Chronic osteomyelitis

An infection that becomes established in bone is difficult to treat,

since bone is relatively avascular. The result is an osteomyelitis. If
this process occurs over years, the bone becomes markedly
remodelled. At the site of involvement, there is a cental area of
pale necrotic "sequestrum" that is surrounded by irregular
remodelled "involucrum" that produces marked distortion. The
weakened bone is prone to fracture. In this case, the irregular
involucrum is seen above in the upper femur. In the view below,
the sequestrum is seen around the metallic prosthesis used to
stabilize a femur at the hip.

Chronic osteomyelitis

This is chronic osteomyelitis. Note the fibrosis of the

marrow space accompanied by chronic inflammatory cells.
There can be bone destruction with remodelling.
Osteomyelitis is very difficult to treat.

This picture in the (left) was taken from the above picture .
if you notice it resembles flowing stream which is very hard
to swim against it . also the chronic osteomyelitis it is very
hard to treat

Chronic / acute osteomyelitis

At high magnification can be seen acute inflammation as

well as chronic inflammation with fibrosis and an irregular
fragment of necrotic bone in this case of acute and chronic
osteomyelitis. In this case, a diabetic foot ulcer extended into
the underling calcaneus.

This picture in the (left) was taken from the above picture .
if you notice the dark pink zone resembles batman symbol
.batman is fast and sudden also acute
inflammation .

Osteosarcoma

This femur has a large eccentric tumor mass arising in the

metaphyseal region. This is an osteosarcoma (a variant
known as parosteal osteogenic sarcoma) of bone. These
tumors most often occur in young persons (note that the
epiphysis seen at the right is still present).

Osteosarcoma

This osteosarcoma arising in the metaphysis at the

upper tibia of a teenage boy breaks through the bone
cortex and extends into soft tissue. The tumor is firm
and tan-white. The glistening white articular cartilage of
the femoral condyle can be seen just to the right of the
tumor in the opened joint space.

The area surrounded by the orange line , represents

the neoplasm .

Osteosarcoma / microscopic appearance

The microscopic appearance of an osteosarcoma is shown

here. Sarcomas have very pleomorphic cells, often with a
spindle shape. One large cell with very large nuclei is seen
near the center. There are islands of reactive new bone.

This picture in the (left) was taken from the above picture .
if you notice there is "C shape" in the picture , cancer starts
with the letter "C" osteosarcoma is also a cancer

Osteosarcoma /diagnostic features under microscope

The neoplastic spindle cells of an osteosarcoma are seen to be

making pink osteoid here. Osteoid production by a sarcoma is
diagnostic of osteosarcoma.

This picture in the (left) was taken from the above picture .
From the right uppermost angle . if you notice it somehow
resembles "O" O is the first letter of both "Osteoid" and
"Osteosarcoma" .

Chondrosarcoma in ischium of pelvis

Here is a chondrosarcoma arising in the ischium of the

pelvis. The tumor is composed of lobulated glistening white
to bluish-white tissue that breaks through the cortex. In
general, peripheral cartilagenous tumors (e.g., fingers) are
benign and those arising in the central axial skeleton are
malignant.

The area surrounded by the orange line , represents

the neoplasm .

Chondrosarcoma in pelvis

Here is another example of a chondrosarcoma arising in the

pelvis. Note the extensive nodules of white to bluish-white
cartilagenous tumor tissue eroding and extending outward from
the bone at the lower right. Chondrosarcomas can occur over a
wide age range, and there is a slight male predominance.
Many of them are slow growing, with symptoms present for a
decade or more.

Chondrosarcoma in femur

This is a femur that is hemisectioned to reveal an irregular tumor

mass composed of islands of bluish-white cartilagenous
tissue. This is a chondrosarcoma, which has a predilection for
involvement of metaphysis or diaphysis. As seen here, the
cortex is thickened and eroded, but there is little periosteal
reaction.

Chondrosarcoma / microscopic appearance

This is the low power microscopic appearance of a

chondrosarcoma. The tissue is recognizable as cartilage, and
there are chondrocytes in clear spaces, but there is no orderly
pattern. At the bottom, this neoplasm can be seen invading and
destroying bone.

Chondrosarcoma / microscopic appearance

This high power microscopic appearance of a chondrosarcoma

shows pleomorphic chondrocytes that are grouped together in
a haphazard arrangement. In general, chondrosarcomas occur
over a wider age range than osteosarcomas, including older
adults.

Ewing sarcoma

This is a Ewing sarcoma. This type of primary bone tumor

mainly occurs in the diaphysis of long bones of children and
young adults. There is a slight male predominance. As seen
here, the irregular tan to red to brown tumor mass is
breaking through the bone cortex. More normal fatty marrow
is seen at the far right.

The area surrounded by the orange line , represents

the neoplasm .

Ewing sarcoma/ microscopic appearance

Ewing sarcoma cells contain abundant glycogen, as seen by the

reddish granular cytoplasmic staining by PAS stain here.

Bone Metastatic carcinoma

Here is a closer view of bone metastases. Virtually all bone

metastases are from carcinomas. The primary sites of
carcinomas that commonly go to bone are: breast, prostate,
kidney, thyroid, lung. Renal cell carcinomas tend to be
osteolytic (they destroy the bone) whereas prostatic
adenocarcinomas tend to be osteoblastic (they initiate new
bone formation).

Bone Metastatic carcinoma

At high magnification, metastatic infiltrating ductal carcinoma

of breast is seen within bone and filling the marrow cavity.
There is reactive new bone with pale pink osteoid being laid
down next to a bony spicule at the upper left.

Osteochondroma of bone

This is an osteochondroma of bone. This lesion appears as a

bony projection (exostosis). Most are solitary, incidental
lesions that may be excised if they cause local pain. There is
a rare condition of multiple osteochondromatosis marked by
bone deformity and by a greater propensity for development
of chondrosarcoma.

Excised Osteochondroma of bone

This is a surgically excised osteochondroma cut into three

sections. A bluish-white cartilagenous cap overlies the bony
cortex. These are probably not true neoplasms, but a
localized proliferation producing a mass lesion that extends
outward from the metaphyseal region of a long bone.

Excised Osteochondroma of bone

This is an example of an excised osteochondroma that has a

broader base, but still consists of cancellous bone capped by
cartilage.

Osteochondroma / Microscopic appearance

The microscopic appearance of an osteochondroma displays

the benign cartilagenous cap at the left and the bony cortex at
the right. This bone growth, though benign, can sometimes
cause problems of pain and irritation that leads to removal
surgically.

This picture in the (left) was taken from the above picture .
if you notice it somehow resembles wolf opening his mouth
if it bites us it will cause pain , also remember that
osteochondroma causes pain so it has to be removed.

Giant cell tumor of bone

Here is a giant cell tumor of bone. The proximal femur has

been amputated and cut in half to reveal an irregular dark redblack hemorrhagic mass in the epiphyseal region. Giant cell
tumors appear lytic on plain film radiography.

This picture ( in the left) was cut from the above

picture . it resembles butterfly , and as you know
butterfly flies for huge (giant ) distances .
Butterfly = giant distances = giant cell tumor :O

Giant cell tumor of bone / microscopic

appearance

Histologically, giant cell tumors of bone as seen here are

composed of osteoclast-like multinucleated giant cells in a sea
of round to oval mononuclear stromal cells. There may also be
foamy macrophages and hemosiderin deposition in the stroma.
Though these tumors are biologically benign, they can expand
and cause pain, deformity, or fracture. They are treated by
curettage or resection, but when radiated, they may undergo
malignant transformation.

Brown tumor of bone with hyperthyroidism

Here is a "brown tumor" of bone in a patient with

hyperparathyroidism. The high parathormone levels increase
osteoclast activity in bone and produce irregular bone
resorbtion with microfractures and hemorrhage and
macrophage proliferation and fibrous connective tissue
proliferation.

This picture in the (left) was taken from the above

picture .
if you notice it somehow resembles "B" shape brown
starts with b , so "B" = brown tumor

Brown tumor of bone with hyperthyroidism

The center of the "brown tumor" contains osteoclasts and

mononuclear cells and fibroblasts with focal hemorrhages. The
hemosiderin from the hemorrhage produces the grossly brown
color. Such lesions are nowadays uncommon because
hyperparathyroidism is treated before such lesions develop.

Fibrous dysplasia of bone

Fibrous dysplasia of bone is a non-neoplastic process in which

there is a localized area in which irregular woven
bone proliferates but does not develop into solid lamellar
bone, leaving a weakened area that can produce deformity or
fracture. Most cases are monostotic, involving a single area in
adolescence. Polyostotic forms often appear earlier in
childhood and persist later into adulthood. The McCuneAlbright syndrome consists of polyostotic fibrous dysplasia in
conjunction with cafe-au-lait spots on the skin and disorders of
the endocrine system. In the low power view above and
medium power view below, there are irregular spicules of
woven bone in a cellular stroma.

- Many thanks to our student raad shatnawi for

providing me with the number of required slides
.

- I'm sorry about some stupid mnemonics that you

won't see in the coming labs, but I advise you to
use it especially in the slides containing
microscopic appearances (it is very helpful).