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Previous edition copyrighted 2017.
Library of Congress Control Number: 2021932241
Printed in Canada by TC Transcontinental, Beauceville, Quebec, Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedications
To my wife and family.
GPN
To my daughters, Olivia and Miranda, who are my lifelong joy; my parents, Philip and Evelyn, who did their best; my siblings, David, Stuart, and Elaine, who have been supportive; my friend and colleague, Al, who always has my back; Corinne, who is always with me; my teachers, who have helped show me the way; my colleagues, with whom I have had the honor to be in the trenches; and the patients who have given me their trust.
AER
Contributing Authors
Ivan Chebib, MD
Director of Immunohistochemistry Laboratory
Massachusetts General Hospital
Assistant Professor of Pathology
Harvard Medical School
Boston, Massachusetts
Yin P. (Rex) Hung, MD, PhD
Assistant Pathologist
Department of Pathology
Massachusetts General Hospital
Assistant Professor of Pathology
Harvard Medical School
Boston, Massachusetts
Michael J. Klein, MD
Pathologist in Chief Emeritus
Hospital for Special Surgery
Professor of Pathology and Laboratory Medicine
Weill Cornell Medicine
Consultant in Pathology
Memorial Sloan Kettering Cancer Center
New York, New York
Daniel I. Rosenthal, MD
Massachusetts General Hospital Professor of Radiology
Harvard Medical School
Boston, Massachusetts
Jaylou M. Velez Torres, MD, FCAP
Assistant Professor of Pathology
Associate Director of Head and Neck Fellowship Program
Head & Neck and Cytopathology
University of Miami Hospital
Miller School of Medicine
Miami, Florida
Preface
The pathology of the skeleton is complex and is the morphologic expression of a broad spectrum of diseases, including those caused by genetic (sporadic and inherited), malformative, inflammatory, metabolic, circulatory, traumatic, iatrogenic, and neoplastic disorders. Bone tumors, including both neoplasms and various conditions that may simulate them, are the focus of our book. This topic is one of the most challenging areas in surgical pathology for several reasons: Bone tumors are uncommon, making it challenging to acquire the necessary experience with their histological variants and mimics. The correct diagnosis usually requires the careful integration of radiological imaging studies and clinical findings; the implications of a diagnosis on a patient can be lifechanging, and medical schools and pathology training programs often have insufficient expertise to provide medical students and young pathologists with the skills needed to diagnose these lesions accurately and precisely.
In this 3rd edition, we updated the text and added many new images or replaced old ones. We also added several new chapters on nonneoplastic orthopedic pathology and a chapter on the radiologic approach to bone tumors.
This book reflects the philosophy and high standards practiced by the truly multidisciplinary team of physicians at the Massachusetts General Hospital, the University of Miami, and the Hospital of Special Surgery, who have diagnosed and surgically treated tens of thousands of patients with bone tumors and nonneoplastic conditions for many decades. Also important to acknowledge are the contributions of the many fellows and residents who participated in the efforts of patient care.
The authors are subspecialized physicians who have dedicated their professional lives to the diagnosis and surgical management of neoplastic and nonneoplastic bone lesions. As a result, the figures include beautiful and classic examples and unusual variants of many of the diseases discussed and are the product of painstaking correlations between the clinical, imaging, macroscopic, histological, immunohistochemical, and molecular characteristics of bone tumors. The text synthesizes the literature and our combined extensive experience, and the images have been selectively culled from the patient files of the Massachusetts General Hospital, the University of Miami Miller School of Medicine, the Hospital of Special Surgery, and the private consultations of the authors. The book is constructed in a thematic format with sections representing groups of related diseases and chapters discussing individual entities and their differential diagnosis.
Accordingly, this textbook serves as an excellent resource for medical students, residents, fellows, and practicing physicians in the disciplines of pathology, radiology, and orthopedics. Medical and radiation oncologists who treat bone tumors will also find it valuable. Our opportunity to participate in the care of patients with bone tumors has been our call and honor, and we hope to do it justice by sharing our experience with the medical community—our goal is to enhance diagnostic accuracy and to provide the biological basis for optimal treatment.
G. Petur Nielsen, MD
Professor of Pathology
Harvard Medical School
Pathologist, Department of Pathology
Director of Bone & Soft Tissue Pathology
Director of Electron Microscopy Unit
Massachusetts General Hospital Boston, Massachusetts
Andrew E. Rosenberg, MD
Professor and Vice Chair
Director, Bone and Soft Tissue Pathology
Department of Pathology and Laboratory Medicine
Miller School of Medicine
University of Miami Miami, Florida
Acknowledgments
LEAD EDITOR
Arthur G. Gelsinger, MA
LEAD ILLUSTRATOR
Laura C. Wissler, MA
TEXT EDITORS
Rebecca L. Bluth, BA
Nina I. Bennett, BA
Terry W. Ferrell, MS
Megg Morin, BA
Kathryn Watkins, BA
IMAGE EDITORS
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
ILLUSTRATIONS
Lane R. Bennion, MS
Richard Coombs, MS
ART DIRECTION AND DESIGN
Tom M. Olson, BA
PRODUCTION EDITORS
Emily C. Fassett, BA
John Pecorelli, BS
Sections
SECTION 1: Growth and Development
SECTION 2: Radiologic Approach to Bone Tumors
SECTION 3: Benign Bone-Forming Tumors
SECTION 4: Malignant Bone-Forming Tumors
SECTION 5: Benign Cartilage Tumors
SECTION 6: Malignant Cartilage Tumors
SECTION 7: Fibrous and Fibrohistiocytic Tumors
SECTION 8: Fibroosseous and Fibroosseous-Epithelial Tumors
SECTION 9: Malignant Small Round Cell Tumors
SECTION 10: Notochordal Tumors
SECTION 11: Giant Cell-Rich Tumors
SECTION 12: Cystic Lesions of Bone
SECTION 13: Vascular Tumors
SECTION 14: Hematopoietic Tumors
SECTION 15: Miscellaneous Mesenchymal Tumors
SECTION 16: Metastatic Tumors
SECTION 17: Bone Tumor Mimics
SECTION 18: Common Nonneoplastic Orthopedic Specimens
