Epiphysis

chondroblastoma

giant cell tumour (GCT)

geode/intraosseous ganglion

osteomyelitis

clear cell chondrosarcoma

Tumor lain yang kemungkinan tetapi jarang, yaitu:

osteosarcoma and osteoblastoma

aneurysmal bone cyst (ABC): biasanya metaphysis, tetapi jika terjadi setelah
pertumbuhan lempeng menghilang, maka dapat meluas sampai ke epiphysis.
brown tumour
haemophilic pseudotumour
enchondroma
Diaphysis

simple bone cyst

fibrous dysplasia

enchondroma

metastases

myeloma / plasmacytoma

lymphoma

osteomyelitis

osteoid osteoma

round cell tumour, e.g. Ewing sarcoma (children)

bone infarct

Langerhans cell histiocytosis

Tumor lain yang kemungkinan tetapi jarang, yaitu:

adamantinoma

osteofibrous dysplasia

Brown tumour secondary to hyperparathyroidism

hydatid cys
Metaphysis

osteomyelitis

metastases

non-ossifying fibroma

enchondroma

aneurysmal bone cyst

simple bone cyst

chondromyxoid fibroma

chondrosarcoma

cortical desmoid

giant cell tumor

desmoplastic fibroma

intraosseous lipoma

osteosarcoma

osteoblastoma

Sumber:

Greenspan A, Remagen W. Differential diagnosis of tumors and tumor-like lesions of bones

and joints. Lippincott-Raven. (1998)

Gereige, Rani & Kumar, Mudra. Bone lesions: Benign & malignant Pediatrics in Review.
Vol.31 No.9. (2010)
 LEIOMYOMA

Makroskopis

Sharply circumscribed, round, firm, grayish white, "raw silk" and whorled cut surface
Often shells out
Bulging and trabeculated cut surface
Usually within myometrium (intramural), may be submucosal or subserosal
May be multiple
Sampling: sample myxoid areas extensively to rule out myxoid leiomyosarcoma; sample
all leiomyomas that lack the classic gross appearance of leiomyomas and 3 largest tumors

Mikroskopis

Whorled (fascicular) pattern of smooth muscle bundles separated by well vascularized

connective tissue
Smooth muscle cells are elongated with eosinophilic or occasional fibrillar cytoplasm and
distinct cell membranes
May develop areas of degeneration if large including hyaline or mucoid change,
calcification, cystic change or fatty metamorphosis
Usually noninfiltrative, thick walled arteries throughout and cleft-like spaces
May have extensive hyaline necrosis if protrudes into endometrial cavity
Variable lymphocytes and mast cells
Usually less than 5 mitotic figures per 10 high power fields in most mitotically active area,
no significant atypia
 Rarely has focal skeletal muscle differentiation (Hum Pathol 1999;30:356) or tubules /
glands
Post lupron treatment: initially edema and necrosis, then hyalinization and mild
lymphocytic infiltrate

Smooth muscle proliferations with unusual growth patterns: disseminated peritoneal

leiomyomatosis; benign metastasizing leiomyoma; intravenous leiomyomatosis;
lymphangioleiomyomatosis
 LEIOMYOSARKOMA

Bulky fleshy tumor invading into myometrial wall or polypoid tumor projecting into lumen
Often hemorrhagic or necrotic
Grossly appears invasive / infiltrative
Usually 5 cm or more, but NOT multiple

Mikroskopis

Hypercellular with spindle cells resembling smooth muscle with moderate to severe
pleomorphism
Infiltrative border is most helpful feature for diagnosis
10+ mitotic figures per 10 high power fields (HPF) in most mitotically active area with
abundant abnormal mitotic figures
Don't interpret small pyknotic nuclei from smooth muscle cells as mitoses; use only
definitive mitotic figures
Coagulative tumor cell necrosis is common
Rarely contains osteoclast-like giant cells
Epithelioid and myxoid leiomyosarcomas are rare variants with mild nuclear atypia and
often < 3 mitotic figures/10 HPF
Smooth muscle tumors of uncertain malignant potential (STUMP): tumor cell necrosis
in a typical leiomyoma; necrosis of uncertain type with 10 MF/10 HPFs or marked
diffuse atypia; marked diffuse or focal atypia with borderline mitotic counts and necrosis
difficult to classify