1. Bone Tumors in the Lower
Extremity
How to identify benign and
malignant osseous tumors in the
foot and ankle
2. Bone Tumors in the Lower
Extremity
• Benign tumors usually present with
– Well-defined sclerotic borders
– Geographic type of bone destruction
– Uninterrupted solid periosteal reaction
– No soft tissue mass
• Malignant tumors usually present with
– Poorly defined border with a wide zone of transition
– Moth eaten or permeative bone destruction
– Interrupted periosteal reaction (sunburst or onion skin)
– Adjacent soft tissue mass
3. Bone Tumors in the Lower
Extremity
• Bone tumors can be primary or secondary (metastatic)
• Staging of these tumors is done once the type of tumor has
been determined
• This staging is done by plain films, bone scans, CT, MRI,
arteriography and biopsy
• Appearance of the lesion can guide the diagnosis
– Appearance includes the pattern of destruction: geographic, moth-
eaten or permeative in nature
– The size, shape and the margin of the tumor must also be
considered.
4. Bone Tumors in the Lower
Extremity
• The matrix of the tumor can be identified as calcified (indicating
cartilaginous origin), or ossification (of bony origin, seen in the
osteoid osteoma and the malignant osteogenic sarcoma)
• Cortical erosive patterns , periosteal response, area of the bone
involved (metaphysis, epiphysis or diaphysis) are also involved
in the identification of the tumor.
• Treatment usually involves either surgical excision or in the case
of metastatic spread, irradiation and/or chemotherapy.
5. Bone Tumors in the Lower
Extremity
• Surgical excision of benign tumors involves a biopsy to confirm
the diagnosis prior to any surgical procedure, done as a two-
stage procedure (biopsy done first and the surgical excision
done at a later date)
• The biopsy is done under general anaesthesia when suspicious
of a malignancy, as use of a local can seed sarcomas
• Make as small a longitudinal incision as possible, so as to allow
adequate skin covering.
6. Bone Tumors
• Some researchers have suggested that bone tumors affect the
feet in a disproportionately small number of cases
• Keep in mind that most major studies on the subject have been
assembled at major centers for the treatment of cancer
• Therefore, lesions that have clearly benign clinical or radiologic
features are largely omitted
7. Bone Tumors
• In order to identify bone tumors of the feet accurately, one
must understand the relative frequency with which various
tumors of bone occur in that location
• Occasional tumors of bone (such as Dupuytren’s exostosis)
occur in the feet in the vast majority of cases
• Osteochondroma, the most common benign bone tumor, is rare
in the small bones of the feet
8. Bone Tumors
• A relatively large number of reactive or reparative lesions of
bone are seen within bone study series.
• Usually identified conditions such as Florid Reactive
Periostitis, Bizarre Parosteal Osteochondromatous
Proliferation (Nora’s lesion) and Giant Cell Reparative
Granuloma were seen at a much higher rate than has been
described outside of the hands and feet
• There is an overwhelming predominance of benign lesions, as
compared to malignant lesions, in these locations
9. Bone Tumor Classification
Divide bone lesions of the small bones of
the feet into three categories:
1. reactive/reparative lesions
2. benign neoplasms
3. malignant neoplasms
10. Bone Tumor Classification
• Reactive/reparative lesions of bone are non-neoplastic
proliferations or hyperplasias that are incited by trauma or
stress in most cases
• Neoplasms are autologous new growths that are clonal in
nature in that they emanate from a single genetically identical
“mother cell”
• In most cases, true neoplasms do not form in response to
trauma or involute upon removal of a stimulus
11. Reactive/Reparative Lesions
• Giant Cell Reparative Granuloma, Florid Reactive
Periostitis, Dupuytren’s Exostosis and Bizarre Parosteal
Osteochondromatous Proliferation accounted for 50 of the
151 benign lesions in the series published by Ostrowski and
Spjut (excluding those lesions that were classified as a reaction
to injury, fracture or osteomyelitis)
• Being aware of these lesions, which share atypical
histopathologic and clinical features, can help prevent erroneous
clinical diagnoses and facilitate referrals for outside pathology
consultations when indicated
12. Giant Cell Reparative Granuloma
• Intraosseous tumors comprised of a mixture of giant cells and
fibrous stroma
• They are believed to arise in response to hemorrhage
• Some investigators have viewed giant cell reparative granuloma
(GCRG) as a solid variant of aneurysmal bone cyst
• Most cases will present as solitary painful and swollen lesions
among teenagers or people who are in their twenties
• These lesions more commonly affect the hands than the feet
with rare history of trauma
13. Giant Cell Reparative Granuloma
• Radiologically, GCRG appear as radiolucent lesions measuring
from 2 to 2.5 cm in greatest diameter
• You will see bone expansion and cortical thinning but you
usually won’t see evidence of destruction
• There is no surrounding sclerosis nor intralesional calcifications
and the epiphyseal ends of long bones are spared in most cases
14. Florid Reactive Periostitis
• A reactive process leading to metaplastic bone and cartilage
formation
• Has radiologic and histopathologic similarities with parosteal
osteogenic sarcoma and osteochondroma
• FRP most commonly causes pain and swelling
• Slight female predominance and a history of trauma is noted in
roughly 40 percent of the cases
• Radiologically a fusiform soft tissue mass enveloping the
proximal phalanx, but can affect any of the tubular bones of the
hands and feet
• A laminated periosteal reaction is evident in about a third of
cases
15. Dupuytren’s exostosis (DE)
• Unlike osteochondromas, which are neoplastic proliferations of
epiphyseal cartilage, DE are metaplastic osteochondral
proliferations that result from persistent microtrauma
• First described by Dupuytren in 1847, this tumor most
commonly arises within the soft tissue deep to the medial nail
bed of the hallux and thus was originally designated as a
“subungual exostosis”
• Unlike an osteochondroma, a neoplastic tumor of bone, DE does
not show a tendency toward malignant transformation and is
not associated with familial osteochondromatosis
16. Nora’s Lesion
• Bizarre parosteal osteochondromatous proliferation (Nora’s
lesion) was first characterized in 1983 by Nora and colleagues of
the Mayo Clinic
• Typically arises around the proximal phalanges, metacarpals or
metatarsals, and presents as a painless and rapidly growing
mass
• When patients do report symptoms, they are most often related
to tumefaction
17. Nora’s Lesion
• Awareness of bizarre parosteal osteochondromatous
proliferation (BPOP) is particularly important due to the lesion’s
tendency for local recurrence and its atypical histopathologic
features
• If this diagnosis is a clinical possibility, be aware that it can be
mistaken for sarcoma
• Radiologically, one will see BPOPs as well-delineated partially
mineralized masses emanating from the cortical surface of the
involved bone. Larger lesions are lobulated and exhibit a
haphazard pattern of mineralization
18. Benign Tumors
Osteochondromas
• Osteochondromas of cartilaginous origin
• The most common benign tumor of bone
– account for between 40 to 50 percent of all benign neoplasms of
bone
– represent only 3 to 8 percent of such neoplasms in the feet
• Radiographic signs are usually diagnostic. Appears sessile or
pedunculated
• If >2.5 cm in size, the lesion has a predilection to progress to a
chondrosarcoma
• Appears in the lower metaphysis of the femur and the upper
metaphysis of the tibia
19. Benign Tumors
Enchondroma
• Exhibit hyaline cartilage differentiation
• Lesions in the bones of the hands and feet are more commonly
symptomatic than those arising elsewhere in the skeletal system
• Are solitary lesions although multiple bones may be involved,
especially in the setting of Maffucci syndrome (enchondroma
seen with hemangiomatosis) or Ollier disease
(enchondromatosis)
• Typically see bone expansion and cortical thinning
• Characteristically radiolucent and well-delineated
• Cortical expansion and endosteal erosion in large long bones
warrant a suspicion of malignancy
20. Benign Tumors
Chondroblastoma
• A benign but locally aggressive neoplasm
• 23% of all chondroblastomas arise in the bones of the
hands and feet
• 90% of the chondroblastomas that arose in the feet
were located in the rearfoot tarsal bones
• Male predominance (83%)
• The most common presenting complaint is pain
without a corresponding history of trauma, occasional
edema
• Moderately well circumscribed lesions; consistently
radiolucent with geographic zones of bone destruction
with little or no matrix production
21. Benign Tumors
Osteoblastoma
• Relatively uncommon neoplasms of bone, they
have a disproportionately high frequency in the
bones of the feet
• Usually presents in the second or third decade of
life with marked male predominance
• Nearly all patients (97%) complain of low grade
aching pain and about one in four experience
concurrent swelling
• Round or oval, well circumscribed, and range
from 2 to 10 cm in size. Most form radiolucent
expansile masses that lack the sclerotic margin
seen in association with osteoid osteoma
• Talus is the most commonly affected bone
22. Benign Tumors
Osteoid Osteoma
• Typically present with pain ranging from dull to
intense and usually shows nocturnal exacerbation,
with 80% of patients experience relief with NSAIDs
• Demonstrates unmyelinated nerve fibers and
excessive prostaglandin E2 production in the nidus
• Children and adolescents are most commonly
affected by osteoid osteoma and may be initially
misdiagnosed as “growing pains”
• Dense, often fusiform, ring of sclerosis surrounding
a radiolucent nidus with ossification of the nidus
leading to a targetoid radiologic appearance
23. Benign Tumors
Unicameral Bone Cyst
• Fibrous in nature
• Radiographic signal is the quot;fallen fragment signquot;
• Look for attenuated cortical wall lined by a fibrous membrane
with serosanguinous fluid
• Diagnosis needs 4 criteria:
– typical radiograph
– yellow fluid aspirate
– arterial pressure 15-18mm
– cyst filling with renografin
24. Benign Tumors
Fibrous Dysplasia
• A skeletal developmental anomaly of the bone-
forming mesenchyme that manifests as a defect in
osteoblastic differentiation and maturation
• Usually monostotic
• When polystotic, you also see melanotic
pigmentation at the skin (café-au-lait) and endocrine
dyscrasias. The combination of fibrous dysplasia,
hormonal disturbances, and skin pigmentation is
called McCune-Albright syndrome
• Patients who have fibrous dysplasia in only one bone
usually do not develop McCune-Albright syndrome.
The genetic abnormality that has been found in
bone is also found in other tissues that have
abnormal function
• Has a diagnostic ground glass appearance
25. Benign Tumors
Giant Cell Tumor
• A benign but locally aggressive tumor
• Characterized by a dense infiltrate of reactive osteoclast-like
giant cells scattered among a neoplastic population of small
epithelioid or slightly spindled mononuclear cells
• Giant cell tumors account for approximately 20% of all benign
tumors with the incidence within the small bones of the feet
estimated to be about 1.8%
• One of the few tumors of bone where there is a significant
female predominance
• Commonly present with either localized pain and swelling, or
with pain in the absence of swelling
• Most often affects people in their third decade of life
• Like chondroblastomas, benign GCTs may also exhibit
pulmonary spread
26. Benign Tumors
Giant Cell Tumor
• In the bones of the feet, GCTs average almost 3cm
• When within long bones, they invariably involve the
physis
• Largely lytic, but may disclose trabeculation that can
vary from fine to moderately coarse leading to the
characteristic “soap-bubble” appearance
• Rarely see periosteal reactions typical of
osteosarcoma (Codman’s triangle, sunburst) and
Ewing’s sarcoma (onion skinning)
• Many GCTs in the small bones of the feet produce
cortical erosion and expansion with the lesion covered
by a thin layer of periosteal new bone that is not
apparent radiologically
27. Benign Tumors
Non-ossifying Fibroma
• Seen at the metaphysis of the long bones
• Heal spontaneously
• One of the more common benign tumors found in children and
adolescents
• The cause of a non-ossifying fibroma is unknown. It is believed
to be a developmental defect associated with a vascular
disturbance or related to a hemorrhage inside the bone
28. Benign Tumors
Eosinophillic Granuloma
• Seen in the 1st decade of life (age 5 - 10 yrs)
• Moth-eaten cortical pattern
• 60-80% of histiocytosis X (Hand-Schuller-Christian Syndrome)
– Disease of the immune system, where histiocytes and eosinophils
grow uncontrollably, usually in the lungs and bone. These cells
constitute malignant or benign macrophages in the tissues, or
Langerhans' cells in the bone marrow.
– This syndrome is characterized by three, simultaneous conditions:
• Diabetes Insipidus
• Exopthalmus
• Destructive Bone Lesions
29. Benign Tumors
Eosinophillic Granuloma
• Presentation: bone pain, local swelling, irritability
• Bones 50 - 75% solitary/monostotic with skull/mandible (50%),
with quot;punched-outquot; lucencies, quot;hole within a holequot;, quot;button
sequestrum
• lungs involved in <10%, signals worse prognosis
– Langerhans cell histiocytosis (LCH) describes a group of syndromes
that share the common pathologic feature of infiltration of involved
tissues by Langerhans cells. Typically, the skeletal system is
involved, with a characteristic lytic bone lesion form that occurs in
young children or a more acute disseminated form that occurs in
infants
30. Benign Tumors
Chondromyxoid Fibroma
• Least common of the tumors
– less than 1% of primary osseous neoplasms
(approximately 2% of benign bone tumors)
• Consists of chondroid, myxoid, and fibrous tissue in
variable amounts
• Most often found in the long tubular bones,
especially the tibia and femur near the knee joint
• Osteoclast-like giant cells also may be present, as
may small cysts and hemorrhagic zones and focal
calcification is found microscopically occasionally,
although any gross evidence of calcification is rare
31. Benign Tumors
Aneurysmal Bone Cyst
• Traditionally been classified as either primary or secondary
• Primary ABCs emerge in the absence of an alternate neoplasm
while secondary ABCs are engrafted upon another tumor with
approximately 50 to 71 percent of ABC cases are primary in
nature
• Associated neoplasms include chondroblastoma, giant cell
tumor, non-ossifying fibroma, osteoblastoma and osteosarcoma
32. Benign Tumors
Aneurysmal Bone Cyst
• Most often present with localized pain and swelling. In a small
number of cases, one may see pathologic fractures
• Unlike most other tumors of bone, ABC will cross open growth
plates in 23% of cases
• Expansion of the involved bone with cortical thinning is a
characteristic feature of ABC and is found in up to 93% of cases
• Roughly half of the cases, the radiographic margin is distinct but
not sclerotic. However, keep in mind that sclerosis is present in
about a third of cases
• These lesions cannot be radiologically distinguished from
malignancies in 42% of cases
33. Malignant Tumors of Bone
Osteogenic Sarcoma
• The most common of all non-hematopoietic primary malignant
neoplasms of bone found in the skeletal system
• Osteogenic Sarcoma or Osteosarcoma encompass a number of
distinct tumor subtypes with a spectrum of clinical
aggressiveness
• single unifying feature is the production of osteoid by a
population of malignant cells
• classified into various subtypes based on the site of origin,
pattern of growth, cytologic features, the type of stroma
produced and the tumor grade
34. Malignant Tumors of Bone
Osteogenic Sarcoma
• One may see tumors arise on the external surface of the
involved bone, within the cortex or within the medullary canal
• Alternatively, neoplastic cells may form large telangiectatic
spaces filled with blood (telangiectatic OS) or, from a cytologic
perspective, might be comprised of small hyperchromatic cells
reminiscent of Ewing's sarcoma (small cell OS)
• The tumor grade is related to the degree of cytologic atypia,
mitotic activity and necrosis
35. Malignant Tumors of Bone
Osteogenic Sarcoma (high grade)
• The high-grade portion of the OS spectrum consists
of conventional intramedullary OS, high-grade
surface OS, telangiectatic OS and small cell OS
• Conventional intramedullary is by far the most
common variety of osteogenic sarcoma, accounting
for more than 90% of all cases intramedullary
• One may sub-classify these exceedingly aggressive
neoplasms even further, according to their
histologic appearance, as either osteoblastic,
chondroblastic, fibroblastic or giant cell rich
36. Malignant Tumors of Bone
Osteogenic Sarcoma (high grade)
• Male predominance that becomes less pronounced with
progressive age
• Over 60% of OS cases occur in people under the age of 25, but
there is a second peak beyond 60, largely related to secondary
factors such as Paget's disease and radiation exposure
• most common presenting complaint is pain but concurrent
swelling is a routine finding
• the calcaneus is the most commonly affected bone, followed by
the talus and the metatarsals
37. Malignant Tumors of Bone
Osteogenic Sarcoma (high grade)
• Most pedal cases disclose transcortical penetration with soft
tissue extension at diagnosis.
• There is an admixture of lysis, sclerosis and rarefaction in most
cases, although a single pattern often predominates.
• One may see quot;starburstquot; phenomenon and Codman's triangle in
the bones of the feet but these are not typical findings
• In one study OS of the foot was misdiagnosed in 50% of cases
• May resemble giant cell tumor or aneurysmal bone cyst in plain
film
38. Malignant Tumors of Bone
Osteogenic Sarcoma (intermediate grade)
• The sole subtype that falls into the category of
intermediate grade is periosteal (juxtacortical
chondroblastic) OS
• Accounts for roughly 2% of all cases
• Unlike conventional OS, periosteal OS commonly
affects the diaphysis of long bones
• Associated with a significantly better prognosis than
conventional OS
• Arises on the external surface of long bones, the
tumor is not typically confused with conventional
intramedullary OS, but must be differentiated from
other surface tumors
39. Malignant Tumors of Bone
Osteogenic Sarcoma (low grade)
• Comprised of parosteal OS, intracortical OS and
well-differentiated (low-grade) intramedullary OS.
• Parosteal OS accounts for roughly 80% of all cases
of low-grade OS
• Parosteal OS arises on the external surface of long
bones with a predilection for the distal posterior
femur (70%), tibia and humerus
• Chief complaint with regard to parosteal OS is pain-
free swelling
• Tendency toward local recurrence although
metastases at presentation are extremely
uncommon
• Radiologically, parosteal OS appears in plain film
radiographs as a dense, heavily mineralized mass
attached to the external surface of tubular bones by
a broad base
40. Malignant Tumors of Bone
Chondrosarcoma
• Roughly 98% of all CHS is seen within bones external
to the foot
• Primary bone CHS may arise within the medullary
canal or upon the periosteal surface.
• There are several histopathologic subtypes and a
spectrum of tumor grades, each exhibiting different
clinical behavior
• Conventional CHS accounts for over 90% of all lesions
with the remaining 10% being comprised of an
admixture of clear cell CHS, myxoid CHS,
dedifferentiated CHS and mesenchymal CHS
• Largely a disease of middle-aged adults and the
elderly
41. Malignant Tumors of Bone
Chondrosarcoma
• Slight male predominance
• Calcaneus most common, but may affect any
bone, including the sesamoids
• Commonly presents with pain, swelling or both. In
the foot, the presence of pain and an older patient
age may be important clues in diagnosing CHS as Low-grade
opposed to enchondromas, which are uniformly
painless and more common in young adults
42. Malignant Tumors of Bone
Chondrosarcoma
• Radiological appearance of CHS is exceedingly important for the
correct diagnosis of low and intermediate grade lesions.
• In many instances, the histopathologic diagnosis of low-grade
CHS cannot be done without radiographic analysis
• In the feet, the most common single feature is endosteal
erosion (94%) with or without frank cortical destruction (92%)
• Bony expansion, soft tissue extension and a permeative pattern
of growth are additional findings that suggest the diagnosis of
CHS over enchondroma
43. Malignant Tumors of Bone
Malignant Fibrous Histiocytoma
• High-grade without osteoid production
• Appears as an osteolytic lesion at the metaphysis
with permeative destructive pattern
• No periosteal reaction, no matrix produced
2º to Paget’s
• Associated with Paget's, fibrous dysplasia and
osteomyelitis
• May occur following radiation treatments
• Among the most common types of soft tissue
tumors found in adults, it is rarely found in children
• Originates in primitive mesenchymal cells
44. Malignant Tumors of Bone
Fibrosarcoma
• Can occur as a soft tissue mass or as a primary or
secondary bone tumor
• Primary fibrosarcoma is a fibroblastic malignancy
that produces variable amounts of collagen. It is
either central, arising within the medullary canal,
or peripheral, arising from the periosteum
• Secondary fibrosarcoma of bone arises from a
preexisting lesion or after radiotherapy to an area
of bone or soft tissue. This is a more aggressive
tumor with poorer prognosis
• Must be distinguished histologically from similar
lesions, such as desmoid tumors, malignant
fibrous histiocytoma, malignant schwannoma, and
high-grade osteosarcoma
45. Malignant Tumors of Bone
Ewing’s sarcoma
• Ewing's sarcoma/primitive neuroectodermal tumor (PNET) has
been documented as the most common non-hematopoietic
primary malignancy of the bones of the feet
• Are considered variations of the same disease, Ewing's sarcoma
is commonly taken to connote tumors that lack
neuroectodermal differentiation
• Ewing's sarcoma and PNET have a chromosomal translocation
t(11; 22) (q24; q12) in common in 85% to 90% of cases. The
remaining 10% to 15% of these malignant neoplasms are
believed to have alternate mutations involving the Ewing's
sarcoma gene on chromosome 22
46. Malignant Tumors of Bone
Ewing’s sarcoma
• May affect any bone of the foot with the
calcaneus the most common, with calcaneal
lesions imparting a worse prognosis
• Usually affects people in their second decade of
life with a male predominance
• In the long bones of the appendicular skeleton,
a diaphyseal-based tumor with admixed lytic and
sclerotic features, and characteristic “onion
skinning” is seen
• In the feet, onion skinning is an uncommon
finding
47. Malignant Tumors of Bone
Angiosarcomas and Epithelioid Hemangioendotheliomas
• Exhibit endothelial (vascular) differentiation. In
some cases, such differentiation is not
apparent by light microscopy and must be
demonstrated with immunohistochemical
studies or electron microscopy
• Angiosarcoma may exhibit a spectrum of
differentiation, ranging from extremely well-
differentiated tumors that resemble benign
hemangiomas to poorly differentiated
neoplasms with few if any vascular features by
light microscopy
• The prognosis is worse for higher-grade tumors
that are less differentiated
48. Malignant Tumors of Bone
Angiosarcomas and Epithelioid Hemangioendotheliomas
• The trend is to use the term quot;hemangioendotheleomaquot; to
denote those lesions that are low-grade (well differentiated) and
quot;angiosarcomaquot; to refer to those tumors that are of a higher
tumor grade (poorly differentiated)
• Together, EHE and AS ranked fourth in frequency amongst non-
hematopoietic primary malignancies of the pedal bones
• They account for roughly 1% of all malignant bone tumors
• Multicentric in 20% to 50% of cases
• Clustering of distinct lesions in a single region is highly
suggestive of EHE or traditional AS
49. Malignant Tumors of Bone
Adamantinoma
• A rare, slow growing tumor most often found
in the tibia or mandible, but are occasionally
found in the forearm, hands or feet. Primarily
in males between the ages of 10-30, usually
after skeletal maturity is reached.
• In about 20% of cases, will metastasize to
other parts of the body, usually to the lungs or
nearby lymph nodes.
• Of unknown etiology, commonly have a
history of trauma, but it is unclear whether
trauma is involved with formation. Symptoms
may include, but are not limited to: pain
(sharp or dull), swelling and/or erythema at
the site of the tumor.
50. Malignant Tumors of Bone
Leiomyosarcoma
• Primary leiomyosarcoma of bone is
extremely rare with approximately 50
cases reported in the literature
• A metastatic lesion must be ruled out
• Differential Diagnosis is usually not
extensive and includes fibrosarcoma,
MFH, and metastatic spindle-cell
carcinoma
51. Malignant Tumors of Bone
Multiple Myeloma
• Multiple myeloma is the most common primary
tumor of bone
• The average patient age is over fifty years old and
men are affected twice as often as women
• The presenting symptom of multiple myeloma is
usually pain
• Bence Jones proteins are present in urine
• Hypercalcemia may cause confusion, weakness
and lethargy
52. Metastatic Carcinoma
• The most common primary sites to metastasize to the bones of
the foot are the lower intestinal tract, followed closely by the
genitourinary system and lower respiratory tract
• This contrasts with metastases to the bones of the hand in which
pulmonary sources overwhelmingly predominate
• Metastases to bone are indicative of end-stage disease
• Patient survival following such events averages less than 12
months
53. Metastatic Carcinoma
• In the rare instances when children are affected, the most common
offending neoplasms are neuroblastoma, rhabdomyosarcoma and
clear cell sarcoma of the kidney
• Metastases may produce lytic lesions, sclerotic (osteoblastic) lesions
or a combination of the two
54. Tumors by Type
Tumors that form bone
Osteoma
Osteoid osteoma
Osteoblastoma
Osteosarcoma
Conventional Intramedullary Osteosarcoma
Extraosseous osteosarcoma
Multifocal Osteosarcoma
Telangectatic Osteosarcoma
Small Cell Osteosarcoma
Intraosseous Well-differentiated Osteosarcoma
Intracortical Osteosarcoma
Periosteal Osteosarcoma
Parosteal Osteosarcoma
High-Grade Surface Osteosarcoma
55. Tumors by Type
Tumors that form Cartilage
Osteochondroma
Osteochondromatosis (HMOCE)
Periosteal Chondroma
Juxtacortical Chondroma
Enchondroma
Enchondromatosis (Ollier's Disease)
Mafucci Syndrome
Chondroblastoma
Chondromyxoid Fibroma
Chondrosarcoma
Dedifferentiated chondrosarcoma
Clear Cell Chondrosarcoma
Mesenchymal Chondrosarcoma
Juxtacortical Chondrosarcoma
56. Tumors by Type
That form Fibrous Tissue
Nonossifying fibroma (fibrous cortical defect)
Fibrous Dysplasia
Osteofibrous Dysplasia
Desmoplastic Fibroma
Extragnathic Fibromyxoma
Fibrosarcoma
Benign Fibrous Histiocytoma
Malignant fibrous hystiocytoma
57. Tumors by Type
Lesions of Marrow Elements
Eosinophilic Granuloma
Multiple myeloma
Solitary myeloma (plasmacytoma)
Leukemia
Non Hodgkin lymphoma
Hodgkin lymphoma of bone
Granulocytic Sarcoma in bone
Systemic mastocytosis
Sinus histiocytosis with Massive
Lymphadenopathy
58. Tumors by Type
Forming Vascular Tissue
Skeletal lymphangiomatosis
Hemangioma
Skeletal Angiomatosis
Massive Osteolysis
Epithelioid hemangioendothelioma
Epithelioid hemangioma
Angiosarcoma - low grade
Angiosarcoma - high grade
Hemangiopericytoma
Glomus tumor
59. Tumors by Type
Miscellaneous
Chordoma
Conventional Chordoma
Chondroid chordoma
Dedifferentiated chordoma
Schwannoma of bone
Neurofibroma of bone
Liposarcoma of bone
Post - Paget's Sarcoma
Malignant Mesenchymoma of bone
60. Tumors by Type
Metabolic Disease
Brown Tumor of Hyperparathyroidism
Bone lesions of Gaucher's Disease
Paget's disease
Disappearing bone disease
61. Tumors by Type
Metastatic to Bone
Metastatic Breast Cancer
Metastatic Lung Cancer
Metastatic Kidney Cancer
Metastatic Prostate Cancer
Metastatic Thyroid Cancer
