Intraoperative pathologic consultation (IOC) for tumors of the bone

When combining clinical examination, laboratory information and noninvasive imaging studies the differential diagnosis of bone lesions is narrowed. For those who are not experts in the field the major purpose of the IOC is to insure that adequate tissue has been obtained and to triage the tissue in the process preparing imprints, whenever possible; fixing some tissue for possible electron microscopic review; placing some tissue in B5 fixative for better cytologic detail; and to save some undecalcified tumor tissue in formalin in case immunostaining procedures are required. Most community pathologists should not be attempt to make an absolute diagnosis at the time of IOC, in many cases. The surgeon should always be warned that despite seeming benignancy 50% of primary bone tumors are malignant, that benign lesions can prove to be low grade sarcomas after full review, and vice versa that occasional cellular, "pleomorphic" lesions can be benign (aneurysmal bone cyst, early reparative and pseudosarcomatous lesions). Following review of the permanent sections, and other appropriate procedures an accurate diagnose is possible in the majority of cases. If the diagnosis is particularly difficult or questionable the above materials can be sent to a bone tumor specialist.