Introduction

Abstract

Orthopedic Pathology, specifically tumors of bone and related conditions, has a reputation as a diagnostically difficult area of practice. The reasons for this are multiple and probably include the reality that such lesions are quite rare (representing <1% of all cases seen in typical community practices) so the “average” pathologist may have limited experience in dealing with such cases and may not develop a sense of confidence in recognizing these lesions. The second cause is the realization that bone has only a limited number of ways to respond to an insult and thus many lesions overlap morphologically at the gross, microscopic, and ultrastructural levels. Thirdly, pathologists have developed a keen insight into what to expect histologically when observing the gross features of a pathologic condition. In bone, the radiograph or special radiographic study (MRI, CT scan, bone scan, and PET scan) acts invariablely as the “gross pathology.” Pathologists, although highly trained, have minimal exposure to radiologic practice and might be helpless in interpreting the images themselves, and with lack of immediate access to musculoskeletal radiologists, usually do not know what the “gross pathology” looks like. This series of challenges is heightened by the isolation of the frozen section suite in many North American hospitals. One further cause for the uncomfortable state many pathologists find themselves in when having to deal with lesions of bone is the incorrect notion that such tumors are by their nature invariably “bone hard” and thus not susceptible to interpretation by frozen section analysis. Nothing could be further from the truth; virtually all lesions of bone including those that are “bone producing” have tissue soft enough to cut on a cryostat, as has been demonstrated for more than 100 years at the Mayo Clinic (which has perhaps the largest collection of bone tumors in the world). Thus, diagnoses obtained by intraoperative consultation, i.e., by frozen sections, are readily possible.