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Bone Pathology: Pathology, Radiology, and Orthopedics
Current Concepts in Bone Pathology
B o n e P a t h o l o g y : Pa t h o l o g y, R a d i o l o g y, an d O r t h o p e d i c s
John D. Reith, MD Guest Editor
primary neoplastic processes. Toward the latter goal, topics such as giant cell-rich neoplasms, bone and cartilage matrix-producing neoplasms, small cell neoplasms, fibro-osseous lesions, and reactive bone lesions are covered in detail, including the necessary clinical and radiographic information necessary to formulate a thoughtful differential diagnosis. Where applicable, information on ancillary immunohistochemical and molecular diagnostic testing is also included. Additionally, articles introducing basic concepts of bone radiology and an update on the treatment of bone sarcomas have been included to reinforce the concept of the multidisciplinary team approach to the diagnosis of bone lesions and to assist the reader in understanding the most important points to include in a pathology report. Finally, because pathologists are increasingly being asked to provide more and more information with smaller and smaller tissue samples, an article on the application of cytology to the diagnosis of bone lesions has been included. The completion of this edition of Surgical Pathology Clinics would not have been possible without the hard work of many individuals. I’d like to express heartfelt thanks to Joanne Husovski for both her continual support and her patience
Surgical Pathology 5 (2012) ix–x doi:10.1016/j.path.2011.12.002 1875-9181/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
surgpath.theclinics.com
Bone pathology, like most fields within surgical pathology, has evolved significantly in recent years. The field has benefited not only from advances in immunohistochemistry and molecular diagnostics, but from improvements in radiographic techniques, particularly the cross-sectional imaging modalities of CT and MRI scans. And yet the diagnoses of many of the cornerstones of bone pathology, including the cartilaginous, bone-forming, and giant cell-rich neoplasms, remain grounded in vigilant examination of hematoxylin and eosin-stained slides coupled with careful radiographic and clinical correlation. In fact, the interaction among pathologists, radiologists, and orthopedic surgeons is just one of several factors that makes the practice of orthopedic pathology so enjoyable as well as effective. Likewise, failure to utilize all information pertinent to a given case––particularly the radiographic findings––can make the practice of orthopedic pathology fraught with danger. In selecting topics for this issue of Surgical Pathology Clinics, the goal was to include concepts relative to the everyday practice of bone pathology––such as arthritis, the evaluation of periprosthetic tissues for infection, and the practical workup of metastases in bone––in addition to the more esoteric subjects, namely, the evaluation of
x
Current Concepts in Bone Pathology while this edition was being completed. Without her wisdom and guidance, this work would not have been possible. I’d also like to express my gratitude to all of the authors for lending their expertise to this journal. It was truly a pleasure to interact with such a talented group of experts in this field. Finally, I’d like to acknowledge my mentors from the world of mesenchymal pathology, Tom Bauer, John Goldblum, Sharon Weiss, and Howard Dorfman, whose guidance over the years has been absolutely invaluable to my career.
John D. Reith, MD Unit of Bone and Soft Tissue Pathology Department of Pathology, Immunology and Laboratory Medicine University of Florida College of Medicine 1600 SW Archer Road PO Box 100275 Gainesville, FL 32610-0275, USA E-mail address: [email protected]
B o n e P a t h o l o g y : Pa t h o l o g y, R a d i o l o g y, an d O r t h o p e d i c s
John D. Reith, MD Guest Editor
primary neoplastic processes. Toward the latter goal, topics such as giant cell-rich neoplasms, bone and cartilage matrix-producing neoplasms, small cell neoplasms, fibro-osseous lesions, and reactive bone lesions are covered in detail, including the necessary clinical and radiographic information necessary to formulate a thoughtful differential diagnosis. Where applicable, information on ancillary immunohistochemical and molecular diagnostic testing is also included. Additionally, articles introducing basic concepts of bone radiology and an update on the treatment of bone sarcomas have been included to reinforce the concept of the multidisciplinary team approach to the diagnosis of bone lesions and to assist the reader in understanding the most important points to include in a pathology report. Finally, because pathologists are increasingly being asked to provide more and more information with smaller and smaller tissue samples, an article on the application of cytology to the diagnosis of bone lesions has been included. The completion of this edition of Surgical Pathology Clinics would not have been possible without the hard work of many individuals. I’d like to express heartfelt thanks to Joanne Husovski for both her continual support and her patience
Surgical Pathology 5 (2012) ix–x doi:10.1016/j.path.2011.12.002 1875-9181/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
surgpath.theclinics.com
Bone pathology, like most fields within surgical pathology, has evolved significantly in recent years. The field has benefited not only from advances in immunohistochemistry and molecular diagnostics, but from improvements in radiographic techniques, particularly the cross-sectional imaging modalities of CT and MRI scans. And yet the diagnoses of many of the cornerstones of bone pathology, including the cartilaginous, bone-forming, and giant cell-rich neoplasms, remain grounded in vigilant examination of hematoxylin and eosin-stained slides coupled with careful radiographic and clinical correlation. In fact, the interaction among pathologists, radiologists, and orthopedic surgeons is just one of several factors that makes the practice of orthopedic pathology so enjoyable as well as effective. Likewise, failure to utilize all information pertinent to a given case––particularly the radiographic findings––can make the practice of orthopedic pathology fraught with danger. In selecting topics for this issue of Surgical Pathology Clinics, the goal was to include concepts relative to the everyday practice of bone pathology––such as arthritis, the evaluation of periprosthetic tissues for infection, and the practical workup of metastases in bone––in addition to the more esoteric subjects, namely, the evaluation of
x
Current Concepts in Bone Pathology while this edition was being completed. Without her wisdom and guidance, this work would not have been possible. I’d also like to express my gratitude to all of the authors for lending their expertise to this journal. It was truly a pleasure to interact with such a talented group of experts in this field. Finally, I’d like to acknowledge my mentors from the world of mesenchymal pathology, Tom Bauer, John Goldblum, Sharon Weiss, and Howard Dorfman, whose guidance over the years has been absolutely invaluable to my career.
John D. Reith, MD Unit of Bone and Soft Tissue Pathology Department of Pathology, Immunology and Laboratory Medicine University of Florida College of Medicine 1600 SW Archer Road PO Box 100275 Gainesville, FL 32610-0275, USA E-mail address: [email protected]