Bone tumours of the clavicle: Histopathological, anatomical and epidemiological analysis of 113 cases

Abstract

Backround: This retrospective study aimed to determine the frequency of bone tumours of the clavicle and their histopathological, anatomical and epidemiological characteristics in a large case series.

Methods: The records of 327 lesions of the clavicle collected from 1976 to 2018 in our bone tumour registry and institute of pathology were reviewed. Following data were evaluated: age, gender, side, radiological assessment, tumour location within the clavicle, and histopathological findings.

Results: Bone tumours were detected in 113 patients with a mean age of 40 years. The lateral third of the clavicle was most frequently involved. Analysis revealed 22 benign, 31 intermediate, and 60 malignant tumours. Eosinophilic granuloma was the most commonly found neoplasm (18.6%), followed by bone metastases (15.0%), Plasma cell myeloma (8.8%), Ewing sarcoma (8.8%), and Osteosarcoma (8.0%). 53% of the tumours were malignant. Mean age was 51 years in the malignant tumour group and 28 years in patients with a benign/intermediate lesion (p < 0.001).

Conclusions: The high incidence of malignant bone tumours of the clavicle found in this study highlight the importance of biopsy to prevent delay in diagnosis and treatment of these lesions, especially in patients with increased age. We believe that the results of this study are of clinical importance and may aid the physician in the management of these rare lesions.

Keywords: Biopsy; Bone tumour; Clavicle; Histology.

Fig. 1

Age distribution. Age distribution of all bone tumours of the clavicle including data of the most common entities per age group. n, number of patients; O, Others; Eg, Eosinophilic granuloma; Abc, Aneurysmal bone cyst; Es, Ewing sarcoma, Os, Osteosarcoma; Fd, Fibrous dysplasia; Ch, Chondroma; Pc, Plasma cell myeloma; Me, Metastases involving bone; He, Hemangioma; Cs, Chondrosarcoma; Ml, Malignant lymphoma.

Fig. 2

Eosinophilic granuloma. Anteroposterior radiograph of the right clavicle demonstrates a lytic bone lesion in the middle third with a dislocated pathological fracture in a 55 years old woman (a). Histopathological analysis revealed Eosinophilic granuloma of bone. Mononuclear histiocytic cells with cleaved nuclei, accompanied by eosinophils display the typical histological appearance of Eosinophilic granuloma (stained with hematoxylin and eosin, 400x magnification) (b). On immunohistochemistry the mononuclear cells are positive for S100 (c) and CD1a (d) (400x magnification).

Fig. 3

Plasma cell myeloma of bone. Anteroposterior radiograph of the right clavicle shows a lytic bone lesion in the lateral third with a pathological fracture in a 78 years old man (a). Plasma cell myeloma of bone was diagnosed. Monotonous populations of plasma cells display the characteristic histological picture of plasma cell myeloma (stained with hematoxylin and eosin, 200x magnification) (b).

Fig. 4

Osteosarcoma. Anteroposterior radiograph of the right clavicle shows an osteoblastic bone lesion with a partially calcified soft-tissue mass in a 73 years old man (a). T1-weighted MR image demonstrates a huge soft tissue mass around the involved clavicle with locally aggressive features (b). Histopathological analysis revealed high-grade osteosarcoma with epitheloid tumor cells embedded in dense collagenous stroma with formation of neoplastic woven bone, as could be seen in the left part of the picture (stained with hematoxylin and eosin, 200x magnification) (c).