The pathologic handling of skeletal tumors

Because bone harbors a wide variety of benign and malignant pathologic entities, most of which are uncommon, pathologists feel uneasy when faced with many of these lesions. Accurate diagnoses of these lesions require correlation of the radiologic and clinical findings with the pathologic features. At the time of biopsy, placing a lesion into one of five pathologic groups based on the predominant cell or matrix type present (osteoid, chondroid, giant cell, fibrous, small cell) aids in analyzing the specimen. Current management of malignant bone tumors includes diagnosis on often tiny biopsy samples followed by preoperative chemotherapy and finally limb-sparing resection of the involved bone. Adequate evaluation of these resections requires extensive examination with grading of the tumor necrosis and careful attention to the resection margins.