Feature punctates for tumors of the bone


Osteoma - A benign tumor, most often affects different bones of the skull. It looks dense bony prominences. Cytological studies can not be due to the impossibility of obtaining punctate.

Osteoid osteoma, – osteoid osteoma

Tumor, developing any bone, but more often in the diaphyseal tibial and femoral bone. It occurs in childhood and adolescence.

Clinically characterized constant dull pain in the affected bone. Patients can not always pinpoint the affected area, since the objective of any changes of soft tissue around the outbreak is not detected.

Osteoid osteoma, are benign tumors, Although some authors consider it chronic osteomyelitis. For cytology used material, derived from tumor nest.

The punctate blood cells on the background and the main (intermediate) substances, okrashivayushtegosya in rozovatыe tons, revealed mononuclear cells such as osteoblasts and single giant multinucleated cells such as osteoclasts. Often, there may be punctate clusters of osteoclasts. Cytologic diagnosis is only possible with the radiological and clinical data. In conclusion, cytology notes, that the morphological data do not contradict the radiological punctate (clinical) diagnozu.

Osteoblastoklastoma – giant cell tumor of bone

There are benign giant cell tumor, which can be converted into ozlokachestvlyatsya or sarcoma, and primary malignant.

Benign osteoblastoklastoma

Benign osteoblastoklastoma 15-20 % of all benign bone tumors. The most common tumor develops at the age of 20-40 years in both sexes in the epiphysis and metaphysis of the femur and tibia.

Within osteoblastoklastomy long. The affected area appears as a swollen bone soft consistency, places with seals. In the context of tumor has mottled appearance due to dark red (reminding hemorrhage) sections, foci of tumor tissue grayish-whitish yellow and necrotic masses. The tumor shows cystic cavities of various sizes, filled with serous fluid. A special feature is the fabric type osteoblastoklastomy circulation (circulation of blood cells is the vascular bed). Such areas of tissue circulation may have different sizes. The destruction of red blood cells in these areas leads to the development of tumor tissue expressed hemosiderosis, gives it a brown color.

Microscopically in punctate osteoblastoklastomy distinguish mononuclear cells such as osteoblasts and multinucleated giant cells of osteoclast type. Cells such as osteoblasts are located separately, clusters, kuchkami, tyazhami. Among them are giant multinucleated (from 10 to 50 cores) type cells osteoclasts. In some cases, a lot of them, in others - single copies. Besides, in preparations may be found naked nuclei, debris from broken cells, clumps of hemosiderin.

Malignant osteoblastoklastoma

Along with the single-core and multi-core giant cells are usually punctate structures observed in cells with signs of atypia.

Цитологическая картина злокачественной остеобластомы

Mononuclear cells have larger nuclei with hypertrophied nucleoli. The primary malignant osteoblastoklastome dominated mononuclear cells. The morphological structure of the tumor reminiscent of fibrosarcoma or, due to the presence of giant cells, polymorphonuclear cell sarcoma. When malignant osteoblastoklastome giant cells smaller and have fewer cores.


Osteosarcoma - The most common tumors in bone sarcomas. Ranging from 30 to 60 % of all malignant bone tumors. It develops mainly in children, adolescents and adults 25-30 years, men often, than in women. Usually it localized in the metaphysis of long bones (Femoral, tibial, peroneal and others.). Often broken limb function (claudication, restriction of mobility in the nearby joint, slight contracture). In 5-10% of cases are detected pathologic fractures.

Osteogennuyu sarkomu share of axle-teoliticheskuyu (osteoclastic) and osteoblastic.

Radiologically when osteolytic sarcoma defined bone defect with jagged edges eaten away. The growing tumor pushes the periosteum and form periosteal visor, or spur.

For osteoblastic sarcoma characterized by a pronounced bone formation, resulting in bone thickens fusiform, sealed and there is detachment of the periosteum. This produces tapered sunshields. The tumor in the form of sleeves surrounding bone, ottesnyaya nadkostnitsu,- As a result formed radiating spicules - bone needle, perpendicular to the bone surface.

Osteogenic sarcoma grows uniformly in all directions. The entire medullary canal (from one to the other epiphysis) filled tumor, which is distributed along the bone and under the periosteum, early metastasizing to the lungs.

The punctate tumor always found a significant admixture of blood and various cells. Despite pronounced signs of malignancy, osteoclasts and osteoblasts in punctate retain their characteristic features. Such mononuclear osteoblasts and osteoclasts, containing 3 to 10 cores and more, referred to as atypical.

Цитологическая картина остеогенной саркомы

Cores, usually, big, round, oval, gripping forms, with indistinct contours. Chromatin deeply dyeable, fine-grained structure, sometimes blurry. In the nuclei of one to six nucleoli. Often there are mitotic figures and amitosis. Eccentrically located nucleus. The cytoplasm of atypical osteoblast often extended, Process forms, intensely colored, basophilic, without oxyphilic grain. Due to the sharp enlargement of nuclei in the cytoplasm of osteoblasts atypical may be narrow, and around the nucleus even subtle. The atypical nuclei osteoclasts More, with large nucleoli, located in the center of the cell. Slabobazofiliaya cytoplasm places oxyphilic, Process, sometimes with vacuoles.

In identifying punctate only in atypical osteoblast, create a picture, similar to fibrosarcoma bone, to determine the true nature of the tumor is quite difficult.

Fibrosarcoma characterized by a uniform cytologic picture, while atypical osteoblasts differ in some polymorphism, as well as the presence of figures of nuclear fission. Osteosarcoma morphologically different from the malignant giant cell tumor, that in the last detected abnormal osteoclasts and osteoblasts on a background of normal cells of this type. When osteosarcoma in punctate found mainly atypical forms.

Bone cyst

It develops relatively rare, mainly in adolescence. Clinically asymptomatic for a long time. Perhaps the development of cysts as an independent disease or the appearance of the background of existing, eg osteoblastoklastomy. In the bone cavity appear, filled with serous or bloody fluid, that contribute to thinning of the bones and can lead to spontaneous fracture. Punctate of bone cyst plentiful, often bloody. On microscopic examination, it found in a small number of mononuclear cells such as osteoblasts, multi-type cells of osteoclasts, isolated blood cells and fibroblasts.


Xondroma - A benign tumor, which often develops in childhood and adolescence, but can also occur in adults.

In childhood and adolescence the tumor develops from the remnants of hyaline cartilage and has a true cartilaginous structure.

In adults, tumors can occur in the process of calcification and ossification or mucilaginized. Depending on the primary tumor site with respect to the bone distinguish central chondroma (enkhondromu) and swelling, growing on the surface of the bone (ekxondromu). In most cases, chondroma is multiple and mainly affects short tubular bones - phalanges, hands and feet, as well as the metacarpal and metatarsals. In most cases, chondroma is characterized by very slow growth and asymptomatic.

The tumor has a lobed structure, lobules different sizes - from a few millimeters to several centimeters. In the context of tumor tissue translucent, bluish color. In tumor tissue specimens has the structure of hyaline cartilage with unevenly spaced cartilage cells. In some places you can find areas of myxomatosis and secondary ossification centers of. A large number of dual-core cartilage cells and cells with large hyperchromatic nuclei should guard, For a transition Hondo- rosarkomu.

Punktat xondromы It has the form of semi-transparent dense tissue cylinder. Microscopically, the formulation found in native cartilage cells of different sizes, oval, round, elongated or polygonal shape with a clearly defined shell and a small core, a centrally located. These cells are weakly stained, so against the backdrop of the preparation allocated mild. Their cytoplasm is slightly bluish in color and a glassy nature. Cores also weakly stained, characterized by delicate chromatin structure, sometimes contain nucleoli. The cells in a punctate usually slightly. They are located on the background of a structureless substance, consisting of collagen and hondromukoida. On Pappenheim structureless substance turns bluish-pink tone. Very rare osteoblasts and osteoclasts.

Red blood cells in a punctate several flattened, dirty green tones, arranged in chains or groups. Thus, the diagnosis of chondroma accounted characteristic macroscopic appearance punctate, the presence of cartilage cells and structureless mass.


Xondroʙlastoma - A rare benign tumor. It develops, according to some authors, of embryonic cartilage cells - chondroblasts, according to others, It is intermediate between chondroma and giant cell tumor.

In punctuates hondroblastomy found a small number of young cartilage cells - chondroblasts. These large sizes, round or polygonal shape, with a major, centrally located nucleus, chromatin which has a soft granular structure. Some nuclei visible nucleoli. The cytoplasm is colored in a light blue tone. Also present in the preparation chondroblasts mature cartilage cells with one or two cores, and osteoclasts.

Chondroblasts and cartilage cells located on the soft purple background of the basic substance. For this tumor is also characterized by a dirty greenish color of red blood cells. PAS-positive reaction in mature cartilage cells and negative in chondroblasts. The chondroblasts found acid and alkaline phosphatase.

Xondromiksoidnaja fiʙroma

Xondromiksoidnaja fiʙroma - A benign tumor, most often cartilaginous nature. Rarely, observed in childhood and adolescence. Makroskopičeski reminiscent Chondroma. The histological preparations indicated lobed structure of the tumor. Between the slices are connective tissue layer. The tumor resembles hyaline or fibrocartilage, places myxomatous character.

The punctate tumor among peripheral blood cells are found cartilage cells with one or two cores, type cells osteoclasts, star-shaped and elongated in the areas of type myxomatous, and pale staining cells. There are cells such as chondroblasts. The cytologic diagnosis is only based on the data of X-ray, clinical and histological studies.


Xondrosarkoma - Malignant tumor, It develops slowly and without symptoms at the age of 25-60 years, and twice as often as men. In most cases, the primary tumor, but 10-15 % cases may develop from chondroma, and other tumors osteochondromas. Localization of the tumor may be different, but more often it is localized in the pelvis, shoulder girdle and ribs.

Xondrosarkoma It develops slowly and without symptoms. On examination, the bones are not determined. The temperature of the skin over the tumor normal, the peripheral blood without changes. The general condition of the patient for a long time remains satisfactory. When the tumor reaches a large size, and there are sites of necrosis and decay, general condition of patients worsens. Radiological central chondrosarcoma has the form of a single hearth of destruction (enlightenment) with a certain amount of bone spotted foci of calcification. During germination of the tumor in the soft tissues, they also found foci of calcification.

Chondrosarcoma often has a lobed structure and the cut is a slightly bluish translucent mass with yellow foci of necrosis and calcification areas.

Gistologičeskoe stroenie hondrosarkomy in various parts unequally. Microscopic cells showed a significant polymorphism. Along with small cartilage cells were large with one or more large nuclei and star-shaped cells. Base material nonuniform, painted in different colors.

The punctate also observed polymorphism of cells.

Цитологическая картина хондросаркомы

Apart from the usual, unaltered cartilage cells, against the background of the main substance found atypical polymorphic cartilage cells with large nuclei and nucleoli hypertrophied, rough texture unevenly distributed chromatin, but with the characteristic transparent cartilage cells, nezhno okrashennoy cytoplasm, containing grain. There are cells with two cores and more. The presence of atypical cells with features, inherent cartilage cells, allows the cytologist suggest malignancy, developing in this tissue. The diagnosis of chondrosarcoma can be placed only with the consideration clinical data and radiographic examination.

Fibrosarcoma bones

Fibrosarcoma bones - Relatively rare, neosteogennaya tumor, morphological structure which is no different from any other localization fibrosarcoma.

Tumor (sarkoma) Yuinga

Malignant bone tumor, It is rare, aged 10-25 years, mostly men. It may affect any bone, but most often develops in the diaphysis of the long bones. Histogenesis it is still not fully elucidated. Clinically, the tumor occurs as chronic osteomyelitis, metastasizes to lymph nodes, lungs and other organs.

In cytological preparations revealed a significant number of similar cells of small size, round or oval. The core of their relatively large, It occupies most of the cells. The structure of chromatin tender, fine-grained. At the core is often contained one or two nucleoli. Basophilic cytoplasm, It surrounds the core in the form of a narrow rim, without clear borders. Often appear in the cytoplasm vacuoles. There mitotic figures. The cells are arranged in a continuous fields.

Ewing's tumor should be differentiated from primary retikulosarkome, undifferentiated cancer metastasis to bone and multiple myeloma.

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