METHODS IN PATHOLOGY Examination of Tumor and Tumor-Like Conditions of Bone Hanh Khuu, MD, Daniel Moore, MD, Scott Young, PA, Kenneth A. Jaffe, MD, and GeneP. Siegal, MD, PhD Surgical pathology specimens composed of bone, ranging from core biopsy to limb amputation specimens, require special attention, processing, and often unique equipment. This readily translates into additional handling steps and time, espe- cially when one factors in clinical correlation with the surgeon and radiologic review of all images with a knowledgeable musculoskeletal radiologist. When these factors are superimposed on the rarity of these lesions in routine practice, it is not surprising that most trainees, as well as seasoned pathologists, are wary of these lesions. In this report, we use a case of osteofibrous dysplasia (Campanacci's disease) to demonstrate the dissection of such a surgical specimen and complete the report with a brief discussion of the entity. Ann Diagn Pathol 3: 364-369, 1999. Copyright © 1999 by W.B. Saunders Company Index Words: Bone neoplasm, bone tumor, osteofibrous dysplasia, gross examina- tion B ONES involved by neoplastic processes when submit- ted as surgical pathology specimens require special treatment and handling. Because these specimens are obtained by different techniques (from needle core biopsies to forequarter amputations), they result in vastly different specimens for malignant skeletal tu- mors. Many pathologists, irrespective of their training and experience, are wary of these specimens because of their rarity in practice. In addition, bone lesions may be especially challenging secondary to overlapping histo- logic appearance. Additional equipment is required (ie, a band saw) and decalcification is invariably needed. Few descriptions of dissection techniques for bone speci- mens have been reported. 1-3In this presentation, we use the example of a case from our practice to demonstrate the standard techniques we use to dissect a bony specimen, ultimately reaching a final diagnosis. No attempt is made to be encyclopedic and it is clearly recognized that the bone or bones involved, the size of the lesion, the involvement of surrounding soft tissues, From the Division of Anatomic Pathology, Department of Pathology, the Musculoskeletal Radiology Section,DepartmentofRadiology, and the Division of OrthopaedicSurgery,Departmentof Surgery, Universityof Alabama at Birming- ham, Supported in part by a grantfrom the Pediatric Oncology Group through National Cancer Institute, National lnstitutes ofHealth (CA 25408). Address reprint requeststo GeneP. Siegal, M_D,PhD, Division of Anatomic Pathology,DepartmentofPathology,506 KrackeBldg, UniversityofAlabama at Birmingham, Birmi@am, AL 35233. Copyright© 1999 by W..B. Saunders Company 1092-9134/99/0306-0005510.00/0 and the vital organs all affect the approach to examining the specimen grossly, sectioning it appropriately, and submitting it for final processing. Case Report A 15-year-old girl presented with a lesion of the left tibia that had been previously biopsied at an outside institution and initially diagnosed as being "consistent with fibrous dysplasia." The patient was referred to our institution for surgical consultation. The biopsy material was reviewed, but no radio- graphic films or reports were available. A diagnosis of benign fibro-osseous lesion consistent with fibrous dysplasia was rendered and the differential diagnosis was discussed with the orthopedist. After the radiographic images were reviewed (see below), the patient underwent partial resection of the left tibia, including the area of concern. Radiographic Description Review of the radiographic images with the musculoskeletal radiologists demonstrated a multiloculated radiolucent expan- sion of the anterolateral cortex of the tibia. An associated anterior bowing with minimal cortical thickening and sclerosis was noted. The radiographic features of the lesion were felt to be most typical of osteofibrous dysplasia. Although possible, fibrous dysplasia was thought to be a much less likely entity in this case given the cortically based location of the lesion. Gross Description A certified pathologist's assistant with significant experi- ence in dealing with musculoskeletal tumors "grossed in" the specimen after discussion with the attending orthopedic pa- thologist and joint review of the radiographs to determine in 364 Annals of Diagnostic Pathology, Vol 3, No 6 (December), 1999: pp 364-369