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Spectrum of Bone Tumors in Chiang Mai University Hospital, Thailand According to WHO Classification 2002: a Study of 1,001 Cases

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Spectrum of Bone Tumors in Chiang Mai University Hospital, Thailand According to WHO Classification 2002: a Study of 1,001 Cases Spectrum of Bone Tumors in Chiang Mai University Hospital, Thailand According to WHO Classification 2002: A Study of 1,001 Cases Jongkolnee Settakorn MD*, Suree Lekawanvijit MD*, Olarn Arpornchayanon MD**, Samreung Rangdaeng MD*, Pramote Vanitanakom MD*, Sarawut Kongkarnka MD*, Ruangrong Cheepsattayakorn MD*, Charin Ya-In MD*, Paul S Thorner MD*** * Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai ** Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai *** Department of Laboratory Medicine, Hospital for Sick Children and University of Toronto, Toronto, Canada Objective: The aim of the present study was to determine the spectrum, frequency and demographics of bone tumors. Material and Method: A retrospective study of the 1,001 bone tumor specimens from the files at the Pathology Department of the Chiang Mai University Hospital, Thailand from 2000 to 2004. Results: From the study, 41 were non-neoplastic mass lesions, and 960 were neoplastic, with 856 (89%) as primary and 104 (11%) as metastatic tumors. In the primary tumor group, 654 (76%) cases were of hemato- logic origin, and 202 (24%) were non-hematologic. The most common benign bone tumors were giant cell tumor (n = 37), osteochondroma (n = 25), and chondroma (n = 15). The most common malignant bone tumors were lymphoma-leukemia (n = 583), metastatic malignancy (n = 104), plasma cell myeloma (n = 71), and osteosarcoma (n = 58). Conclusion: The present study showed a higher frequency of osteosarcoma (68%), lower frequencies of chondrosarcoma (12%) and Ewing sarcoma (4%) among primary non-hematologic malignant bone tumors when compared with similar studies based on Western patients. Whether these differences reflect differences in the ethnic population or in practice patterns remains to be determined. Keywords: Bone tumor, Osteosarcoma, Frequency, Distribution, Location J Med Assoc Thai 2006; 89 (6): 780-7 Full text. e-Journal: http://www.medassocthai.org/journal Among the varieties of human neoplasms, The precise incidence of bone tumors is not bone tumors are relatively uncommon. However, they known as many benign lesions are not biopsied. In are diverse in their pathologic features and range in general, bone sarcomas account for only 0.2% of all their biologic potential from the innocuous to the rapid- neoplasms(2). Despite the low incidence, bone sarcoma ly fatal. This diversity makes it critical to accurately accounted for 36% of major limb amputations in diagnose, stage, and treat tumors appropriately, so that the hospital(3). The frequency of bone tumors in the the patients can survive and maintain optimal function northern part of Thailand has not been well studied. It of the affected body part(1). was previously reported that bone cancer accounted for 0.7% of all cancer cases in Chiang Mai University Hospital, which is the largest tertiary health care pro- Correspondence to : Settakorn J, Department of Pathology, vider in this area(4). Since this is somewhat higher than Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. Phone: 0-5304-5442-4, 0-4047-6100, the value reported in a series from Western countries, Fax: 0-5321-7144, E-mail: [email protected] accurate information of the bone tumor distribution 780 J Med Assoc Thai Vol. 89 No. 6 2006 in this part of the world would be of value for iden- Table 1. Frequency of bone tumors tifying any differences in specific tumor types. Hence, the objective of the present study was to obtain Tumors (% in group) Total, n (%) accurate data on the spectrum, frequency and demo- graphics of bone tumors in Chiang Mai University Cartilaginous tumors 57 (5.7) - Osteochondroma (43.9) 25 (2.5) hospital, Thailand during a 5-year period. - Chondroma (26.3) 15 (1.5) - Chondroblastoma (10.5) 6 (0.6) Material and Method - Chondromyxoid fibroma (1.8) 1 (0.1) This was a descriptive retrospective study - Chondrosarcoma (17.5) 10 (1.0) of all clinical and pathological data from bone tumor specimens including bone marrow biopsies submitted Osteogenic tumors 76 (7.6) to the Pathology Department of Chiang Mai Univer- - Osteoma (18.4) 14 (1.4) sity Hospital from 2000 to 2004. The parameters studied - Osteoid osteoma (3.9) 3 (0.3) included pathological diagnosis, age and gender of - Osteoblastoma (1.3) 1 (0.1) - Osteosarcoma (76.3) 58 (5.8) the patients and location of the tumors. The tumors were classified according to the recent WHO classifi- Fibrogenic tumors 1 (0.1) (2) cation of bone tumors . Locations were divided into - Desmoplastic fibroma (100.0) 1 (0.1) 8 groups, craniofacial, vertebra including sacrum, scapula, clavicle, rib, sternum, pelvic bone, bones of Fibrohistiocytic tumors 6 (0.6) limbs, and bone marrow biopsy. The data were sum- - Benign fibrous histiocytoma (16.7) 1 (0.1) marized using Intercooled Stata 8.0. This project was - Malignant fibrous histiocytoma (83.3) 5 (0.5) approved by the Research Ethics Committee, Faculty of Medicine, Chiang Mai University (reference number Ewing sarcoma / peripheral PNET 3 (0.3) 172/2004). Hematologic neoplasms 654 (65.3) - Leukemia-lymphoma (89.1) 583 (58.2) Results - Plasma cell myeloma (10.9) 71 (7.1) There were a total of 1,001 tumor specimens (Table 1). Patient ages ranged from 7 months to 88 years Giant cell tumor 37 (3.7) with median age of 44.2 years (Table 2). Five hundred and fifty patients were male (54.9%). The majority of Chordoma 5 (0.5) the specimens were from bone marrow biopsies (n = 664, 66.3%), followed by bones of limb (n = 222, 22.2%), Vascular tumors 2 (0.2) - Hemangioma 2 (0.2) craniofacial bones (n = 45, 4.5%), vertebra and sacrum (n = 34, 3.4%), pelvic bone (n = 22, 2.2%), scapula (n = Miscellaneous tumors 119 (11.9) 6, 0.6%), clavicle (n = 4, 0.4%), rib (n = 3, 0.3%), and - Adamantinoma of jaw bone (8.4) 10 (1) sternum (n=1, 0.1%). - Metastatic malignancy (87.4) 104 (10.4) Hematologic neoplasms were the most - Mixed tumor of long bone (0.8) 1 (0.1) common group of tumors (n = 654, 65.3%). The other - Sarcoma, not otherwise specified (3.4) 4 (0.4) common groups of tumors were miscellaneous tumors (n = 119, 11.9%), osteogenic tumors (n = 76, 7.6%), Miscellaneous lesions 41 (4.1) cartilaginous tumors (n = 57, 5.7%), and giant cell - Aneurysmal bone cyst (7.3) 3 (0.3) - Simple bone cyst (14.6) 6 (0.6) tumors (n = 37, 3.7%) (Table 1). After excluding the - Fibrous dysplasia (24.4) 10 (1.0) non-neoplastic bone lesions (n = 41), the number of - Osteofibrous dysplasia (12.2) 5 (0.5) malignant bone tumors (n = 854, 89.0%) was eight - Non-ossifying fibroma (5.1) 2 (0.2) times of thebenign tumors (n = 106, 11.0%). Excluding - Langerhans cell histiocytosis (9.8) 4 (0.4) metastatic tumors, there were 856 (89.2%) primary - Bone cysts associated with 10 (1.0) tumors including 654 (76.4%) hematologic malignan- dental structures (24.4) cies and 202 (23.6%) non-hematologic tumors. - Juvenile xanthogranuloma (2.4) 1 (0.1) The three most common bone lesions found in the present study were lymphoma and leukemia (n = Total 1001 (100.0) 583, 58.2%), metastatic malignancy (n = 104, 10.4%), J Med Assoc Thai Vol. 89 No. 6 2006 781 782 89No.62006 Assoc ThaiVol. JMed Table 2. The distributions of gender, age, and location of bone tumors Tumors (M:F ratio) Age in year Location, n(%) Total Range, median (N) Mean (SD) Cranio- Spine Scapula Clavicle Rib Sternum Pelvic Bone of Bone facial and bone limb marrow bone sacrum biopsy Lymphoma-leukemia (1.4:1) 12-88, 46 - - - - - - - 2 581 583 46.4 (16.7) (0.3) (99.7) Metastatic malignancy (0.9:1) 1-82, 60 1 24 - 2 1 - 10 49 17 104 57.3 (14.4) (1.0) (23.1) (1.9) (1.0) (9.6) (47.1) (16.4) Plasma cell myeloma (1.4:1) 15-81, 58 - - - - - - 1 4 66 71 56.8 (13.7) (1.4) (5.6) (93.0) Osteosarcoma (1.2:1) 8-61, 18 3 - - - - - 4 51 - 58 20.5 (11.4) (5.2) (6.9) (87.9) Giant cell tumor (0.9:1) 12-58, 37 1 - 1 - - - 2 33 - 37 35.8 (12.7) (2.7) (2.7) (5.4) (89.1) Osteochondroma (1.1:1) 4-51, 16 - - 2 - - - 1 22 - 25 18 (10.0) (8.0) (4.0) (88.0) Chondroma (0.4:1) 9-58, 33 1 - 1 - - - - 13 - 15 31.2 (15.5) (6.7) (6.7) (86.7) Osteoma (0.2:1) 0.58-67, 41 12 - - 1 1 - - - - 14 37.5 (16.3) (85.7) (7.1) (7.1) Chondrosarcoma (1.5:1) 20-71, 48.5 - - 1 - - 1 1 7 - 10 49.5 (14.9) (10.0) (10.0) (10.0) (70.0) Adamantinoma of jaw (0.7:1) 6-54, 42.5 10 - - - - - - - - 10 bone 38.6 (15.4) (100.0) Fibrous dysplasia (1:1) 4-56, 20 4 - - - 1 - - 5 - 10 25.8 (17.6) (40.0) (10.0) (50.0) J Med Assoc Thai Vol. 89No.62006Assoc ThaiVol. J Med 783 Table 2. The distributions of gender, age, and location of bone tumors (cont.) Tumors (M:F ratio) Age in year Location, n(%) Total Range, median (N) Mean (SD) Cranio- Spine Scapula Clavicle Rib Sternum Pelvic Bone of Bone facial and bone limb marrow bone sacrum biopsy Bone cyst associated (0.25:1) 6-70, 33 10 - - - - - - - - 10 with dental structure 35.4 (22.5) (100.00) Chondroblastoma (All male) 14-43,22 - - - - - - 6 - 6 23.5 (10.4) (100.0) Simple bone cyst (1:1) 12-31, 24 1 1 - - - - 1 3 6 23.4 (7.7) (16.7) (16.7) (16.7) (50.0) Malignant fibrous (4:1) 47-78, 66 - - - - - 1 4 - 5 histiocytoma 63.6 (12.0) (20.0) (80.0) Chordoma (1.5:1) 39-78, 69 0 5 - - - - - - - 5 62.2 (18.1) (100.0) Osteofibrous dysplasia (1.5:1) 9-47, 19 1 - - - - - - 4 - 5 23.2 (15.4) (20.0) (80.0) Sarcoma NOS (All male) 22-54, 39.5 - - - - - - - 4 - 4 38.75 (13.4) (100.0) Langerhans cell (0.3:1) 17-37, 27 - 2 - - - - - 2 - 4 histiocytosis 27 (14.1) (50.0) (50.0) Osteoid osteoma (All male) 6, 7, 17# - - - - - - - 3 - 3 (100.0) Ewing sarcoma / PNET (0.5:1) 15, 19, 19# - - 1 - - - 1 1 - 3 (33.3) (33.3) (33.3) Aneurysmal bone cyst (2:1) 12, 15, 24# - 1 - - - - - 2 - 3 (33.3) (66.7) 784 89No.62006 Assoc ThaiVol.
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