1. Compare and contrast osteosarcoma (Robbins 5th Ed. p. 1234-1236) or (Robbins 6th Ed. p. 1236-1237), chondrosarcoma (Robbins 5th Ed. p. 1240-1241) or (Robbins 6th Ed. p. 1240-1242), giant cell tumor (Robbins 5th Ed. p. 1244)or (Robbins 6th Ed. p. 1244-1245) and Ewing's tumor (Robbins 5th Ed. p. 1245-1246) or (Robbins 6th Ed. p. 1244) with respect to:
a. histogenesis
b. age of group affected
c. location in the skeleton
d. histologic hallmarks
e. clinical behavior
f. prognosis
2. Secondary sarcoma of bone
a. What is the difference between primary and secondary cancer of bone?
B. List three factors that predispose to secondary cancer (Robbins 5th Ed. p. 1235) or (Robbins 6th Ed. p. 1236).
3. Cancer metastatic to bone (Robbins 5th Ed. p. 1246) or (Robbins 6th Ed. p. 1245)
a. Contrast incidence of cancer metastatic to bone with that of primary cancer of bone.
b. List the tumors that commonly metastasize to bone.
c. Note which metastatic tumor is likely to produce a sclerotic response.
1. (Robbins 5th Ed. p. 1223-1225, 1234-1237, 1240-1241, 1245-1246) or (Robbins 6th Ed. p. 1236-1237, 1240-1242, 1244-1245)
2. Images 1-12 relate to Case 2, 13 and 14 illustrate prostatic metastases to the skeleton.
A 17-year-old white male presented to his physician with a history of insidious, often transitory pain in his left knee, which had persisted over the last six months. He reported that he had been kicked on the knee during a high school soccer match and he thought that the joint had never recovered from that insult. Over the last several weeks the pain had become more persistent and intractable, and he thought that there was some swelling just below the knee.
On physical examination the physician could palpate a hard bony expansion in the metaphyseal area of the tibia. The mobility of the knee joint was normal. Radiographs revealed a large area of lucency in the metaphysis of the tibia, which focally destroyed the cortex. A biopsy of the bone lesion was ordered and the chest was radiographed.
The core biopsy revealed varied histopathology. In some sections of the mass, malignant osteoblasts surrounded by osteoid predominated, as in Image 5, while in other sections malignant cells embedded in cartilaginous matrix predominated, a morphology reminiscent of Image 8. In other sections, large numbers of giant cells were seen, reminiscent of Image 14. This varied histologic profile presented a diagnostic dilemma to the junior pathology resident. She scheduled a consultation with the resident orthopedic pathologist to help formulate a final diagnosis.
The preliminary clinical and radiologic diagnosis, pending a definitive pathologic report, was cancer of the bone. The boy's mother was not only concerned for her oldest son but also expressed concern for the possibility that his three brothers and two sisters might develop bone cancer. She said that her father had developed primary cancer of the bone in his 8th decade.