Abstract
Objective
To discuss the concept of pseudoanaplastic tumors of bone, which pathologically show hyperchromatism and marked pleomorphism with quite enlarged, pleomorphic nuclei, but with no to extremely rare, typical mitoses, and to propose guidelines for their diagnosis.
Design and patients
From a database of 4,262 bone tumors covering from 1971 to 2001, 15 cases of pseudoanaplastic bone tumors (0.35% of total) were retrieved for clinical, radiographic and pathologic review. Postoperative follow-up after surgical treatment was at least 3 years and a maximum of 7 years.
Results
There were eight male and seven female patients. Their ages ranged from 10 to 64 years with average of 29.7 years. Pathologic diagnoses of pseudoanaplastic variants of benign bone tumors included: osteoblastoma (4 cases), giant cell tumor (4 cases), chondromyxoid fibroma (3 cases), fibrous dysplasia (2 cases), fibrous cortical defect (1 case) and aneurysmal bone cyst (1 case). Radiography of all cases showed features of a benign bone lesion. Six cases, one case each of osteoblastoma, fibrous dysplasia, aneurysmal bone cyst, chondromyxoid fibroma, giant cell tumor and osteoblastoma, were initially misdiagnosed as osteosarcoma. The remaining cases were referred for a second opinion to rule out sarcoma.
Conclusions
Despite the presence of significant cytologic aberrations, none of our cases showed malignant behavior following simple curettage or removal of bony lesions. Our observation justifies the concept of pseudoanaplasia in some benign bone tumors as in benign soft tissue tumors, especially in their late evolutionary stage when bizarre cytologic alterations strongly mimic a sarcoma.
Similar content being viewed by others
References
Dahl. I. Ancient neurilemmoma (Schwannoma). Acta Pathol Microbiol Scand (A) 1977; 85:812–818.
Enzinger FM, Weiss SW. Soft tissue tumors, 3rd edn. St Louis: Mosby Yearbook, 1995:837-838.
Fechner RE. Atypical leiomyomas and synthetic progestin therapy. Am J Clin Pathol 1968; 49:697–703.
Prakash S, Scully RE. Sarcoma-like pseudopregnancy changes in uterine leiomyomas. Obstet Gynecol 1964; 24:106–110.
Angervall L, Dahl I, Kindblom LG, Säve-Söoderberg J. Spindle cell lipoma. Acta Pathol Microbiol Scand (A) 1976; 84:477–487.
Smith CJ, Echevarvia R, McLelland CA. Pseudo-sarcomatous changes in antrochoanal polyps. Arch Otolaryngol 1974; 99:228–230.
Norris HJ, Taylor HB. Polyps of the vagina. A benign lesion resembling sarcoma botryoides. Cancer 1966; 19:227–232.
Cheung FMF, Wu WC, Lam CK, Fu YK. Diagnostic criteria for pseudomalignant osteoblastoma. Histopathology 1997; 31:196–200.
Mirra JM, Kendrick RA, Kendrick RE. Pseudomalignant osteoblastoma versus arrested osteosarcoma. Cancer 1976; 37:2005–2014.
Mitchell ML, Ackerman LA. Metastatic and pseudomalignant osteoblastoma: a report of two unusual cases. Skeletal Radiol 1986; 15:213–218.
Bahk WJ, Mirra JM, Sohn KR, Shin DS. Pseudoanaplastic chondromyxoid fibroma. Ann Diagn Pathol 1998; 2:241–246.
Mirra JM. Bone tumors. Clinical, radiologic, and pathologic correlation. Vol 1. Philadelphia: Lea & Febiger, 1989:642.
Craver RD, Heinrich S, Mirra JM. Fibrous cortical defect with bizarre nuclear features. Ann Diagn Pathol 1997; 1:26–30.
Dahlin DC. Bone tumors, 3rd edn. Springfield, IL: Charles C Thomas, 1978.
Mcleod RA, Dahlin DC, Beabout JW. The spectrum of osteoblastoma. AJR Am J Roentgenol 1976; 126:321–335.
Bertoni F, Unni KK, Mcleod RA, Dahlin DC. Osteosarcoma resembling osteoblastoma. Cancer 1985; 55:416–426.
Mirra JM. Bone tumors. Clinical, radiologic, and pathologic correlation. Vol 1. Philadelphia: Lea & Febiger, 1989:979–981.
Mirra JM. Bone tumors. Clinical, radiologic, and pathologic correlation. Vol 1. Philadelphia: Lea & Febiger, 1989:1302–1304.
Gherlinzoni F, Rock M, Picci P. Chondromyxoid fibroma. The experience at the Instituto Orthopedico Rizzoli. J Bone Joint Surg Am 1983; 65:198–204.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bahk, WJ., Mirra, J.M. Pseudoanaplastic tumors of bone. Skeletal Radiol 33, 641–648 (2004). https://doi.org/10.1007/s00256-004-0826-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-004-0826-2