OSTEOCHONDROMA

GROSS SPECIMEN AFTER SURGERY

Red Arrow destructive bone-forming intramedullary

lesion with cortical destruction and extension into the
adjacent soft tissues; Asterisk multicystic,
hemorrhagic spaces separated by bony septations
CASE SLIDE
PARAMETERS

Red Arrow Cartilage-capped bony outgrowth attached to

skeleton by bony stalk, not in medullary cavity; cartilage cap
usually regular and thin; Blue Arrow lesions grow out in a
direction opposite to the adjacent bone

RULE IN
CLINICAL PRESENTATION

RULE OUT

17 year old male

6 months PTA: right thigh swelling
2 weeks PTA: thigh pain
GROSS FINDINGS
tumor in the right distant femur;
metaphyseal in location
destructive bone-forming intramedullary
lesion
Presence of cortical destruction and
extension into the adjacent soft tissues
multicystic, blood filled cavity separated by
bony septations

metaphyseal but not grow in medullary cavity; slow

growing, painful if impinges on nerve or stalk is
broken
lesions grow out in a direction opposite to the
adjacent bone; seldom with cortical destruction
smaller osteochondromas are sessile, whereas the
larger ones tend to be pedunculated
Decision: RULED OUT

Osteochondroma is the most frequent benign bone tumor. It is usually asymptomatic, but it may lead to deformity
or interfere with the function of adjacent structures such as tendons and blood vessels. It may also undergo spontaneous
regression. The most common locations are the metaphyses of the lower femur, upper tibia, upper humerus, and pelvis.
The radiographic appearance of osteochondroma is very characteristic; one of the most typical features is the fact that the
lesions, when located in metaphyses of long bones, grow out in a direction opposite to the adjacent joint.
The average age of the patient at onset is approximately 10 years; in the large majority of the cases, the tumor
appears before the patient is 20 years old.

The average greatest diameter is approximately 4 cm, but the tumors may reach sizes of 10 cm or more. The
smaller tumors are sessile, whereas the larger ones tend to be pedunculated. Characteristically, there is a cap of cartilage
covered by a fibrous membrane, which is continuous with the periosteum of the adjacent bone. This cap is usually
lobulated in the large lesions. Its average thickness is about 0.6 cm; it is rare for it to exceed 1 cm. Microscopically, the
cells resemble those of normal hyaline cartilage. Eosinophilic, periodic acidSchiff (PAS)-positive inclusions may be seen
in the cytoplasm. The bulk of the lesion is made up of mature bone trabeculae located beneath the cartilaginous cap and
containing normal bone marrow. At the interphase between cartilage and bone, there is active endochondral ossification.
In older lesions, the cap thins out and may disappear altogether. A bursa may develop around the head of a long-standing
osteochondroma; in turn, this bursa may develop complications such as osteocartilaginous loose bodies, synovial
chondrometaplasia, and exceptionally chondrosarcoma.

Reference:
Kumar, V., Abbas, A. K., Fausto, N., & Aster, J. C. (2009). Robbins and Cotran Pathologic Basis of Disease, Professional
Edition: Expert Consult-Online. Elsevier Health Sciences.
Rosai (2011). Rosai and Ackerman's Surgical Pathology. 10th Edition.