Chondro-osseous tumours
Revision as of 12:32, 25 August 2013 by Michael (talk | contribs) (→Giant cell tumour of bone: split out)
Chondro-osseous tumours occasionally cross the desk of the pathologist. They are grouped together as bone may develop from cartilage.
Primary bone tumours are rare; the most common bone tumour is metastases.[1]
Bone tumours occasionally are lumped with soft tissue tumours. Soft tissue tumours are dealt with in the soft tissue lesions article. An introduction to bone is found in the bone article. An introduction to cartilage is found in the cartilage article.
General
- Diagnosis of a primary bone tumour should not be made without radiologic & clinical information!
- Metastasis:primary bone tumours = >20:1.[1]
Common malignant
- Osteosarcoma.
- Chondrosarcoma.
- Ewing's sarcoma.
- Multiple myeloma.
- Metastases.
- Most common tumours metastatic to bone (mnemonic: BLT with Ketchup & Pickles):
Epidemiology:[2]
- Osteosarcoma -> 2nd decade.
- Ewing's ->5-20 yrs.
- Chondrosarcoma -> from enchondroma or osteochrondroma -- patients over 40 yrs.
- Multiple myeloma -> most common primary bone tumour in adults.
Malignant bone tumours by age
Most common by age:[2]
- <1 year old - neuroblastoma.
- 1-10 years old - Ewing's of tubular bones.
- 10-30 years old - osteosarcoma, Ewing's of flat bones.
- 30-40 years old - reticulum cell sarcoma, fibrosarcoma, parosteal osteosarcoma, malignant giant cell tumour, lymphoma.
- >40 years old - mets, multiple myeloma, chondrosarcoma.
Benign aggressive bone tumours
- Giant cell tumour of bone.
- Osteoblastoma.
- Thought to be related to osteoid osteoma.
- If in long bones often diaphyseal.
Summary tables
Bone tumours
| Entity | Key feature | Other features | Radiology / gross | Clinical | Stains / other | Image |
|---|---|---|---|---|---|---|
| Osteoma | normal bone (???) | other features (???) | radiology / gross (???) | ? | no stains / may be assoc. with FAP | Image (???) |
| Osteoid osteoma | osteoblastic rimming | anastomosing bony trabeculae | <= 1.5 cm, metaphysis | painful, NSAIDs remove pain, young | IHC / other | |
| Osteoblastoma | osteoblastic rimming | anastomosing bony trabeculae | > 1.5 cm, metaphysis | not painful | IHC / other | |
| Ewing sarcoma | small round blue cell tumour | cytoplasmic clearing (due to glycogen) | usu. diaphysis | pediatric, typically 1-10 years | PAS+, PASD-, chromosomal translocations (usually t(11;22)(q24;q12)) |  Ewing sarcoma. PAS stain. (WC) |
| Osteosarcoma | osteoid | +/-hemorrhage, +/-cartilage | distal femur, prox. tibia, prox. humerous | typically 10-30 years, pain, swelling | no stains; many subtypes | |
| Giant cell tumour of bone | abundant giant cells | nuclei of surrounding cells similar to those in giant cells | growth plate of long bones | 20-45 years old, +/-joint pain, +/-immobility | IHC / other |
Cartilage tumours
| Entity | Key feature | Other features | Radiology / gross | Clinical | Stains / other | Image |
|---|---|---|---|---|---|---|
| Chondroma | ctyologically benign cells | equally spaced nests | usu. diaphysis | benign / DDx: chondroma, well-diff. chondrosarcoma | IHC / bone marrow cavity chondroma = enchondroma | |
| Chondroblastoma | abundant extracellular material, abundant eosinophilic cytoplasm | calcifications surround cells nests ("chickenwire" appearance) - classic | epiphysis | DDx: giant cell tumour of bone | S100+ve, vimentin +ve | |
| Chondrosarcoma | cartilaginous appearance +/- nuclear atypia | lack osteoid, if present -> osteosarcoma | usu. diaphysis, classically hip; almost never distal extremity | >40 years old | IHC / may be histologically benign looking |
.jpg)
Other
| Entity | Key feature | Other features | Radiology / gross | Clinical | Stains / other | Image |
|---|---|---|---|---|---|---|
| Osteochondroma | benign bone and cartilage | Other features | metaphyseal lesions | Clinical | IHC / other | Image |
| Adamantinoma | bisphasic - stroma & epithelium | Other features | tibia, fibula, intracortical, radiolucent | Clinical | IHC / other | |
| Diffuse tenosynovial giant-cell tumour (AKA PVNS) | pigmented giant cells | nodules | Radiology / gross | Clinical | IHC / other | |
| Brown tumour | fibrosis, +/-giant cells | unaffected bone incr. osteoblasts and osteoclasts | Radiology / gross | due to hypercalcemia; not a neoplasm | IHC / other |
Radiology
Radiologic features
| Features | Benign | Malignant |
|---|---|---|
| Bone changes | sclerotic rim | tumour perforation |
| Circumscription | pushing margins | ill-defined/moth-eaten |
| Soft tissue involvement | no | common |
| Periosteal reaction | no | "hair-on-end" or "sunburst", "onion skin", Codman's triangle |
Location
| Diagnosis | Epiphysis | Metaphysis | Diaphysis | Type of lesion |
|---|---|---|---|---|
| Aneurysmal bone cyst | common | most common | rare | bone |
| Chondroblastoma | most common | rare | extremely rare | cartilage |
| Chondrosarcoma | uncommon | common | most common | cartilage |
| Chondromyxoid fibroma | rare | most common | common | other |
| Enchondroma | rare | common | common | cartilage |
| Ewing sarcoma | rare | common | most common | bone |
| Giant cell tumour | most common | rare | extremely rare | bone |
| Metastatic carcinoma | rare | common | most common | other |
| Non-ossifying fibroma | extremely rare | most common | common | other |
| Osteoblastoma | rare | most common | uncommon | bone |
| Osteochondroma | extremely rare[citation needed] | most common | common | bone/cartilage |
| Osteoid osteoma | uncommon | common | common[5] | bone |
| Osteosarcoma | rare | most common | uncommon | bone |
How to remember the primary bone lesions:
- Ewing sarcoma is the only malignant primary bone tumour of the diaphysis.
- Giant cell tumour of bone is the only primary bone lesion of the epiphysis.
- The rest of the primary bone lesions are metaphyseal.
- Osteochondroma is bone first and cartilage second. It behaves like most primary bone lesions; it is usually metaphyseal.
How to remember the primary cartilaginous lesions:
- Chondroblastoma is epiphyseal. The chicken wire goes around the chicken coop.
- The others are diaphyseal.
Cartilage
Chondroma
General
- Benign thingy.
- Usual legs and feet.
- May be difficult to separate from chondrosarcoma.
- Multiple chondromas = enchondromatosis; three distinct syndromes:[6]
- Ollier disease.
- Maffucci syndrome - with hemangiomas, increased risk of chondrosarcoma.[7]
- Metachondromatosis - autosomal dominant.
- Enchondroma = chondroma in the marrow space.
Clinical:[6]
- Pain.
Radiology
Features:[6]
- Lytic lesion.
- Usual close to a growth plate.
Microscopic
Features:
- Ctyologically benign cells is spaced nests.
Images
Enchondroma - intermed mag. (WC)
Enchondroma - very high mag. (WC)
Chondroblastoma
General
- Growth plate lesion.
- Sclerotic margin.
- "Young" = growth plates open.
- Typically painful.[8]
Gross
- Well-defined lesion.
Image:
Microscopic
Features:[9]
- Abundant extracellular material - pink on H&E stain - looks vaguely like cartilage.
- Chondroblasts:
- Nuclear morphology variable: ovoid, folded or grooved.
- Moderate-abundant eosinophilic cytoplasm.
- +/-Calcification surrounds the cell nests ("chickenwire" appearance) - classic feature.
- Cell nests have a thin pale blue rimming.
- +/-Giant cells.
- May lead to confusion with giant cell tumour of bone.
DDx:
- Giant cell tumour of bone.
- Chondroma.
- Well-differentiated chondrosarcoma.
Images
Chondroblastoma - intermed. mag. (WC)
Chondroblastoma - very high mag. (WC)
www:
- Chondroblastoma (medscape.com).[10]
- Chondroblastoma with "chickenwire" appearance (medscape.com).[10]
- Chondroblastoma (upmc.edu).[11]
IHC
Features:[9]
- S100 +ve.
- Vimentin +ve.[10]
Chondromyxoid fibroma
General
- Benign.
- Teenagers or young adults.
Gross
- Metaphyseal lesion.
- Well-circumscribed.
Microscopic
Features:[12]
- Spindle cells or stellate cells in a myxoid or chondroid stroma.
Images:
- Chondromyxoid fibroma - low mag. (webpathology.com).
- Chondromyxoid fibroma - high mag. (webpathology.com).
Chondrosarcoma
General
- Usually a good prognosis.
Clinical/epidemiologic features:[13]
- Usually arise in a (benign) abnormality of cartilage (e.g. osteochondroma, enchondroma).
- May be associated with a syndrome:
- Olier disease (multiple enchondromatosis).
- Maffucci syndrome (multiple enchondromas and hemangiomas).
Notes:
- Review article (from oncology perspective): PMID 17545802.
Subtypes
Several subtypes exist:
- Chondrosarcoma not otherwise specified (NOS).
- Juxtacortical chondrosarcoma.
- Myxoid chondrosarcoma.
- Mesenchymal chondrosarcoma.
- Clear cell chondrosarcoma.
- Dedifferentiated chondrosarcoma.
Microscopic
- "Abnormal cartilage":
- +/-Nuclear atypia - high grade lesions.
- High grade lesions:
- Nuclear clearing.
- Nucleoli.
- Hyperchromasia.
- Low/intermediate grade lesions:
- Bi-nucleation.
- Hypochromatic enlarged nuclei.
- Infiltration of lamellar bone ("invasion") - not common - diagnostic.
- High grade lesions:
- Increased cellularity.
- More cellular than cartilage... but relatively paucicellular compared to other sarcomas.
- Irregular spacing of chondrocytes.
- +/-Nuclear atypia - high grade lesions.
Notes:
- Low grade chondrosarcoma are not cytologically malignant; the diagnosis rests mostly on radiologic findings.
- The exception is infiltration of lamellar bone -- this is diagnostic of chondrosarcoma.[16]
DDx:
- Chordoma.
- Enchondroma.
- Synovial chondromatosis.
- Osteosarcoma - esp. chondroblastic osteosarcoma - has osteoid, may be focal.
Images
Chondrosarcoma - low mag. (WC)
Chondrosarcoma - high mag. (WC)
Chondrosarcoma - high mag. (WC)
.jpg)
.jpg)
Variants
Mesenchymal chondrosarcoma
- Arise in soft tissue; this is where the name comes from.[17]
- Rare variant of chondrosarcoma.
Microscopic: Features:
- "White clouds in a blue sky".
Image:
Myxoid chondrosarcoma
Microscopic: Features:
DDx:
Extraskeletal myxoid chondrosarcoma
- Originally thought to be a variant of myxoid chondrosarcoma of bone; however, may not be a chondrosarcoma at all.[19]
- Characteristic chromosomal translocation: t(9;22) CHN-EWS.
DDx:
- Chordoma.[19]
- S-100 +ve (strong).
- EMA +ve.
Image:
Dedifferentiated chondrosarcoma
Clinical:
- Abysmal to poor prognosis.
Features:[22]
- Poorly differentiated (mesenchymal) malignancy.
- Well-differentiated cartilaginous component.
Images:
Grading
Features:[23]
- Grade I: mild-to-moderate increase of cellularity +/- binucleated cells.
- Grade II: between Grade I and Grade III.
- Grade III: nuclear pleomorphism, mitoses common.
IHC
- S-100 -ve. (???)
Bone
Osteoma
General
- Benign.
- May be associated with familial adenomatous polyposis.
- Normal bone - unusual location/outgrowth.
Microscopic
Features:
- Normal bone.
Osteoid osteoma
- Abbreviated OO.
General
- Benign bone lesion.
Clinical:[24]
- Extremely painful.
- Relieved by NSAIDs.
Gross
Images:
Microscopic
Features:[24]
- Anastomosing bony trabeculae with:
- Variable mineralization.
- Mineralization (calcium phosphate) = purple on H&E stain.
- Osteoblasts rimming.
- Cells line-up at edge of bone.
- Variable mineralization.
Note:
- Histomorphologically near identical/indistinguishable from osteoblastoma;[28] one needs some history to make the diagnosis.
Images
Osteoid osteoma - low mag. (WC)
Osteoid osteoma - intermed. mag. (WC)
Osteoid osteoma - high mag. (WC)
Osteoid osteoma - very high mag. (WC)
www:
Sign out
BONE, RIGHT FEMUR, EXCISION: - OSTEOID OSTEOMA.
Micro
The sections show anastomosing bony trabeculae with variable mineralization and osteoblastic rimming. Multinucleated osteoclasts are scattered through the lesion. Hemosiderin-laden macrophages are present. No osteocyte nuclear atypia is apparent. Mitotic activity is not apparent. The osteoid is not lace-like.
Osteoblastoma
General
- Benign bone tumour.
Microscopic
Features:[24]
- Anastomosing bony trabeculae with:
- Osteoblasts rimming.
- Cells line-up at edge of bone.
- Osteoblasts rimming.
Notes:
- Histomorphologically near identical/indistinguishable from osteoid osteoma.[28]
- Must be greater 1.5 cm by definition.[28]
Images
Osteoblastoma - high mag. (WC)
Osteoblastoma - low mag. (WC)
Ewing sarcoma
Main article: Ewing sarcoma
Osteosarcoma
Main article: Osteosarcoma
Giant cell tumour of bone
Main article: Giant cell tumour of bone
Other
This section collects stuff that doesn't neatly fit into the bone or cartilage category.
Osteochondroma
General
- Benign.
- Very common.
- Abnormal outgrowth of bone and cartilage - associated with growth plate.
- Usually present before age 20.[29]
Gross
Features:
- Metasphyseal lesions.[30]
- Mushroom-like shape - with broad or narrow base.
Note:
- Very unusual in craniofacial bones.[29]
Microscopic
Features:[29]
- Bone - forms base of "mushroom".
- Cartilage - layer usu. thinner in older individuals.
- Lobular arrangement[32] - clusters of 3-12 lacunae (separated by stroma).
- May have mild atypia.
- Nuclear enlargement - up to 5x normal.
- Perichondrium - covers the cartilage.
- Thin layer of cells - higher cellular density than cartilage.
- Bland spindle cells in a fibrous (eosinophilic) stroma.
- Thin layer of cells - higher cellular density than cartilage.
Notes:
- Benign cartilage - one chondrocyte per lacuna, small and round nucleus, no binucleation.
DDx:
- Chondrosarcoma - esp. in older individuals.
Images:
Diffuse tenosynovial giant-cell tumour
- AKA tenosynovial giant-cell tumour, diffuse type.
- Previously known as pigmented villonodular synovitis (PVNS).[33]
General
- Course: benign.
- Giant cell tumor of the tendon sheath is considered to be the soft-tissue counterpart of PVNS.[34]
- Typically knee or hip.[35]
Microscopic
Features:[36]
- Subsynovial nodules composed of cells with:
- Abundant cytoplasm.
- Pale nuclei.
- Multinucleated giant cells.
- Hemosiderin-laden macrophages.
- Foam cells.
Images
PVNS - low mag. (WC)
PVNS - high mag. (WC)
www:
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RIGHT FEMORAL HEAD AND JOINT CAPSULE, EXCISION: - DEGENERATIVE JOINT DISEASE. - DIFFUSE TENOSYNOVIAL GIANT-CELL TUMOUR (PIGMENTED VILLONODULAR SYNOVITIS).
Micro
The soft tissue sections show nodules with abundant hemosiderin-laden macrophages and multinucleated giant cells. Nuclear atypia is not identified. Mitotic activity is not apparent.
Giant cell tumour of tendon sheath
- Abbreviated GCT of tendon sheath.
General
- Can be thought of as the small joint version of diffuse tenosynovial giant-cell tumour (AKA PVNS).[37]
- Rarely recur.
- Classically afflicts the hand.[38]
- Rarely malignant.[39][40]
Gross
Features:[38]
- Circumscribed mass - yellow-brown to tan.
Note:
- May be associated with bony erosions in larger lesions.[38]
Image:
Microscopic
Features:[37]
- Foam cells.
- Cells with moderate to abundant foamy-appearing cytoplasm.
- Multinucleated giant cells - may be scarce.
- +/-Tendon.
- Dense connective tissue.
- +/-Hemosiderin-laden macrophages.
Note:
- Features of malignancy: nuclear pleomorphism,[40] abnormal mitoses, >10 mitoses/HPF, tumour necrosis lack of maturation to superficial part (nuclei shrink, cytoplasm lipid-ified).[37]
DDx:
Images
GCT of tendon sheath. (WC/KGH)
.jpg)
www:
- GCT of tendon sheath - very low mag. (webpathology.com)
- GCT of tendon sheath - low mag. (webpathology.com).
- GCT of tendon sheath - high mag. (webpathology.com).
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LESION, RIGHT INDEX FINGER, EXCISION: - GIANT CELL TUMOUR OF THE TENDON SHEATH.
Micro
The sections show histiocytes and rare multinucleated giant cells on a background of dense connective tissue compatible with tendon. No nuclear atypia is apparent. Rare mitotic activity is identified. No atypical mitoses are apparent.
Adamantinoma
- Should not be confused with adenomatoid tumour.
General
Features:[42]
- Rare: < 1% of bone tumours.
- 25-35 years old.
- Tibia, fibula.
- Benign, may be locally aggressive.
- Cousin of ameloblastoma. (???)
Radiology
- Intracortical, radiolucent.
Microscopic
Features:
- Biphasic tumour:
- Fibrous/spindle cell component.
- Epithelial component.
DDx:[43]
- Vascular tumours (Epithelioid hemangioendothelioma).
- Metastatic carcinoma.
Images
Adamantinoma - intermed. mag. (WC)
www:
IHC
Features:[43]
- CK14 +ve (HMWK).[45]
- CK19 +ve (LMWK).
- CK8/18 -ve (LMWK).
Brown tumour
General
- Not a true neoplasm.[46]
- If tumour is understood as a synonym for neoplasm, the name is a misnomer.
- May (clinically) mimic a true neoplasm.
- Due to hyperparathyroidism - usually parathyroid adenoma.
- Usually secondary to chronic renal failure.
Hypercalcemia DDx
Mnemonic GRIMED:[47]
- Granulomatous disease (tuberculosis, sarcoidosis).
- Renal disease.
- Immobility.
- Malignancy (esp. squamous cell carcinoma, plasmacytoma).
- Endocrine (primary hyperparathyroidism - leads to brown tumour).
- Drugs (thiazides ... others).
Microscopic
Features:
- Fibrosis.
- +/-Giant cells with round to oval nuclei and nucleoli.[48]
- Bone unaffected by tumour - increased numbers of the following:
- Multinucleated cells (osteoclasts).
- Mononuclear cells around the bony trabeculae (osteoblasts).
DDx:
- Giant cell tumour of bone and other giant cell lesions.
Images
Brown tumour - low mag. (WC)
Brown tumour - intermed. mag. (WC)
Brown tumour - high mag. (WC)
www:
See also
References
- ↑ 1.0 1.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 632. ISBN 978-0781765275.
- ↑ 2.0 2.1 Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. OR42. ISBN 978-0968592854.
- ↑ Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. OR41. ISBN 978-0968592854.
- ↑ URL: http://www.emedicine.com/RADIO/topic494.htm.
- ↑ URL: http://www.wheelessonline.com/ortho/osteoid_osteoma. Accessed on: 7 May 2012
- ↑ 6.0 6.1 6.2 URL: http://emedicine.medscape.com/article/389224-overview. Accessed on: 25 December 2010.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 166000
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 625. ISBN 978-1416054542.
- ↑ 9.0 9.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 642. ISBN 978-0781765275.
- ↑ 10.0 10.1 10.2 URL: http://emedicine.medscape.com/article/1254949-diagnosis. Accessed on: 31 December 2010.
- ↑ URL: http://path.upmc.edu/cases/case494.html. Accessed on: 24 January 2012.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 642. ISBN 978-0781765275.
- ↑ Skubitz KM, D'Adamo DR (November 2007). "Sarcoma". Mayo Clin. Proc. 82 (11): 1409–32. PMID 17976362. http://www.mayoclinicproceedings.com/content/82/11/1409.long.
- ↑ IAV. 26 February 2009.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 417. ISBN 978-1416002741.
- ↑ Dickson, B. 28 April 2011.
- ↑ Dowling EA (June 1964). "Mesenchymal chondrosarcoma". J Bone Joint Surg Am 46: 747–54. PMID 14161087. http://www.ejbjs.org/cgi/reprint/46/4/747.pdf.
- ↑ Fisher C (May 2000). "Parachordoma exists--but what is it?". Adv Anat Pathol 7 (3): 141–8. PMID 10809219.
- ↑ 19.0 19.1 Aigner, T.; Oliveira, AM.; Nascimento, AG. (Feb 2004). "Extraskeletal myxoid chondrosarcomas do not show a chondrocytic phenotype.". Mod Pathol 17 (2): 214-21. doi:10.1038/modpathol.3800036. PMID 14657948.
- ↑ URL: http://www.cttr.org/cms/?p=736. Accessed on: 1 May 2011.
- ↑ Mitchell, AD.; Ayoub, K.; Mangham, DC.; Grimer, RJ.; Carter, SR.; Tillman, RM. (Jan 2000). "Experience in the treatment of dedifferentiated chondrosarcoma.". J Bone Joint Surg Br 82 (1): 55-61. PMID 10697315.
- ↑ 22.0 22.1 Sopta, J.; Dordević, A.; Tulić, G.; Mijucić, V. (Feb 2008). "Dedifferentiated chondrosarcoma: our clinico-pathological experience and dilemmas in 25 cases.". J Cancer Res Clin Oncol 134 (2): 147-52. doi:10.1007/s00432-007-0262-5. PMID 17653766.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 643. ISBN 978-0781765275.
- ↑ 24.0 24.1 24.2 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 285. ISBN 978-0781740517.
- ↑ 25.0 25.1 URL: http://radiology.uthscsa.edu/CME/ELTXT/OOT/skeletallocation.html http://radiology.uthscsa.edu/CME/ELTXT/OOT/skeletallocation.html]. Accessed on: 7 May 2012.
- ↑ URL: http://www.radiologyassistant.nl/en/494e15cbf0d8d. Accessed on: 7 May 2012.
- ↑ URL: http://njms2.umdnj.edu/tutorweb/gross.htm. Accessed on: 7 May 2012.
- ↑ 28.0 28.1 28.2 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 286. ISBN 978-0781740517.
- ↑ 29.0 29.1 29.2 29.3 Parkin, B.; Bennett, JC.; Zaher, A. (Aug 2003). "Pathologic quiz case: an iliac mass in a 25-year-old woman. Osteochondroma.". Arch Pathol Lab Med 127 (8): e355-6. doi:10.1043/1543-2165(2003)127e355:PQCAIM2.0.CO;2. PMID 12873205.
- ↑ URL: http://www.medpath.info/MainContent/Skeletal/Bone_07.html. Accessed on: 18 September 2012.
- ↑ Kokavec, M.; Gajdoš, M.; Džupa, V. (2011). "[Osteochondroma of the iliac crest: case report].". Acta Chir Orthop Traumatol Cech 78 (6): 583-5. PMID 22217414.
- ↑ 32.0 32.1 URL: http://path.upmc.edu/cases/case341/dx.html. Accessed on: 19 September 2012.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1247. ISBN 978-1416031215.
- ↑ URL: http://emedicine.medscape.com/article/1253223-overview. Accessed on: 6 January 2011.
- ↑ Frassica, FJ.; Bhimani, MA.; McCarthy, EF.; Wenz, J. (Oct 1999). "Pigmented villonodular synovitis of the hip and knee.". Am Fam Physician 60 (5): 1404-10; discussion 1415. PMID 10524485.
- ↑ URL: http://www.wheelessonline.com/ortho/pigmented_villonodular_synovitis.
- ↑ 37.0 37.1 37.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 341. ISBN 978-0470519035.
Cite error: Invalid
<ref>tag; name "Ref_DCHH341" defined multiple times with different content Cite error: Invalid<ref>tag; name "Ref_DCHH341" defined multiple times with different content - ↑ 38.0 38.1 38.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 612. ISBN 978-0781765275.
- ↑ Pan, YW.; Huang, XY.; You, JF.; Tian, GL.; Li, C. (Nov 2008). "[Malignant giant cell tumor of the tendon sheaths in the hand].". Zhonghua Wai Ke Za Zhi 46 (21): 1645-8. PMID 19094761.
- ↑ 40.0 40.1 Shinjo, K.; Miyake, N.; Takahashi, Y. (Oct 1993). "Malignant giant cell tumor of the tendon sheath: an autopsy report and review of the literature.". Jpn J Clin Oncol 23 (5): 317-24. PMID 8230758.
- ↑ Suresh, SS.; Zaki, H. (Dec 2010). "Giant cell tumor of tendon sheath: case series and review of literature.". J Hand Microsurg 2 (2): 67-71. doi:10.1007/s12593-010-0020-9. PMID 22282671.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 650. ISBN 978-0781765275.
- ↑ 43.0 43.1 URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970057-2. Accessed on: 28 April 2011.
- ↑ URL: http://southbaypath.org/CaseImages/sb5260/sb5260.htm. Accessed on: 7 December 2010.
- ↑ URL: http://www.nordiqc.org/Epitopes/Cytokeratins/cytokeratins.htm. Accessed on: 28 April 2011.
- ↑ Meydan N, Barutca S, Guney E, et al. (June 2006). "Brown tumors mimicking bone metastases". J Natl Med Assoc 98 (6): 950–3. PMC 2569361. PMID 16775919. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569361/?page=1.
- ↑ Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. Emerg.. ISBN 978-0968592861.
- ↑ URL: http://path.upmc.edu/cases/case139/micro.html. Accessed on: 6 January 2012.