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Bone
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Primary neoplasms of bone are rare and occur with an annual frequency of fewer than 1 case per 100,000 population of all ages.257 In a hospital which serves 200,000 patients per year, approximately 2 to 4 primary bone tumors will be seen annually.258 The pertinent clinical data are of great importance for the pathologist who is requested to render a frozen section diagnosis. The pathologist must be aware of the age, sex, and race of the patient, of the clinical signs and symptoms, and of all essential laboratory findings. Study of the relevant radiographs is a prerequisite of the pathologic diagnosis. The radiologic appearance of a bone tumor may be of greater importance in arriving at the correct diagnosis than the biopsy specimen, especially if non-representative samples were submitted for pathologic study.259 If the pathologist has not been provided with all pertinent clinical and radiologic information, an incorrect frozen section diagnosis is quite likely. A banal chronic osteomyelitis in a young patient can easily be misdiagnosed as Ewing’s sarcoma. An exuberant callus has many of the histologic features of osteosarcoma. It may be exceedingly difficult to differentiate the so-called “brown tumor” of hyperparathyroidism and true giant cell tumor of bone. Quite a few laboratories of surgical pathology established a policy of not rendering a pathologic diagnosis of a bony lesion in the absence of pertinent clinical and radiologic information.260
Orthopaedic Oncology
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Nimalan Maruthainar, Rej Bhumbra, Steve Cannon
Occurs after skeletal maturity (80%).Arises on the metaphyseal side of the physis, expanding into the epiphysis as a juxta-articular eccentrically placed lytic lesion with internal septation.Classically low signal intensity on both T1- and T2-imaging, but can undergo cystic degeneration, which changes the signal characteristics.Aggressive, locally recurrent tumour.Rarely malignant from outset (giant-cell sarcoma); malignant transformation may occur and is seen particularly after local recurrence and treatment with radiotherapy.Radiological grading system: cortex intact, expanded, broken (Campanacci).Treatment: essential to check calcium and phosphate to exclude brown tumour (primary hyperparathyroidism) prior to considering curettage and augmentation by bone graft/cement or cryosurgery. Consider resection or even amputation for recurrence or lesions demonstrating malignant features histologically.
Bone, Muscle, and Tooth
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
John L. Vahle, Joel R. Leininger, Philip H. Long, D. Greg Hall, Heinrich Ernst
In toxicology studies, fibrous osteodystrophy is most often encountered in 2-year studies in the setting of chronic renal failure with renal secondary hyperparathyroidism. While increased circulating parathyroid hormone is an important part of the pathogenesis, other factors such as metabolic acidosis likely contribute to the stimulation of bone resorption. Experimental manipulations that result in advanced renal disease, such as administration of cadmium (Uchida et al. 2010) or hydrochlorothiazide (Bucher et al. 1990) or nephrectomy models (Mandalunis and Ubios 2005), result in an increased incidence of fibrous osteodystrophy. In humans with hyperparathyroidism, large lytic lesions resembling neoplasia (brown tumor of hyperparathyroidism) may be present in advanced cases; however, this is not a typical feature in rodents.
Complex spinal fixation of a cervical vertebra Brown tumour: report of an unusual case
Published in British Journal of Neurosurgery, 2019
Sebastian Miguel Toescu, Maria Ibrahim, Dominic G. O’Donovan, Gowrie Balasubramaniam, Karoly M. David
Brown tumours are uncommon bone lesions. They occur in hyperparathyroidism due to increased osteoclastic activity and aberrant bone turnover, with coexistent hypocalcaemia leading to poor mineralisation of newly formed bone. Despite the nomenclature, this is not a neoplastic process but rather a reparative cellular one. Macroscopically, brown discoloration of the lesion is observed due to repeated haemorrhage and haemosiderin deposition. Microscopically, the lesion possesses numerous giant cells with interstitial hemorrhage, hemosiderin, microfractures, and ingrowth of vascularized fibrous tissue with fibroblasts. Histologically, they are analogous to giant cell tumour of bone (and both are technically osteoclastomas), but in the setting of a raised serum PTH (whether primary, secondary or tertiary), the term brown tumour is applied.
Refractory secondary hyperparathyroidism in waiting list for parathyroidectomy: who we should operate first in a quaternary hospital in Brazil regarding survival
Published in Renal Failure, 2019
Lia Roque Assumpção, Isadora de Paula Ramos, Gerson Nunes da Cunha, Cid Manso de Mello Vianna, Maria Cristina Araújo Maya, Denizar Vianna Araújo
Of the operated patients, 21(67.7%) of them presented with pre-operative surgical risk categorized as ASA III, even though 27 (87.1%) needed an ICU for immediate post-operative care [10]. After PTX there was a significant drop of PTH levels from mean 2578 to 121 ng⁄ml (paired t-test, p < .001). Length of stay after surgery was a median of 11 days (IQ range: 8–15 days), where 100% of them had post-operative hungry bone syndrome. Post-operative morbidity was 29%, exposed in Figure 1. Seven patients had clinical cardiac (57%) and pulmonary (43%) complications and one of those patients deceased on the twenty-fourth day of the hospital stay. Two patients had surgical complications: one wound infection and one oral bleeding from a mandibular brown tumor that required surgical hemostasis.
Primary rectal monophasic synovial sarcoma
Published in Baylor University Medical Center Proceedings, 2021
Junlin Zhang, Sarah K. Findeis, Benjamin J. Lang, Gerald O. Ogola, Atin Agarwal
The patient underwent a low anterior resection approximately 6 weeks after diagnosis. On gross examination, there was a 6.3 × 4.1 × 4.0 cm fungating tan-brown tumor with focal areas of hemorrhage. Microscopic examination showed more classic morphologic features of monophasic SS than the biopsy: the tumor involved the mucosa, submucosa (Figure 1a), and muscularis propria and extended into the perirectal adipose tissue. Spindled to ovoid cells with hyper- and hypocellular areas were seen, admixed with dilated staghorn vessels and abundant mitotic figures (Figure 1b–1d). The resection margins were negative for tumor. Perineural invasion was not identified. Lymph node metastasis was present in 4 out of 18 lymph nodes.