Bone tumour

Background

A range of specimens containing bone may be received in the laboratory.

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Resections of bone tumours both benign and malignant are undertaken. Examples of benign tumours are enchondromas, osteochondromas, osteoid osteomas, bone cysts, fibrous dysplasia and giant cell tumors.  Malignant tumours include chondrosarcomas, osteosarcomas and Ewing's sarcoma. 1,2

This protocol includes specimens for the excision and resection of bone tumours. See separate protocol for bone biopsies and non-tumour bone specimens.


Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. 

Radiological information is particularly relevant for bone specimens. Optimally the images and reports should be available for the reporting pathologist to review. 2

See overview page for more detail on identification principles.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.
Intraoperative consultation
  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, describe

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify the anatomical features of the specimen.

Orientation markers

Record additional orientation or designation provided by operating clinician:

  • Absent
  • Present
    • Method of designation (e.g. suture, incision)
    • Featured denoted

Photograph the intact specimen if required.

Describe the following features of the specimen:

Procedure 3-5

Record as stated by the clinician.

Options
  • Bone resection
    • Segmental resection
    • Limb salvage
    • Other, describe

Anatomical components included (more than one may apply) and specimen dimensions (mm)

Describe and measure the anatomical components present. 

  • Total specimen size, in three dimensions
  • Weight (g) if applicable
  • Bone, specify and measure in three dimensions
  • Skin, in two dimensions
  • Muscle, specify and measure in three dimensions
  • Blood vessels, specify and measure in two dimensions
  • Nerves, specify and measure in two dimensions

Specimen laterality (if applicable)

  • Left
  • Right
  • Unoriented

Specimen integrity

  • Intact
  • Disrupted/fragmented, describe

Evidence of previous biopsy or surgery (if present)

  • Needle track
  • Scar
  • Sutures

DissectionBack to top


  • Review radiology images and report to identify tumour location and original size.5
  • Large specimens containing bone are slow to fix and require initial dissection prior to fixation and decalcification6-9  See separate decalcification protocol for more information.
  • Various saws are available for the dissection of bone; hand saws, band saws and/or diamond-coated saws. 4,8 Selection of appropriate equipment will depend on the resources in a particular laboratory. 8
  • Dissect any soft tissue tumour and submit for processing. If a bone margin is present, bone marrow can be curetted and submitted prior to decalcification.
  • Section the specimen with an appropriate bone saw according to diagrams provided. Dissect the tumour in a plane that demonstrates the largest dimension; preferably a longitudinal section in long bone specimens.5,8
  • If the plane of largest dimension is not obvious (usually reflecting a lack of extraosseous extension) it is best to start the dissection in the coronal plane in long bones and in either the axial or sagittal plane at other sites, particularly in the flat bones.
  • Decalcification may be required before further sectioning.5,8

Internal InspectionBack to top


Describe the internal or cut surface appearance including the following items:

Tumour

  • Absent
  • Present
  • Number; if more than one tumour, designate and describe each tumour separately

Tumour size (mm)

Measure in three dimensions.

  • Maximum dimension
  • Other dimensions

Tumour site (more than one may apply)

  • Epiphysis (articular cartilage to epiphyseal plate)
  • Metaphysis (epiphyseal plate to diaphysis)
  • Diaphysis (end of proximal metaphysis to beginning of distal  metaphysis)
  • Medullary cavity
  • Cortex
  • Surface
  • Other, specify

Tumour extent

  • Cortical erosion
  • Subperiosteal projection (elevation of periosteum)
  • Soft tissue extension
  • Articular cartilage/joint cavity
  • Joint extension, specify
  • Extension into epiphyseal plate or to bone end (subchondral plate in adults/growth plate in children)
  • Skin
  • Nerve(s), specify if known
  • Vessel(s), specify if known

Tumour description

  • Border
  • Circumscribed
  • Irregular

Tumour necrosis

  • Absent
  • Present, as proportion of tumour (%)

Appearance of cut surface

  • Colour, describe
  • Cyst formation
    • Absent
    • Present, describe contents
  • Tumour constituents/matrix
    • Bone-forming
    • Cartilage-forming
    • Fibrous material
    • Myxoid material

Associated fracture

  • No
  • Yes

Distance to margins (mm)

  • Distance of tumour to surgical soft tissue margin(s), specify margin(s)
  • Distance of tumour to bone resection margin(s), specify margin(s)

Satellite lesion(s)

  • Absent
  • Present
    • Number
    • Location
    • Max. dimension in mm

Non-lesional tissue appearance

  • Normal
  • Abnormal, describe
Lymph nodes

Retrieved from resection specimen

  • Describe site(s)
  • Number retrieved

Separately submitted

  • For each specimen container, record specimen number and designation
  • Collective size of tissue in three dimensions (mm)
  • Number of lymph nodes submitted
  • Maximum diameter of each

Photograph the dissected specimen if required. The slab specimen of tumour should also be photographed and the nature and location of blocks taken for histology recorded on the slab specimen photograph. Consideration should be given to obtaining plain radiographs of the intact and slab specimens.


Note photographs taken, diagrams recorded and markings used for identification.

ProcessingBack to top


Dissect the specimen further and submit sections for processing according to the illustrations provided.

Submit representative sections of: 2

  • Bone margins, an en face section of each surgically cut surface
  • A slab of the whole tumour in its maximum dimension should be taken and submitted in its entirety
  • Tumour demonstrating interface with adjacent tissue
  • Tumour, additional blocks from non-slab areas where the macroscopic appearance is unusual or variable (heterogeneous areas of tumour)
  • Previous incision site and biopsy tract if applicable
  • Major vessels at the soft tissue amputation site, if applicable
  • Non-lesional tissue
  • Other structures

Submit all lymph nodes and identify the site of each.


Record details of each cassette.

An illustrated block key similar to the one provided below may be useful.

Block allocation key

Bone resection for tumour

Demonstrated in the proximal tibia photographs provided.

Cassette id
Site
No. of pieces
A-K
Tumour slab (coronal slab)
 
L
Bone distal margin, en face/shave sections
 
M-R
Tumour and adjacent muscle (sagittal slab) with soft tissue resection margin
 

Acknowledgements

Associate Professor Fiona Bonar for her contribution in reviewing and editing this protocol.

ReferencesBack to top


  1. Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
  2. Athanasou NA and Mangham DC. Dataset for histopathology reports on primary bone tumours, The Royal College of Pathologists, London, 2010.
  3. Freemont AJ, Denton J and Mangham DC. Tissue pathways for bone and soft tissue pathology, The Royal College of Pathologists, London, 2011.
  4. Dimenstein IB (2008). Bone grossing techniques: helpful hints and procedures. Ann Diagn Pathol 12(3):191-198.
  5. Bancroft JD and Gamble M. Theory and practice of histological techniques. Churchill Livingstone Elsevier, Philadelphia, PA 2008.
  6. Suvarna KS, Layton C and Bancroft JD. Bancroft's Theory and Practice of Histological Techniques. Churchill Livingstone, 2012.