BONE NEOPL ASM

BONE TUMOR GRADES

Grade 1 (Low Grade)
• Low-grade central osteosarcoma Parosteal osteosarcoma Adamantinoma
Grade 2
• Periosteal osteosarcoma
Grade 3 (High Grade)
• Malignant giant cell tumor Ewing sarcoma / PNET Dedifferentiated
chondrosarcoma
• Conventional osteosarcoma
• Telangiectactic osteosarcoma
• Small cell osteosarcoma
• Secondary osteosarcoma
• High-grade surface osteosarcoma
Variable Grade
• Conventional chondrosarcoma of bone (grades 1 to 3)
• Soft-tissue type sarcomas (e.g., leiomyosarcoma)

Ungraded
• Chordoma, conventional
Chordoma, dedifferentiated (high grade)
STAGING SYSTEMS
• Staging refers to an assessment of the grade of the tumor and the
extent to which the disease has spread. Several staging systems are
used, but all have the purpose of helping the physician plan a logical
treatment program and establish a prognosis for the patient. The
two major systems are discussed here.
AMERICAN JOINT COMMITTEE OF
CANCER
• The American Joint Committee of Cancer (AJCC) system of staging
is used by most surgical oncolo- gists when dealing with soft tissue
and bone sarcomas . It has a four-point scale for classifying tumors
as grade 1, 2, 3, or 4 on the basis of their histologic appearance.

• A grade 1 or 2 tumor in the AJCC system is equivalent to a stage I

tumor in the Enneking system; grade 3 or 4 is equivalent to
Enneking stage II.
SYSTEM OF THE AMERICAN MUSCULOSKELETAL
TUMOR SOCIETY (ENNEKING SYSTEM)
• The Enneking system has a three-point scale for classifying tumors as stage I, II,
or III on the basis of their histologic and biologic appearance and their
likelihood of metastasizing to regional lymph nodes or distant sites such as the
lung.
1. Stage I refers to low-grade sarcomas with less than 25% chance of metastasis.
2. Stage II refers to high-grade sarcomas with more than 25% chance of
metastasis.
3. Stage III is for either low- or high-grade tumors that have metastasized to a
distant site such as a lymph node, lung, or other distant organ system.
• The Enneking system further classifies tumors on the basis of
whether they are intracompartmental (type A) or
extracompartmental (type B) in nature.
a) Intracompartmental
Bone tumors are confined within the cortex of bone
b) Extracompartmental
Bone tumors extend beyond the bone cortex
CLASSIFICATION OF TRUE PRIMARY
NEOPLASM OF BONE
A. Osteogenic
1. Osteosarcoma (osteogenic sarcoma)
2. Surface osteosarcoma (parosteal sarcoma; periosteal sarcoma)
B. Chondrogenic
1. Benign chondroblastoma
2. Chondromyxoid fibroma
3. Chondrosarcoma
C. Fibrogenic
1. Fibrosarcoma of bone
2. Malignant fibrous histiocytoma of bone
D. Angiogenic
1. Angiosarcoma of bone
E. Myelogenic
1. Myeloma of bone (multiple myeloma)
2. Ewing's sarcoma (Ewing's tumor)
3. Hodgkin's lymphoma of bone
4. Non-Hodgkin's lymphoma (reticulum cell sarcoma)
5. Skeletal reticuloses (Langerhans' cell histiocytoses;)
6. Leukemia

F. Uncertain origin
1. Giant cell tumor of bone (osteoclastoma)