|Year : 2013 | Volume
| Issue : 2 | Page : 135-139
Histopathological evaluation of bone tumors in a tertiary care hospital in Manipur, India
Yopovinu Rhutso, Rajesh Singh Laishram, L Durlav Chandra Sharma, Kaushik Debnath
Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||19-Nov-2013|
Rajesh Singh Laishram
Department of Pathology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
Source of Support: None, Conflict of Interest: None
Objective: To determine the spectrum of various bone tumors and their relative frequency at Regional Institute of Medical Sciences (RIMS) Hospital. Materials and Methods: A retrospective review of histopathological reports of all bone specimens received in the Department of Pathology (histopathology section), RIMS hospital for a period of 2 years from January 2009-December 2011 was done. Results: Of the 98 histopathologically diagnosed bone lesions, 50 (51%) were males and 48 (49%) were females, with a male to female ratio of 1.04:1. Age ranged from 7-74 years. Nonneoplastic lesions accounted for 36.7%, while neoplastic lesions accounted for 63.3%. Osteomyelitis was the most common and only nonneoplastic lesion encountered with 36 cases (36.7%). Out of 62 cases of bone tumors, benign tumors made up to 66.01%, while the malignant tumor and tumor-like lesions made up 17.71 and 16.2%, respectively. Age ranged from 8-74 years, in which 34 (55%) were males and 28 (45%) were females with M:F ratio of 1.2:1. Osteochondroma with 22 cases (35.2%) and osteosarcoma with seven cases (11.27%) were the most common benign and malignant tumors, respectively; while fibrous dysplasia with five cases (8.05%) was the most common tumor-like lesion. The age peak incidence was in the 2 nd (43.55%) and 3 rd (32.2%) decades. Femur was the most common site with 19 (30.6%) occurrences followed by tibia with 18 (29%). Conclusion: Chronic osteomyelitis was the commonest nonneoplastic lesion. Among the bone tumors, osteochondroma and osteosarcoma was the most common benign and malignant bone tumor, respectively.
Keywords: Bone, Fibrous dysplasia, Histopathology, Osteochondroma, Osteomyelitis, Osteosarcoma
|How to cite this article:|
Rhutso Y, Laishram RS, Sharma L D, Debnath K. Histopathological evaluation of bone tumors in a tertiary care hospital in Manipur, India. J Med Soc 2013;27:135-9
|How to cite this URL:|
Rhutso Y, Laishram RS, Sharma L D, Debnath K. Histopathological evaluation of bone tumors in a tertiary care hospital in Manipur, India. J Med Soc [serial online] 2013 [cited 2020 Aug 13];27:135-9. Available from: http://www.jmedsoc.org/text.asp?2013/27/2/135/121591
| Introduction|| |
Bone consists of cartilaginous, osteoid, fibrous tissue, and bone marrow elements. Each tissue can give rise to benign or malignant tumors. Bone tumors are classified on the basis of cell type and recognized products of proliferating cells. Bone tumors may be primary which originate in the bone or secondary. Etiologically, most bone tumors arise de novo from somatic mutation,  but other factors have been implicated. The important causes include chemotherapy,  irradiation,  preexisting bone lesions, , and less commonly trauma,  foreign bodies,  and viruses. 
Histopathological study enables us to understand the spectrum of bone lesions and gives an idea of different bone tumors and tumor-like lesions in population among different age group and sex. Bone lesions often pose diagnostic challenges to surgical pathologists. Therefore, an integrated approach involving radiographic, histologic, and clinical data are necessary to form an accurate diagnosis and to determine the degree of activity and malignancy of each lesion.  A proper histopathological diagnosis is useful in confirming the diagnosis and helps in staging the tumor and aid the surgeon in planning limb salvage surgery for early malignant and benign bone lesions. 
The present retrospective study was carried out to assess the patterns of various bone lesions and their relative frequency among already existing data of 92 patients whose biopsy specimens were received in the Department of Pathology at RIMS, Imphal during a period of 2 years (January 2009-December 2011).
| Materials and Methods|| |
This is a retrospective study conducted in the Department of Pathology (histopathology section) at Regional Institute of Medical Sciences, Imphal covering a period of 2 years from January 2009-December 2011. All the histopathological reports and slides of patients who had bone tissue biopsies were reviewed to provide relevant information on age, sex, histopathological interpretation, and the anatomical site of occurrence. Data tabulation and analysis was done to deduce the relative frequency of all observed parameters. All tumors of hematopoietic and odontogenic origin were excluded in this study.
| Results|| |
A total of 98 histopathological specimens were received in the department during the period under review. By far the majority, 62 (63.3%) of the bone lesion were neoplastic; whereas 36 (36.7%) of the lesions were nonneoplastic. The histopathological diagnosis showed that chronic osteomyelitis was the most common diagnosis on nonneoplastic lesion. After exclusion by criteria, of the 62 neoplastic bone lesions, benign lesions accounted for 41 (66.01%) cases and malignant tumors accounted for 11 (17.71%) cases, while 10 (16.1%) cases were tumor-like lesions.
Out of the 62 cases of neoplastic bone lesions, the most common benign and malignant tumors were osteochondroma 22 (35.42%) and osteosarcoma 7 (11.27%), respectively; while the most common tumor-like lesion was fibrous dysplasia five (8.05%). Primary malignant bone tumors (72.72%) were found to be more common than metastatic tumors (27.27%). Among the benign lesions, osteochondroma was seen in 53.65%; giant cell tumor in 21.95%; and osteoma, osteiod osteoma, and chondroma in 4.87% each. Osteoblastoma, chondroblastoma, chondromyxoid fibroma, and desmoplastic fibroma accounted for 2.43% each. Of the 11 (17.71%) malignant tumors, osteosarcoma was seen in 63.63%, metastatic adenocarcinoma in 18.18% and chondrosarcoma and metastatic squamous cell carcinoma in 9.09% each. Out of 10 (16.1%) tumor-like lesions, fibrous dysplasia was seen in 50%, aneurismal bone cyst in 40% and nonossifying fibroma in 10% [Table 1].
The age range of neoplastic bone lesions was from 8 years-74 years, in which 34 (55%) were males and 28 (45%) were females with M: F ratio of 1.2:1. Youngest was an 8-year-old female child with fibrous dysplasia and oldest was 74-year-old woman with metastatic well-differentiated squamous cell carcinoma. The peak incidence for most lesions was between 2 nd and 3 rd decade of life accounting for 47 (75.8%) cases [Table 2] and [Table 3].
|Table 2: Age (in years) frequency of various benign and tumor-like lesion of bone lesions|
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The most common site of occurrence of tumor was in the femur 19 (30.6%) followed by tibia 18 (29%). Osteochondroma mostly involved the tibia (45.4%) whereas Osteosarcoma mostly involved the femur (71.4%) and fibrous dysplasia commonly involved the femur and tibia equally (40% each) [Table 4] and [Table 5].
|Table 4: Anatomical distribution of benign and tumor-like bone lesions with anatomical site|
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|Table 5: Anatomical distribution of malignant bone lesions with anatomical site|
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| Discussion|| |
This retrospective study was done to study the spectrum and relative frequency of various bone lesions. The study was carried out by reassessing all the slides of received bone specimens that were sent from the Department of Orthopedics of this institute to Pathology Department, RIMS for the study period.
In this study, out of the 98 bone specimens received during the study period neoplastic lesions were found to be more common than nonneoplastic lesions which is in conformity with studies done by Settakom et al.,  Most tumors of the bone showed male preponderance with male to female ratio of 1.2:1. Similar findings were reported in other studies. ,,,,,
The peak age incidence of primary bone tumors in our study was seen in the 2 nd and 3 rd decade. Similar findings in age incidence were also reported in other studies. ,,,
Benign tumors were more common than malignant which are in conformity with other studies; ,, whereas, the reverse is true in other studies where malignant bone tumors was found to be more common than benign. ,,, This disparity may be due to the fact that hematopoietic tumor is dealt by hematology section and are not included in our study.
Metastatic bone tumors were seen in older age group (above 50 years). In a study conducted by Sirikulchayanonta et al.,  there were similar findings with average age of 50 years in metastatic bone tumors.
Primary malignant bone tumors were more common than metastatic tumors which are in conformity with other studies; ,,,, whereas, the reverse is true for studies done by Gomez et al.,  The likely reason may be due to the fact that our study was based on a small number of cases. It may be also due to lack of care in old age, no access to hospital because of poverty. and inadequate medical facilities.
Osteochondroma was the most common benign lesion with male preponderance. Most of the patients fell within 11-20 years of age and long bones were commonly involved. This corresponds to study done by others. ,,,,,,,, However, in a study conducted by Settakom et al.,  giant cell tumor was found to be the commonest benign bone tumor.
The most common malignant bone tumor was osteosarcoma seven (11.27%) of the 11 malignancies. Male preponderance was seen and long bones were commonly involved. Similar findings were observed in other studies. ,,,,,,,,,,, We found two peaks in age incidence, first between 11 and 20 years and second between 31 and 40 years which is similar to other studies. 
Among the tumor-like lesions, fibrous dysplasia was found to be the commonest with total of five (8.05%) cases. Other tumor-like lesions include aneurysmal bone cyst and nonossifying fibroma. Fibrous dysplasia occurred mostly in patients under 20 years of age with slight male preponderance. Other studies also showed similarity in the frequency, age incidence, and male preponderance. ,
Giant cell tumor made up nine (14.49%) of the total bone tumors. Patients were mostly 20-50 years of age with a female preponderance. These findings were in agreement with the study done by others. ,
Long bones were mostly affected. Most commonly femur followed by tibia which is in conformity with other studies. ,,,,,
In our study, we have found that the pathology department (histopathological section) has reported spectrum of 16 different types of histopathological bone tumors during the study period of 2 years which indicate the presence of different types of bone tumors in RIMS hospital and Manipur in general. Specific tumor has predilection for certain age, sex, and site which are in conformity with our study from the data reviewed. Lastly, an exact diagnosis of bone tumors is at times difficult. Therefore, an integrated use of clinical, radiological, and histopathological finding is recommended to increase accuracy of diagnosis and for better management of the patient.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]