A.

Osteosarcoma
1.Gross description
 Big, bulky, gritty, hemorrhagic with cystic degeneration
 Spreads within medullary cavity, destroys cortical bone, elevates periosteum and invades soft
tissue
 Rarely penetrates joint along tendons / ligaments
 May form satellite nodules (“skip metastases”)
 Usually has well defined proximal and distal margins
 25% have large amounts of cartilage

2.Microscopic

 High grade spindle cell tumor that produces osteoid matrix unconnected by cartilage (by
definition)
 Tumor cells produce neoplastic bone - basophilic thin trabeculae of neoplastic bone
resembling fungal hyphae or neoplastic osteoid - eosinophilic, homogenous, glassy with
irregular contours and osteoblastic rimming
 Destroys or grows around trabeculae
 Vascular invasion and necrosis common
 May have osteoblastic, fibroblastic (pure spindle cell growth with minimal matrix)
or chondroblastic predominance (malignant appearing cartilage with peripheral spindling
and osteoid production)
 Osteoid may be variable in amount
 With bizarre giant cells in stroma or acellular stroma
 Vessels may have hemangiopericytoma-like features
 Tumor cells may be spindly, oval or round of variable size
 25% have osteoclast-like multinucleated giant cells
 Cartilage may be mineralized, immature, myxoid
 B. Osteochondroma
1.Gross description
 Cartilage - capped bony outgrowth up to 10 cm (mean 4 cm), attached to skeleton by bony
stalk, not in medullary cavity
 May have bursa around its head
 Cartilage cap usually regular and thin

2. Microscopic

 Periosteum appears as pink fibrous capsule

 Cartilage resembles disorganized growth plate with ossification towards base
 Medullary cavity merges with that of underlying bone
 Bony trabeculae appear normal
 Normal appearing marrow
 No spindle cells
 C. Carsinoma basal cell
1. Gross description
 Reddish tan to pink papules or nodules, with or without central ulceration, often with
telangiectasia (prominent subepidermal vessels)
 Atrophic to indurated, scar-like lesions typically will show an infiltrative histologic

2. Microscopic
 hyperchromatic nuclei, peripheral palisading, peritumoral clefting and mucinous alteration of
surrounding stroma
 Also mitotic figures, apoptotic bodies
 The presence of myxoid stroma and peripheral clefting has been suggested to be most helpful
to distinguish BCC from other basaloid tumors
 Many secondary features may occur, such as dystrophic calcification, amyloid deposition or
inflammatory reactions with or without partial regression

Other variants of histopathologic interest:

 Clear cell basal cell carcinoma:
o Tumor cells with prominent cytoplasmic vacuoles or signet ring morphology
 Fibroepithelial tumor:
oAlso called Pinkus' tumor, fibroepithelioma
oPolypoid variant, often on back, with abundant stroma
 Granular basal cell carcinoma:
o Contains tumor cells resembling granular cell tumor
o No clinical significance
 Infundibulocystic basal cell carcinoma:
o Hair follicle differentiation