General Principles of Bone Pathology

  • Marco GambarottiEmail author
  • Alberto Righi


Bone tumors are among the rarest neoplasms in humans. Bone sarcomas account for 0.2% af all neoplasms arising in the human body. Considering that and the fact that more than 40 malignant histological types have been described, it is reasonable to think that only specialized centers can have enough experience in managing these neoplasms. The peculiar “multidisciplinary-team” approach is mandatory in bone tumors, in order to avoid dramatic mistakes in the diagnosis and treatment of these tumors. The pathologist dealing with bone must follow a diagnostic flowchart that starts from the accurate collection of clinical information, followed by the careful examination of the imaging, then the decision about the kind of diagnostic procedure to apply, and finally the histological diagnosis. All these steps must be shared with the other colleagues of the team, such as the orthopedic surgeons, the radiologists, and the oncologists. Examining in detail every single step of the diagnostic approach, analysis of clinical features, such as patient age, symptoms and anatomic location of the lesion, are necessary for a preliminary assessment of the lesion. Bone tumors like Ewing sarcoma and osteosarcoma usually occur in young patients. Tumors like chordoma, myeloma, and chondrosarcoma are typical of adults or elderly patients. When osteosarcomas occur in patients older than 50, they are frequently secondary to pre-existing bone conditions, such as Paget’s disease, bone infarcts, or arising after radiation therapy. Symptoms and features are frequently of great clue for diagnosis. Pain during night that can be treated with salicylates is typical of osteoid osteoma; the presence of fever favors for the diagnosis of Ewing sarcoma rather than lymphoma. Laboratory tests can also be very useful; for example, the blood levels of parathormone are the key features for the diagnosis of hyperparathyroidism. The site of the tumor within the bone and the specific bone segment are very important, as some tumors occur usually in the epiphysis, such as giant cell tumor, chondroblastoma, and clear cell chondrosarcoma, while other tumors are centrally located, and others are eccentrically located in the bone cortex; others, such as adamantinoma occur almost exclusively in the tibial diaphysis. In low-grade chondroid lesions, the site of the lesion is very important for a correct interpretation of histology: if the lesion is in the small bones of the hands and feet, it is usually benign, while, with similar histological features, it is usually malignant if located in the ribs and sternum. Tumors that arise in the periostium are generally clinically less aggressive than the intramedullary counterparts. The radiographic features of the lesion are very important for the pathologists: they have to be considered like a negative image of the macroscopic appearance of the neoplasm. Bone lesions can cause osteolysis or reactive bone production (osteosclerosis). Combinations of these two processes give rise to three typical patterns of bone destruction:


Multidisciplinarity Clinical correlations Imaging correlations WHO classification Ancillary techniques 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of PathologyIRCCS Istituto Ortopedico RizzoliBolognaItaly

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