in children MICROSCOPIC
• Lesions in osteopoikilosis may undergo slow, progressive Histologic Features
enlargement or involution
• Consist of cortical-type bone containing haversian-like
Treatment canals
• Observation for small solitary lesions with classic • Predominately lamellar but may be focally woven
radiographic features • Osteoblasts lining surfaces are flat and quiescent
• Larger variants or cases in adolescents may require biopsy • Osteocytes are small and cytologically banal
to exclude more aggressive lesions, such as well- • Bone islands in osteopoikilosis are identical to sporadic,
differentiated osteosarcoma and sclerotic metastases in solitary bone islands
adults
DIFFERENTIAL DIAGNOSIS
Prognosis
• Excellent Well-Differentiated Osteosarcoma
• Malignant transformation does not occur • Infiltrative, composed of proliferating mildly atypical
spindle cells and woven bone
IMAGING Sclerotic Metastases
General Features • Usually in adults and contain histologically malignant cells
• Location
○ Most frequent sites are pelvis, ribs, and proximal femur DIAGNOSTIC CHECKLIST
○ In adults, incidence in pelvic bones (1.0%) and ribs (0.5%) Clinically Relevant Pathologic Features
○ Epiphyseal in tubular bones • Multiple lesions raise differential diagnosis of blastic
○ Osteopoikilosis is bilateral and symmetrical in metastases; multiple bone islands seen in osteopoikilosis
distribution and in metaphyseal and epiphyseal regions
of tubular bones Pathologic Interpretation Pearls
– Any bone may be affected, including tarsal and carpal • Lesion is intramedullary, cortical in type, and predominately
bones lamellar in architecture
• Size
○ Usually < 1 cm in diameter SELECTED REFERENCES
○ Infrequently, "giant" bone islands several cm in diameter 1. Korkmaz MF et al: Osteopoikilosis: report of a familial case and review of the
occur literature. Rheumatol Int. ePub, 2014
5
Another random document with
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ascertained to be the case by observation; the observations being
made by Captain Hewett, then employed in a survey of that sea.
But many points of this kind might be decided, and our knowledge
on this subject might be brought to a condition of completeness, if a
ship or ships were sent expressly to follow the phenomena of the
Tides from point to point, as the observations themselves might
suggest a course. Till this is done, our knowledge cannot be
completed. Detached and casual observations, made aliud agendo,
can never carry us much beyond the point where we at present are.
Double Stars.
58 Outlines of Astronomy.
59 Out. 844.
END OF VOL. I.
HISTORY
OF THE
I N D U C T I V E S C I E N C E S.
VOLUME II.
B O O K VIII.
. . . . . . Ἐσσυμένη δὲ
Ἠερίην ἀψῖδα διεῤῥοίζησε πεδίλῳ
Εἰς δόμον ἉΡΜΟΝIΗΣ παμμητόρος, ὁππόθι νύμφη
Ἴκελον οἶκον ἐναίε τύπῳ τετράζυγι κόσμου
Αὐτοπαγῆ Nonnus. Dionysiac. xli. 275.
2 Ibid.
3 De Arch. v. 3.
Both the comparison, and the notice of the difference of the two
cases, prove the architect to have had very clear notions on the
subject; which he further shows by comparing the resonance of the
walls of a building to the disturbance of the outline of the waves of
water when they meet with a boundary, and are thrown back.
“Therefore, as in the outlines of waves in water, so in the voice, if no
obstacle interrupt the foremost, it does not disturb the second and
the following ones, so that all come to the ears of persons, whether
high up or low down, without resonance. But when they strike
against obstacles, the foremost, being thrown back, disturb the lines
of those which follow.” Similar analogies were employed by the
ancients in order to explain the occurrence of Echoes. Aristotle
says, 4 “An Echo takes place, when the air, being as one body in
consequence of the vessel which bounds it, and being prevented
from being thrust forwards, is reflected 26 back like a ball.” Nothing
material was added to such views till modern times.
4 De Animâ, ii. 8.