Tests and Procedures To Diagnose Bone Cancer PART 2: Biopsy, Microscopy and Staging
Step Six: Biopsy
Supporting Images For Step Six
Microscopic appearance
Overview of Histology/Microscope findings (Pullan and Lotfollahzadeh, 2024)
Microscopic Findings Of Subtypes Of Osteosarcoma
Location: Intramedullary canal
Location: Surface
Supporting and Microscopic Images Of Subtypes Of Osteosarcoma
Source: https://www.slideshare.net/slideshow/osteosarcomapptx-256355969/256355969
Microscopic Findings Of Ewing Sarcoma
- High-grade aggressive sarcoma
- A sheet of Monomorphic (one form) of small cells with round nuclei.
- Disperses chromatin
- Necrosis (cell death) seen; this is called pseudo-rosettes
- Live cells arranged perivascular.
- Membranes express the glycoprotein CD99 with immunohistochemistry.
- Ewing sarcoma has more than 95% expression of CD99
Microscopic findings of Chondrosarcoma
- Production of hyaline cartilage.
- Different-sized lobules of cartilage.
- Pleomorphic nuclei with chondrocytes that vary in shape and size.
Subtypes Of Chondrosarcoma
Supporting Images And Videos Of Chondrosarcoma
Clear Cell Chondrosarcoma By Dr. Jerad Gardner
Clear Cell Chondrosarcoma By Dr. Jerad Gardner
Dedifferentiated Chondrosarcoma (with osteosarcoma heterologous area) – hemipelvectomy (UNC case 7) By Jared Gardner
Microscopic Findings Of The Giant Cell Tumour Of the Bone
Recommended Reading
Step Seven: Staging
Enneking System
TNM Staging System
Grading System: Campanacci Classification
- This is a type of classification system that can help guide treatment, but in the case of diagnosing giant cell tumours it is ambigouous/doubtful.
- There is no correlation/relationship between the grading system and the incidence of local recurrence (returning tumours) and metastasis.
Staging and grading of specific types of bone tumours
Chondrosarcoma (Cleveland Clinic, 2025; Pullan and Lotfollahzadeh, 2024)
Recommended Reading
References
Alexiev, B. (2021) Bone & joints Osteoclastic giant cell rich tumors Giant cell tumor of bone, NOS, Available at: https://www.pathologyoutlines.com/topic/bonegiantcelltumor.html (4th April 2026)
Biermann, J.S., Hirbe, A., Ahlawat, S., Bernthal, N.M., Binitie, O., Boles, S., Brigman, B., Callan, A.K., Cipriano, C., Cranmer, L.D., Davis, J., Donnelly, E., Ferguson, M., Graham, A., Groundland, J., Hess, M., Hiniker, S.M., Hoover-Regan, M.L., Hornick, J.L. and Jonard, B. (2025). Bone Cancer, Version 2.2025, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, [online] 23(4). DOI: HTTPs://doi.org/10.6004/jnccn.2025.0017.
Cleveland Clinic (2025) Chondrosarcoma. Available at: https://my.clevelandclinic.org/health/diseases/22112-chondrosarcoma (Accessed: 2nd June 2026)
Curtis, E. and Woolwine, S. (2026) Chondrosarcoma. Available at: https://www.orthobullets.com/pathology/8023/chondrosarcoma (Accessed: 30th July 2026)
Gerrand, C., Amary, F., Anwar, H.A., Brennan, B., Dileo, P., Kalkat, M.S., McCabe, M.G., McCullough, A.L., Parry, M.C., Patel, A., Seddon, B.M., Sherriff, J.M., Tirabosco, R. and Strauss, S.J. (2024). UK guidelines for the management of bone sarcomas. British Journal of Cancer. DOI: HTTPs://doi.org/10.1038/s41416-024-02868-4.
MacKay, B.J., McCormack, R.A., Blank, A.T., Bettiol, P., Cox, C., Brindley, G. and Rapp, T.B. (2021). Diagnosis and management of primary malignant tumors in the upper extremity. Orthopedic Reviews, 12(4). doi: https://doi.org/10.4081/or.2020.8345.
Oliveira, I., Chavda, A., Rajakulasingam, R. and Saifuddin, A. (2020). Chondral tumours: discrepancy rate between needle biopsy and surgical histology. Skeletal Radiology, 49(7), pp.1115–1125. doi:https://doi.org/10.1007/s00256-020-03406-y.
Pullan, J. and Lotfollahzadeh, S. (2024). Primary Bone Cancer. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560830/ (Accessed: 9th April 2026)
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