Contributed by Borislav A. Alexiev, M.D.
Tibia lesion, radiography
Tibia lesion, MRI
Contributed by Mark R. Wick, M.D.
Tibial lesion
Contributed by Borislav A. Alexiev, M.D. and William B. Laskin, M.D.
Fibro-osseous lesion
Trabecular growth pattern
Anastomosing trabeculae of epithelial cells
Epithelial cells
Classic adamantinoma
Osteofibrous dysplasia-like adamantinoma
CK AE1 / AE3 expression
CK19 expression
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Femur
Humerus
Patella
Pelvis: left-male, right-female
Tibia and fibula
Radius and ulna
Shoulder joint
Different types of synovial joints
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Elbow joint; deep dissection; anterior view
Contributed by Elham Nasri, M.D.
Aneurysmal bone cyst of proximal tibia
Aneurysmal bone cyst of humerus
Aneurysmal bone cyst of distal tibia
Aneurysmal bone cyst of calcaneus bone
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Intraoral tumor
Contributed by Elham Nasri, M.D.
Blood filled cysts
Multiloculated cyst
Contributed by Elham Nasri, M.D. and Kelly Magliocca, D.D.S., M.P.H.
Cysts and giant cells
Blue chondroid like material
Blood filled cystic spaces
Solid area of cyst wall
Reticulated chondroid-like material
Multiple cystic spaces
Blood filled cysts
Reticulated chondroid-like material
Cyst wall and giant cells
Aneurysmal bone cyst
Contributed by Mark R. Wick, M.D.
Primary bone multifocal
Contributed by Mark R. Wick, M.D. and AFIP images
Primary bone
Grade 3
Contributed by Serenella Serinelli, M.D., Ph.D. and Gustavo de la Roza, M.D.
Xray and MRI appearance
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Xray and MRI appearance
Cartilaginous cap MRI appearance
Contributed by Serenella Serinelli, M.D., Ph.D. and Gustavo de la Roza, M.D.
Humeral
central atypical
cartilaginous
tumor
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Femoral secondary
peripheral atypical
cartilaginous tumor
Contributed by Serenella Serinelli, M.D., Ph.D. and Gustavo de la Roza, M.D.
Lobulated architecture
Bone permeation
Scalloping of cortical bone
Bone scalloping
Lamellar bone scalloping
Myxoid changes
Necrosis
Cytology features
Arising from osteochondroma
Chondrosarcoma versus enchondroma: bone pathology with Dr. Andrew Rosenberg
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Xray of femoral head AVN
MRI of bilateral AVN
Contributed by Rola H. Ali, M.D.
Wedge infarct
Subchondral collapse
Contributed by Rola H. Ali, M.D.
Subchondral infarct
Necrotic zone
Empty lacunae
Reactive zone
New bone
Creeping substitution
Contributed by F. Bilge Ergen, M.D.
Plain Xray features
MRI of BCOR::CCNB3 sarcoma
Contributed by Kemal Kösemehmetoğlu, M.D.
BCOR::CCNB3 sarcoma of radius
Contributed by Kemal Kösemehmetoğlu, M.D.
Typical morphology of BCOR::CCNB3 sarcoma
High power cytological morphology
Various cellularity
Hemangiopericytic pattern
Whorling pattern
Subtle osteoid formation
Epithelioid balls and nests
Telangiectatic areas
CCNB3 expression
CD99
BCOR
SATB2
TLE1
Focal EMA expression
Diffuse cyclin D1 expression
Contributed by Kemal Kösemehmetoğlu, M.D.
Cytological features of BCOR::CCNB3
Contributed by Kemal Kösemehmetoğlu, M.D.
Reverse transcription PCR for BCOR::CCNB3
BCOR::CCNB3 sarcoma of the proximal tibia
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Pathogenesis of osteomyelitis associated septic arthritis
Contributed by Mark R. Wick, M.D.
Bacterial osteomyelitis of tibia and vertebra in thoracic spine
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Osteomyelitis of the distal fourth metatarsal
Abnormal T1 weighted signal
Localized increased radioactive tracer uptake
Contributed by Dariusz Borys, M.D. and Mark R. Wick, M.D.
Acute osteomyelitis
Bacterial acute osteomyelitis
Contributed by Borislav A. Alexiev, M.D.
Left scapular neck mass
Contributed by Ajay R. Chapa, M.D.
Bone biopsy system
Contributed by Mark R. Wick, M.D.
Various images
Contributed by Mark R. Wick, M.D.
Various images
Nora lesion foot
Contributed by Mark R. Wick, M.D.
Femur Xray
Contributed by Mark R. Wick, M.D.
Femur
Contributed by Mark R. Wick, M.D.
Femur
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Pathogenesis
Contributed by Nasir Ud Din, M.B.B.S.
Multiple lytic lesions
Multiple lytic lesions
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Mandibular lesion
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Multilocular, expansile, hemorrhagic mass in rib
Contributed by Nasir Ud Din, M.B.B.S.
Lobulated pattern
Scattered nodular pattern
Vague circumscription of nodule
Vague nodularity
Irregularly distributed giant cells
Giant cells exhibiting tunneling resorption
Tunneling resorption
Abundant hemosiderin deposition in the lesion
Bone changes in hyperparathyroidism
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Elbow
Elbow: chronic fibrinous bursitis
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Extracellular pyrophosphate mechanism
Pathogenesis
Contributed by Nasir Ud Din, M.B.B.S. and Jose G. Mantilla, M.D.
Right knee joint, AP
Right knee joint, lateral
Talonavicular joint, foot
Shoulder CPPD Xray
Shoulder CPPD CT
Shoulder CPPD T1 MRI gadolinium
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Pyrophosphate arthropathy
Meniscal
chondrocalcinosis
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Right index finger swelling
Calcified brittle intradural mass
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Chalky white depositions
Contributed by Nasir Ud Din, M.B.B.S.
Basophilic deposits
Histiocytic reaction
Rhomboid crystals
Positive birefringence
Chondroid metaplasia
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Aggregates of birefringent crystals
Pseudogout
Contributed by Mark R. Wick, M.D., Borislav A. Alexiev, M.D. and AFIP
Femur Xray
Foot talus Xray
Humerus Xray
Left acromion lesion
Radiograph of tibia
Contributed by Ashley Patton, D.O., Ph.D., Nasir Ud Din, M.B.B.S. AFIP and @JMGardnerMD on Twitter
Chicken wire calcification and mature cartilage formation
Osteoclast-like giant cell
Sheets of chondroblasts
H3K36M antibody
Nuclei vary in size
Neoplastic cells with ovoid to spindled nuclei
Well formed chondroid matrix
Chicken wire appearance
Chondroblastoma
Contributed by Borislav A. Alexiev, M.D.
Giant cell rich lesion
Histological overview of chondrosarcoma
Contributed by Qurratulain Chundriger, M.B.B.S.
Drawing showing histology
Contributed by Mark R. Wick, M.D. and Nasir Ud Din, M.B.B.S.
Metatarsal Xray
Femur Xray
Tibia Xray
Proximal femur
Distal tibia
Proximal tibia
Distal tibia
Metatarsal
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Nasal mass
Sternum
Sellar lesion
Radius
Rib
Sacrum
Metatarsal
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Lesion in mandible
Orbital tumor with globe displacement
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Orbital tumor resection specimen
Resection of rib tumor
Contributed by Nasir Ud Din, M.B.B.S.
Confluent nodules with giant cells
Well defined nodular growth
Fibroblastic population
Peripheral giant cell proliferation
Stellate mesenchymal cells in nodules
Adjacent ABC-like areas
Chondroid differentiation
Well developed chondroid areas
Calcifications
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FNA of metatarsal lesion
FNA of lytic lesion in femur
FNA of metatarsal head lesion
Cartilage forming tumors
Contributed by Shadi Qasem, M.D.
Soft tissue extension
Corresponding MRI for previous image
Finger tumor
Pelvic tumor
Secondary tumor
Contributed by Shadi Qasem, M.D.
Femoral tumor
Pelvic tumor
Contributed by Shadi Qasem, M.D.
Grade I
Myxoid degeneration
Grade II
Grade III
Bone permeation
Contributed by Shadi Qasem, M.D.
Magenta color matrix
Multinucleation
Contributed by @Elena_PradosMD on Twitter
Chondrosarcoma
Chondrosarcoma versus enchondroma
Contributed by Jesse Hart, D.O. and Case #110
High signal intensity
Destruction of cervical vertebrae
MRI with sacral mass
Contributed by Jesse Hart, D.O.
Chordoma has fleshy cut surface
Chordoma has invaded the soft tissue
Contributed by Jesse Hart, D.O. and Nasir Ud Din, M.B.B.S.
Lobular architecture
Vesicular chromatin
Abundant myxoid stroma
Epithelioid cells with eosinophilic chords
Tumor necrosis
Poorly differentiated chordoma in 2 year old
Chondroid chordoma
Dedifferentiated chordoma
Brachyury
Cytokeratin cocktail
EMA
S100 protein
Contributed by Nasir Ud Din, M.B.B.S.
Epiphyseal osteomyelitis
Sequestrum
Periosteal reaction
Cystic
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Chronic osteomyelitis with wound infection
Contributed by Nasir Ud Din, M.B.B.S. and Mohammad Khurram Minhas, M.B.B.S.
Area of suppurative necrosis
Chronic granulomatous osteomyelitis
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Gender and anatomical distribution
Contributed by Borislav A. Alexiev, M.D.
Conventional radiography
T1 weighted MRI
MRI STIR sequence
T2 weighted MRI
Contributed by Borislav A. Alexiev, M.D.
Femoral head mass
Contributed by Borislav A. Alexiev, M.D. and @JMGardnerMD on Twitter
Malignant bone neoplasm
Cells with pale cytoplasm
Woven bone formation
Large round nuclei
Cartilaginous component
S100
D2-40
AE1 / AE3
H3K36M
Clear cell chondrosarcoma
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Arthroscopic finding
External aspect of cyst
Cyst resection
Contributed by Mark R. Wick, M.D. and AFIP images
Pathological fracture
Cartilaginous matrix
Contributed by Mark R. Wick, M.D.
Gray-white cartilage next to tan sarcomatous component
Contributed by Erica Kao, M.D. and Mark R. Wick, M.D.
Abrupt demarcation
Low grade cartilage
High grade component
Low grade cartilage juxtaposed with high grade sarcoma
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Mechanism of osteoarthritis
Development of osteoarthritis
Contributed by Nasir Ud Din, M.B.B.S.
Left knee joint
Right hip joint
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Hand osteoarthritis
Knee osteoarthritis
Hip joint osteoarthritis
Contributed by Jian-Hua Qiao, M.D.
Advanced osteoarthritis of hip
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Cartilage fragment in synovial fluid; chondrocytes
Synoviocytes in synovial fluid
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Crystals in cartilage
Osteoarthritis - causes, symptoms, diagnosis, treatment & pathology
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Desmoplastic fibroma
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Intervertebral disc
Disc degeneration
Contributed by Borislav A. Alexiev, M.D. and Terrance D. Peabody, M.D.
Left thumb Xray
Right index finger Xray
Left thumb MRI
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Ollier disease
Contributed by Borislav A. Alexiev, M.D. and Mark R. Wick, M.D.
First rib lesion
Multifocal in Ollier disease
Contributed by Borislav A. Alexiev, M.D.
Intramedullary lesion
Hypocellular lesion
Chondrocytes in lacunar spaces
Short tubular bone lesion
Degenerative changes
Contributed by Nasir Ud Din, M.B.B.S
Distal phalanx of thumb
Distal phalanx of fourth finger
Skull bone
Contributed by Nasir Ud Din, M.B.B.S.
Absence of adnexal structures
Keratin flakes in cystic cavity
Lamellated keratin
Squamous epithelium with granular layer
Reactive bone around the cyst
Chronic inflammation
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Multifocal liver lesions
Contributed by Iva Brčić, M.D., Ph.D. and Bernadette Liegl-Atzwanger, M.D.
Poorly circumscribed
Cords and nests
Tumor within bone
Erythrocytes in lumen
Cords in myxohyaline stroma
Cellular atypia
Mitosis and atypical cells
Nuclear CAMTA1 staining
Diffuse CD31
Diffuse ERG
CAM5.2 focally positive
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YAP1-TFE3 fusion
Contributed by Kshitij Arora, M.D.
CT of spine
T1 weighted MRI of foot
Contributed by Andrew E. Rosenberg, M.D.
Foot amputation
Contributed by Andrew E. Rosenberg, M.D. and Kshitij Arora, M.D.
Well demarcated
Nodular architecture
Arteriole type vessels
Well formed vascular spaces
Epithelioid cells
Sheets of cells
Epithelioid endothelial cells lining the lumen
CD31 IHC
FOS IHC
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Skeletal and lung involvement
Peirenal soft tissue thickening
Contributed by Aishwarya Ravindran, M.B.B.S. and Karen L. Rech, M.D.
Excisional biopsy of perinephric soft tissue mass
CD163
Factor XIIIa
Core biopsy of soft tissue (buttock) mass
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AFIP images
Saucerization
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Radiograph of humeral lesion
Radiograph of humeral lesion (close up)
CT of humeral lesion
Radiograph of humeral head lesion
MRI of humeral head lesion
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Extraosseus Ewing sarcoma of the forearm
Contributed by Mark R. Wick, M.D.
Ewing sarcoma
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Ewing sarcoma of foot
Amputation for Ewing sarcoma
Contributed by Laura Warmke, M.D., Mark R. Wick, M.D. and Erdener Özer, M.D., Ph.D.
Small round cells
Clear cell change
Apoptotic cells
"Light" cell and "dark" cell appearance
Rosettes
CD99
FLI1
Contributed by Laura Warmke, M.D. and Erdener Özer, M.D., Ph.D.
Round cells
Fine chromatin
Small nucleoli
Cytological appearance
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Ultrastructure analysis of tumor
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Dual color break apart probe FISH test
Ewing family of tumors
Contributed by Mark R. Wick, M.D. and AFIP images
Humerus Xray
Radius
AFIP images
Well circumscribed tumor
Contributed by Mark R. Wick, M.D. and AFIP images
Various images
Well differentiated
Grade 2
Grade 3
Contributed by Jose G. Mantilla, M.D., Mark R. Wick, M.D. and AFIP images
Femur
Femur coronal
Mandible
Femur
Ulna
Expanded rib
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Craniofacial lesions
Buccal protrusion
Contributed by Jose G. Mantilla, M.D. and AFIP images
Bone lesion
Expanded rib
Expanded lesion of calvarium
Contributed by Jose G. Mantilla, M.D., Kelly Magliocca, D.D.S., M.P.H. and @JMGardnerMD on Twitter
Irregular trabeculae
Stromal cells
Aneurysmal bone cyst
Fibrous dysplasia
Fibrous dysplasia
Fibrous dysplasia
Fibrous dysplasia
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Types of bone fracture
Fracture healing
Salter-Harris classification of physeal fractures
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CT of left ankle, sagittal view
Xray of distal femur
CT of scaphoid, coronal view
Xray of mid tibia
Xray of mid leg fracture
Xray of femoral fracture
Xray of humerus fracture
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53 year old man with open fracture of tibia
External fixation of fracture
Segmental fracture of tibia
Open fracture
Bruising in broken arm
Contributed by Laura Warmke, M.D. and Mark R. Wick, M.D.
Hemorrhage
Fibrovascular stroma
Fracture callus
Endochondral ossification
Hemorrhagic background
Woven bone
Devitalized bone
Bone resorption
Inflammatory cells
Fracture callus
Atypical cartilage component
Healing
Common types of bone fracture
How do broken bones heal?
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Dorsal wrist ganglion
Ganglion: intraoperative view
Volar wrist ganglion
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Ultrasound: dorsal wrist ganglion
MRI: volar wrist ganglion
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Ganglion
Contributed by Serenella Serinelli, M.D., Ph.D.
Unilocular ganglion cyst
Cyst wall and content
Multilocular ganglion cyst
Myxoid changes
Absence of synovial lining
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Ganglion cyst mucoid material
Histiocytes in ganglion cyst
Ganglion cyst features
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Anatomical distribution
Contributed by Borislav A. Alexiev, M.D.
Lytic lesion
Expansile solid lesion
Mass with extraosseous component
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Right proximal humerus tumor
Contributed by Borislav A. Alexiev, M.D. and Mark R. Wick, M.D.
Left distal femur lesion
Distal femur
Contributed by Borislav A. Alexiev, M.D.
Osteoclasts-rich bone lesion
Typical features
Reactive bone formation
Aneurysmal change
Neoplastic mononuclear cells
Residual tumor
Depletion of giant cells
Reactive bone formation
Complete response with hemorrhage
Spindle cell proliferation
Complete response with fibrosis
G34W IHC
p63 IHC
Contributed by Lucy Jager, M.D.
Cellular smears
Mononuclear and MGCs
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Acute gout
Chronic tophaceous gout
Pathogenesis of gout
Contributed by Nasir Ud Din, M.B.B.S.
Left foot
Foot
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Bilateral tophi, hands
Bilateral tophi, feet
Contributed by @Elena_PradosMD on Twitter
Gout and gouty arthritis
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Tan-white chalky, crumbly tophi
Contributed by Nasir Ud Din, M.B.B.S. and @Elena_PradosMD on Twitter
Nodular aggregates
Granulomatous appearance
Feathery appearance
Needle shaped crystals
Chronic inflammatory cells
Intersecting pattern of arrangement
Brightly anisotropic crystals
Gout and gouty arthritis
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Gouty tophus with crystalline material and inflammatory response
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Needle-like crystals
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Urate transporters
Uric acid transportasome
Brilliant polarizable birefringent monosodium urate crystals
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Hepatic hemangioma
Intrathoracic hemangioma
Infantile thyroid hemangioma
Infantile hepatic hemangioma
Choroidal hemangioma (fundoscopy)
Hemangioma in long bones
Hemangioma in long bones
Contributed by Nasir Ud Din, M.B.B.S.
Noninvoluting congenital hemangioma
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Infantile hemangioma
Infantile hemangioma with ulceration
Infantile hemangioma in beard distribution
Rapidly involuting congenital hemangioma
Partially involuting congenital hemangioma
Laryngeal hemangioma (laryngoscopic view)
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Atrial hemangioma
Hepatic hemangioma
Pulmonary hemangioma
Contributed by Nasir Ud Din, M.B.B.S.
Anastomosing hemangioma
Skeletal hemangioma
Cavernous hemangioma
Hobnail hemangioma
Hepatic hemangioma
Infantile hemangioma
Infantile hemangioma
Lobular capillary hemangioma
Spindle cell hemangioma
Spindle cell hemangioma
Phleboliths in spindle cell hemangioma
Synovial hemangioma
Verrucous hemangioma
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Endothelial differentiation
Cutaneous hemangioma
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Sanger sequencing for RASA1
Spindle cell hemangioma
Cutaneous vascular tumors
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Bone structure
Bone architecture
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Cancellous and compact bone
Contributed by Nasir Ud Din, M.B.B.S.
Active osteoblasts
Inactive osteoblasts
Osteoclasts
Osteoclast type giant cells
Woven bone
Osteocytes in woven bone
Lamellar bone
Osteocytes in Lamellar bone
Cortical bone
Cortical bone
Cortical bone
Reversal cement lines
Periosteum
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Osteoclast structure
Normal bone histology & embryology 101 with Dr. Andrew Rosenberg
Bone cells and bone formation
Contributed by Edward F. DiCarlo, M.D.
Tibial plateau
Contributed by Lingxin Zhang, M.D.
Articular cartilage
Normal articular cartilage
Ligament
Enthesis
Synovium
Histology of the joint
Embryology, history and pathology of articular cartilage
Case #300
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Polyethylene liner wear
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Metallosis surrounding implant and cervical neck
Case #300
Case #300
Polarizing light showed
crystal-like structures
consistent with polyethylene
particles
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Prosthetic synovitis:
hyperplastic synovial
membrane adjacent
to prosthesis
Methylmethacralate
debris (linear webs)
surrounded by
giant cells
Polyethylene flakes (shiny linear material) surrounded by foreign body giant cell reaction (polarized microscopy)
Calcium pyrophosphate crystals under polarized light
Contributed by Mark R. Wick, M.D.
Multifocal congenital Xray
Contributed by Mark R. Wick, M.D.
Multifocal congenital
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Cytokine signaling pathways
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Various images
Swelling and flexion contracture
Polyarticular disease
Systemic onset disease
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Various images
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Arthroscopic image
of lesion within
suprapatellar pouch
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Glassy appearance
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Myxoid stroma and spindle cells
Bland myxoid
neoplasm without
mesenchymal atypia
or hypercellularity
Contributed by Vignesh Shanmugam, M.D.
Misguided myeloid / dendritic cell model
Contributed by Vignesh Shanmugam, M.D.
Sagittal view
Coronal view
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LCH
Contributed by Vignesh Shanmugam, M.D.
Preservation of follicle centers
Sinusoidal infiltration
Infiltrate of subcapsular sinus
Frequent admixed eosinophils
Prominent nuclear grooves
Admixed multinucleated giant cells
Langerin
CD1a
S100
Cyclin D1
Contributed by Catherine Hagen, M.D.
Langerhans cell histiocytosis
CD1a positive LCH
S100 positive LCH
AFIP images
With Hodgkin lymphoma
Involving spleen
Malignant
S100
Nuclear and cytoplasmic staining S100
Case #314
Diffuse involvement
Sinusoidal and pericapsular involvement
Pericapsular involvement
Admixed eosinophils
Nuclear grooves
Mitotic activity
CD1a
CD5
CD20
CD23
Langerin
S100
Contributed by Vignesh Shanmugam, M.D.
Prominent nuclear grooves and admixed eosinophils
Scattered multinucleated giant cells
AFIP images
Birbeck granules
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Birbeck granules
Contributed by Borislav A. Alexiev, M.D.
MRI of tibia mass
Contributed by Borislav A. Alexiev, M.D.
Bone mass
Contributed by Borislav A. Alexiev, M.D.
Cortical destruction
Well formed neoplastic bone trabeculae
Fascicles of spindle cells
Lack of bone matrix
Mild nuclear atypia
Contributed by Madina Sukhanova, Ph.D.
MDM2 FISH
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Erythema migrans skin lesion
Bullseye rash
Lyme arthritis of right knee
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Borrelia burgdorferi
AFIP images
Femur
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Imaging of sacral lymphoma
AFIP images
Dense nuclei and histiocyte-like cells
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Sacral diffuse large B cell lymphoma
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FISH: diffuse
large B cell
lymphoma with
MYC translocation
Contributed by Jessica L. Davis, M.D.
Fibrous dysplasia
Intramuscular myxoma
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Ulnar fracture
Lucency in long bones
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5 year old girl: jagged "coast of Maine" borders
Café au lait spots
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Ovarian abnormalities
Contributed by Jessica L. Davis, M.D.
Fibrous dysplasia
Contributed by Borislav A. Alexiev, M.D.
Anterior mediastinal mass
Contributed by Iva Brčić, M.D., Ph.D. and Bernadette Liegl-Atzwanger, M.D.
Lobulated mass
Calcifications
Contributed by Iva Brčić, M.D., Ph.D. and Bernadette Liegl-Atzwanger, M.D.
Biphasic tumor
Abrupt transition
2 components
Spindle cell morphology
Transition higher power
Cellular atypia
CD99 staining
Contributed by Mark R. Wick, M.D. and AFIP images
Breast carcinoma
Lung carcinoma to metatarsal
Prostate adenocarcinoma
Thyroid carcinoma
Lung carcinoma metastasis
Prostate carcinoma - osteoblastic features
Thyroid carcinoma
Contributed by Mark R. Wick, M.D.
Lung carcinoma in humeral head
Lung squamous cell carcinoma
Contributed by Semir Vranić, M.D., Ph.D., Mark R. Wick, M.D. and AFIP images
Bone metastasis
Primary prostate adenocarcinoma
Lung carcinoma to metatarsal
Lung carcinoma to metatarsal
Lung carcinoma to metatarsal TTF1
Prostate adenocarcinoma
Renal cell carcinoma
Lung: metastatic carcinoma
Lung: metastatic carcinoma BerEp4
Prostate: metastatic carcinoma
Thyroid: metastatic carcinoma
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Different stages
Pathogenesis
Contributed by Nasir Ud Din, M.B.B.S.
Xray of early stage
Xray of mid to late stage
MRI buttock for soft tissue mass
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Different stages
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Large right pectoral mass and chest radiograph
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Excised and bisected mass
Contributed by Ghazi Zafar, M.B.B.S., Nasir Ud Din, M.B.B.S. and @JMGardnerMD on Twitter
Periphery
Circumscription
Zonation
Central zone
Foci of cartilage
Osteoid production
Multinucleated giant cells
Myositis ossificans and fibro-osseous pseudotumor of digits
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Cytological features
Myositis ossificans (benign mimic of sarcoma) bone / soft tissue pathology & radiology correlation
Contributed by Qurratulain Chundriger, M.B.B.S.
Schematic presentation
Contributed by Nasir Ud Din, M.B.B.S. and AFIP images
Distal tibia
Proximal tibia
Proximal fibula
Femur with fracture
Multifocal
Nonossifying fibroma
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Radius (plain radiograph)
Radius (MRI)
Femur (plain radiograph)
Femur (CT scan)
Vertebral body
Mandible
Growth stages
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Lesion in clavicle
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Lesion in clavicle
Lesion in mandible
Contributed by Nasir Ud Din, M.B.B.S.
Circumscribed border on resection
Storiform arrangement
Interspersed giant cells
Few giant cells
Resembling ABC
Reactive woven bone
Aggregates of foamy macrophages
Hemorrhage and inflammatory cells
Necrosis after fracture
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Lesion in femur
Bone and cartilage tumors
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Epidemiology and localization
Contributed by Borislav A. Alexiev, M.D. and David R. Lucas, M.D.
Left frontal sinus mass
Calcified mass
T7 osteoblastoma with central nidus
Contributed by Borislav A. Alexiev, M.D. and David R. Lucas, M.D.
Bony mass with nidus
Osteoblastoma of clavicle
Spinal T7 osteoblastoma
Contributed by Borislav A. Alexiev, M.D. and David R. Lucas, M.D.
Well marginated lesion
Loose edematous fibrovascular stroma
Osseous trabeculae
Demarcated tumor
Activated osteoblasts
Anastomosing trabeculae
Central nidus of sclerotic woven bone
Woven bone trabeculae with osteoblastic rimming
Degenerative atypia
Contributed by David R. Lucas, M.D.
Cytology smears
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Osteoblasts with eccentric nuclei
Osteoblast with
indented nucleus
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Head of femur
Osteochondritis of left humeral head
with secondary deformation of bone,
eighth to ninth century from Iona
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Pathological specimen of Danish sow
Contributed by Jose G. Mantilla, M.D., Mark R. Wick, M.D. and AFIP images
Osteochondroma arising in the proximal femur
Osteochondroma arising in the distal femur
Distal portion of femur
Metatarsal Xray
Xray
Contributed by Jose G. Mantilla, M.D. and AFIP images
Hyaline cartilage cap
Outer and cut surfaces
Contributed by Jose G. Mantilla, M.D. and AFIP images
Whole slide
Cartilage cap
Whole mount section
Cellular cartilaginous foci
Junction of cartilage cap and underlying bone
Contributed by Nasir Ud Din, M.B.B.S., Mark R. Wick, M.D. and AFIP images
Multiloculated radiolucent lesion in tibia
Multiloculation and sclerotic borders
Thickened sclerotic areas
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Marked bowing deformity
Synchronous tumors in tibia and fibula
Contrast enhancing lesion on CT scan
Contrast enhancing lesion on MRI scan
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Radiolucent and sclerotic areas
Ill defined lucencies and bowing deformity
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Soft tissue and medullary cavity involvement
Soap bubble appearance on CT scan
Cortical lesion with sclerotic rim
Contributed by Mark R. Wick, M.D. and AFIP images
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Solid tumor involving cortex and medulla
Focally eroded cortex
Contributed by Nasir Ud Din, M.B.B.S. and Mark R. Wick, M.D.
Fibro-osseous lesion with zonation pattern
Thickened trabeculae at the periphery
Bone trabeculae and storiform pattern
Osteoblastic rimming of bone trabeculae
Osteoblastic rimming and storiform pattern
Osteoblastic rimming
Multinucleated osteoclast-like
giant cells
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Keratin immunostain
Osteofibrous dysplasia
Fibrous dysplasia and osteofibrous dysplasia: bone forming tumors,
part 4
Imaging osteofibrous dysplasia
Contributed by Elham Nasri, M.D. and John D. Reith, M.D.
Tibia
Elbow
Finger
Distal femur
Distal femur
Wrist
Contributed by John D. Reith, M.D.
Nidus tissue with surrounding bone
Contributed by Elham Nasri, M.D. and John D. Reith, M.D.
Well defined borders
Osteoblastic rimming
Sheet-like osteoid deposition
Sclerotic nidus
Peripheral transition to sclerotic bone
Bone trabeculae with variable mineralization
AFIP images
Dense lobular mass in frontal sinus
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CT bone window
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Osteoma of anterior maxilla
Forehead osteomas
Nasal cavity osteoma with actinomycosis
Contributed by David R. Lucas, M.D. and Mark R. Wick, M.D.
Osteoblastoma-like osteoma
Skull osteoma
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Osteoma with smooth bosselated surface
Giant orbit osteoma
Fronto-ethmoidal osteoma
Contributed by Serenella Serinelli, M.D., Ph.D., Gustavo de la Roza, M.D. and Kelly Magliocca, D.D.S., M.P.H.
Cortical type bone architecture
Trabecular bone architecture
Lamellar bone
Osteoblasts and osteocytes
Fibrous stroma in marrow spaces
Osteoma
Osteoma of bone
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Osteoporosis
Contributed by Jesse Hart, D.O., Borislav A. Alexiev, M.D. and AFIP
Soft tissue extension
Proximal humerus mass
Proximal femur mass
Metadiaphyseal aspect of proximal tibia
Proximal fibula
Contributed by Jesse Hart, D.O., Borislav A. Alexiev, M.D. and Mark R. Wick, M.D.
Low grade central osteosarcoma of femur
Osteosarcoma of the humerus
Osteosarcoma of the femur
Telangiectatic osteosarcoma
Grid pattern diagram
Contributed by Jesse Hart, D.O., Borislav A. Alexiev, M.D. and AFIP
Permeative growth pattern
Lace-like bone
Marked pleomorphism
Soft tissue extension
Chondroblastic osteosarcoma with focal bone
Fibroblastic osteosarcoma
Fibroblastic osteosarcoma spindle cells
Postneoadjuvant resection
Postneoadjuvant tumor cell drop out
Postneoadjuvant loose, fibrous scar
Low grade central osteosarcoma
Low grade central osteosarcoma invasion
Small osteoblasts with indistinct cytoplasm
Lymphoma-like pattern
Small foci of osteoid
Telangiectatic osteosarcoma
Telangiectatic osteosarcoma
Contributed by Jose G. Mantilla, M.D.
Coronal CT of femur
Xray of femur
Contributed by Dana J. Hariri, M.D.
Osteoblastic rimming
Jigsaw pattern
Haphazard lamellar bone
Peritrabecular fibrosis
Overview of diagnosis and management of Paget disease
Contributed by Nasir Ud Din, M.B.B.S., Mark R. Wick, M.D. and AFIP
Surface tumor with intact cortex
Intact cortex
Radiolucent cleavage of intact periosteum
Lobulated tumor with cartilage component
Parosteal osteosarcoma of rib
Distal femur Xray
Proximal tibia Xray
Mass behind knee
Femur
Contributed by Mark R. Wick, M.D. and AFIP
Distal femur
Proximal femur tumor
Cross section
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Tumor encircling bone
Dedifferentiated parosteal osteosarcoma
Contributed by Nasir Ud Din, M.B.B.S.
Cartilage cap, bone and spindle cells
Cartilage nodule, bone and spindle cells
Parallel bone trabeculae
Parallel and interconnected bone trabeculae
Parallel and interconnected bone trabeculae
Interconnected bone trabeculae
Small islands of bone
Chinese letter-like bone trabeculae
Low grade spindle cell component
Intermediate grade spindle cell component
Dedifferentiated areas
Fat and muscle entrapment
Skeletal muscle atrophy
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MDM2 gene amplification by FISH
Parosteal osteosarcoma
by Lewis Hassell
Parosteal osteosarcoma made easy by Vikram Deshpande
Contributed by Shadi Qasem, M.D., M.B.A.
Xray of distal femur lesion
CT scan of distal femur lesion
Proximal tibia lesion
Contributed by Shadi Qasem, M.D., M.B.A. and Mark R. Wick, M.D.
Marginal resection specimen
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Wide resection specimen
Contributed by Shadi Qasem, M.D., M.B.A.
Well defined margin
Low cellularity
No significant atypia
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Yellowish discharge of altered synovial fluid
Contributed by @MirunaPopescu13 on Twitter and Case #308
Rheumatoid arthritis
Various images
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Amorphous, pink, necrotic material
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HLA-DR4 molecule
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Ankle joint
Contributed by Nasir Ud Din, M.B.B.S.
Proximal humerus
Humerus
Proximal femur
Proximal femur MRI
Calcaneus
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Mandible
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Humerus
Contributed by Nasir Ud Din, M.B.B.S.
Cyst fragments
Cyst wall
Fibrin-like deposits
Reactive bone
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Osteogenesis imperfecta:
Postmortem photograph shows
deformed extremities, findings
that are consistent with fractures
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Intervertebral disc
(top center) destroyed
by vertebral abscess
Spinal cord compressed by abscess
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C. tropicalis
Contributed by Anshu Bandhlish, M.D. and AFIP images
Distal phalanx Xray
Distal phalanx of great toe
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Subungual exostosis of index finger
Subungual exostosis in an 8 year old child
Subungual exostosis of right fifth toe
Contributed by Robert Ricciotti, M.D. and AFIP images
Exophytic lesion of distal phalanx
Enchondral ossification
Thin cartilaginous cap
Reactive bone
Moderately cellular cartilage
What is a subungual exostosis?
Contributed by Nasir Ud Din, M.B.B.S.
Multiple osteochondral bodies
Small
osteocartilaginous
bodies
Clumps of cartilaginous bodies
Multiple rounded to oval lesions
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Right thumb: dorsal aspect, lateral aspect, palmar aspect
Intraoperative view and excised loose bodies
Contributed by Nasir Ud Din, M.B.B.S.
Multiple osteochondral loose bodies
Chondral loose bodies
Contributed by Nasir Ud Din, M.B.B.S.
Loose chondral bodies
Subsynovial cartilaginous bodies
Clustering of chondrocytes
Mild cellularity
Subsynovial cartilaginous body
Mild atypia
Calcification
Synovial chondromatosis:
5 minute pathology pearls
by Dr. Jerad Gardner
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Baker cysts
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Spinal synovial cyst
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Baker cysts
Cutaneous metaplastic synovial cyst
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MRI of Baker cyst
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Cutaneous metaplastic synovial cyst with numerous villous-like structures; vimentin+ CD34- CD68-
Hemorrhagic spinal synovial cyst with thin fibrous wall
Contributed by Mark R. Wick, M.D.
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Villi-like structures
Papillary architecture
Mature adipocytes
Focal hyperplasia
Few mature lipocytes
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Correctable swan neck deformities and ulnar deviation
Readily correctable swan neck deformities and subluxation of right fifth MCP
Metacarpal heads - no cartilage damage seen
Noncorrectable deformities of PIP joints
Mild ulnar deviation, especially on right
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Synovial membrane
Contributed by Mark Girton, M.D. and AFIP
Marrow mast cell cluster
Intermixed with lymphoid aggregate
Aspirate with mast cells
Mast cell cluster
Hypercellular bone marrow biopsy
Bone marrow biopsy with marrow replacement
Cytologic spectrum
CD117 positive mast cells
CD25 positive mast cells
CD2 positive mast cells
CD30 positive mast cells
CD117 positive mast cells
Mast cell tryptase positive
CD25 positive mast cells
Perifollicular distribution
Characteristic sclerosis
Mast cell infiltrate
Delicate collagen fibrils and eosinophils
Mast cell staining
Interfollicular pattern
Diffuse involvement
Ovoid nuclei with eosinophilic cytoplasm
Spindle shaped mast cells
Spindly configuration
Contributed by Mark Girton, M.D.
Peripheral blood mast cell
Contributed by Jigang Wang, M.D., Ph.D. and Jiufa Cui, M.D., Ph.D.
Diffuse type
Bone erosion on CT
Low signal on MR
Low signal on MR
Low signal on MR
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Localized type
Mass on the tendon
Ultrasound of finger lesion
Hand MRI
Diffuse type
MRI of the ankle
Malignant
Progressive increasing mass
Contributed by Mark R. Wick, M.D.
Localized type
Digit lesion
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Localized type
Mass over lateral right foot
Tumor at surgery
Neurovascular bundle involvement
Swelling appearance
Lateral route
Diffuse type
Brownish mass
Contributed by Mark R. Wick, M.D.
Localized type
Cut surface
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Diffuse type
Tumor mass
Contributed by Jigang Wang, M.D., Ph.D., Jiufa Cui, M.D., Ph.D. and Michella Whisman, M.D.
Localized type
Fibrous bands
Lobular appearance
Large epithelioid cells
Multinucleated giant cells
Pigment laden histiocytes
Foamy histiocytes
Foamy histiocytes
Mononuclear component
Diffuse type
Foamy histiocytes (xanthoma cells)
Mononuclear cells
Large mononuclear cells
Chondroid metaplasia
Papillary growth pattern
Numerous mononuclear cells
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Localized type
Mononuclear stromal cells, osteoclast giant cells
Malignant
Mitosis
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Diffuse type
Structural chromosomal aberration
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Arthroscopic view of elbow joint
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Synovial tissue
Contributed by Mark R. Wick, M.D.
Paraspinal tuberculous abscess MRI
Contributed by Mark R. Wick, M.D.
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Tubeculous vertebral osteomyelitis
Contributed by Mark R. Wick, M.D.
Various images
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Schematics of tumoral calcinosis
Approach for tumoral calcinosis
Contributed by Nasir Ud Din, M.B.B.S.
Right finger, distal phalanx
Calcified lesion, foot
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Nodules on patient’s hands
Metastatic
calcifications
presenting as
firm solid masses
NFTC and dermatomyositis
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Cystic spaces filled with yellowish material
Contributed by Nasir Ud Din, M.B.B.S. and John Irlam, D.O.
Irregular basophilic deposits
Foreign body giant cell reaction
Amorphous granular pink deposits
Chunky basophilic deposits
Psammoma body-like calcospherites
Calcinosis
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Amorphous pink deposits
Basophilic, amorphous calcium deposits
Scrotal calcinosis - pathology mini tutorial
Contributed by AFIP and Mark R. Wick, M.D.
Radiograph of tibial tumor
Primary, distal femur
Contributed by Mark R. Wick, M.D.
Primary
Contributed by Hatem Kaseb, M.D., Ph.D., M.P.H., Mark R. Wick, M.D. and AFIP
Significant pleomorphism
Significant pleomorphism
Significant pleomorphism
Fascicles of fibroblasts
Noncalcified collagen
Contributed by Borislav A. Alexiev, M.D.
Enchondroma
Chondrosarcoma
Dedifferentiated chondrosarcoma
Mesenchymal chondrosarcoma
Low grade osteosarcoma
Osteosarcoma
Aneurysmal bone cyst
Chondroblastoma
Giant cell tumor of bone
Nonossifying fibroma
Conventional chordoma
Bocklage: 2014
Czerniak: 2015
Deyrup: 2015
Dodd: 2014
Folpe: 2022
Forest: 1998
Greenspan: 2015
Horvai: 2012
IARC: 2020
Jo: 2015
Klein: 2011
Montgomery: 2020
Nielsen: 2021
Nielsen: 2021
Picci: 2019
Santini-Araujo: 2020
Unni: 2009
Wei: 2013
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