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Orthopedic Surgery Ultimate > Tumors > Flashcards

Tumors Flashcards

1
Q

Tumors and tumor-like lesions of bone. Present how? 4

A
  1. Persistent skeletal pain and swelling
  2. Limitation of motion
  3. Spontaneous fracture
  4. Proceed with clinical, radiographic, lab and biopsy exam
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2
Q

Tumors and tumor-like lesions of bone: What are the three types of tumors?

A
  1. Osteoblastic connected tissue tumors
  2. Cartilage tumors
  3. Bone
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3
Q

What are the tumors in the following categories:
1. Osteoblastic connected tissue tumors? 2

  1. Cartilage tumors? 3
  2. Bone? 3
A
  1. Osteoblastic connected tissue tumors
    - Osteoid osteoma
    - Osteosarcoma
  2. Cartilage tumors
    - Enchondromas
    - Chondromyxoid fibromas
    - Chondrosarcomas
    • Giant Cell
    • Chondroblastomas
    • Ewing’s sarcoma
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4
Q

How would you treat the following:

  1. Osteoid osteoma?
  2. Osteosarcoma?
A
  1. Osteoid osteoma
    - Pain usually relieved by aspirin
  2. Osteosarcoma
    - Resection and chemotherapy
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5
Q

Tumors and tumor-like lesions of bone:
1. Giant cell are mostly benign or malignant?

  1. Chondroblastomas: benign or malignant?
  2. Ewing’s sarcoma prognosis?
A
  1. 50% are benign
  2. Almost always benign
  3. 50% mortality rate in spite of chemotherapy, radation and surgery
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6
Q

RED FLAGS FOR TUMORS?

5

A
  1. Night pain,
  2. constant pain,
  3. unusual symptoms,
  4. no improvement with conservative management,
  5. or general symptoms such as fever, malaise, weakness
  6. Unexplained mass, especially in the thigh
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7
Q

RED FLAGS on xray findings?

3

A

X-ray findings with

  1. lytic or blastic bone changes,
  2. soft tissue calcification or
  3. periosteal reaction
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8
Q

Evaluation of tumors?

A
  1. Physical exam and x-rays for most
  2. Possible bone scan, CT scan, MRI, chest x-rays/CT for more high risk lesions
  3. Consider
    - lab tests
  4. consults/referral Oncologist, Path, etc
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9
Q

Whch labs to evaluate for tumors? 3

A
  1. CBC
  2. calcium, phosphorous
  3. alk phos
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10
Q

If you have a patient that has weakness, anemia and is over 40 what do you have to R/O?

A

MM

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11
Q

What are you looking for on CT with evaluaiton of bone tumors?

A

history of calcifications

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12
Q
  1. If suspecting Malignancy after XRAY you must order a what?
  2. What lab would be elevated in lots of bone breakdown?
  3. Bottom line need to what?
A
  1. CT
  2. ALK phos= lots of bone breakdown
  3. biopsy
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13
Q
  1. Who should the biopsy be performed by?
  2. How should the biopsy be dissected?
  3. Consult for what?
A
  1. Ideal if performed by “ultimate” surgeon
  2. Longitudinal and stay in one compartment
  3. Consult to plan incision
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14
Q

What would be the different in trying to decide whether to observe, excise or refer in malignant vs benign tumors of the bone?

A
  1. Clearly benign-observation versus excision/curettage
  2. Possibly malignant- consider referral to Regional Cancer Center having teams of pathologists, radiologists, surgeons, and oncologists and radiation therapists
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15
Q

How do we classify tumors? 3

A
  1. Bony versus soft tissue
  2. Benign versus malignant
  3. Primary versus metastatic
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16
Q

MALIGNANT BONE TUMORS
Prognosis greatly improved in recent years with dedicated referral centers, pre-op chemotherapy, limb-sparing procedures, etc.

4

A
  1. Osteosarcoma
  2. Ewing’s
  3. Soft tissue tumor
  4. Mets
17
Q

Second most common primary bone tumor after myeloma?

A

OSTEOSARCOMA

18
Q

OSTEOSARCOMA

  1. High risk of what?
  2. What percent of all bone sarcomas?
  3. What years?
  4. Gender?
  5. Where?
  6. Xray findings?
  7. Other imaging?
A
  1. high risk mets (poor prognosis!)
  2. 20% of all bone sarcomas
  3. second decade (10-20YO)
  4. male equal female
  5. appendicular (50% knee)
  6. x-rays mixed lytic/sclerotic with cortical destruction (Codman’s triangle, “star burst” periosteal reaction, etc)
  7. MRI
19
Q

EWING’S

  1. Highly what?
  2. Path looks like what?
  3. Xray findings? 5
  4. Prognosis?
A
  1. Highly anaplastic
  2. small round cell tumor in sheets
    • long bone diaphyses,
    • lytic,
    • moth-eaten,
    • indistinct margins,
    • “onion skin”
  4. survival rates now 80 to 90% with pre-op chemotherapy (versus 20%)
20
Q

SOFT TISSUE TUMORS
1. Why is the diagnosis challenging? 2

  1. Will present how?
  2. Where will the tumor be found?
  3. Type of resection? 4
A
  1. Challenging –
    - history rarely helpful,
    - x-rays usually negative
  2. Small (less than five centimeter) superficial cystic lesions usually benign/observed
  3. Large deep solid tumors-studies/biopsy
  4. Type of resection-
    - intralesional,
    - marginal,
    - wide,
    - radical
21
Q

Sot tissue tumors:

Class based on apparent differentiation such as? 7

A
  1. Fibrous
  2. Lipomatous
  3. Smooth muscle
  4. striated muscle
  5. vascular
  6. synovial
  7. neurologic
22
Q

Sot tissue tumors:
Class based on apparent differentiation.
1. What are some fibrous tumors? 2

  1. What are some lipomatous tumors? 2
A
  1. Fibrous
    - Dupuytren’s
    - desmoid
  2. Lipomatous
    - lipoma
    - liposarcoma
23
Q

What is the most common cause of bone distruction in adults?

A

METASTATIC BONE DISEASE

24
Q

Which cancers commonly mets to bone?
4

Initial presentation may be to the orthopedist with what?

A
  1. breast,
  2. lung,
  3. prostate,
  4. kidney

back pain

25
Q

Cancer typically goes to which bones?

4

A
  1. Spine,
  2. ribs,
  3. pelvis,
  4. proximal limb girdles most common
26
Q

Common pitfalls in bone tumors? 4

Tx? 3

A
  1. assume metastatic,
  2. not recognizing that a fracture is pathologic,
  3. inadequate workup/planning/fixation,
  4. not knowing when to refer

Treatment-

  • fracture risk,
  • function,
  • palliation
27
Q

Benign Bone Tumors

4

A
  1. Osteochondroma
  2. Osteoid Osteoma
  3. Bone Cyst
  4. Nonossifying fibroma
28
Q

Most common (35 to 50%) of benign and 20 to 15% of all primary bone tumors?

A

OSTEOCHONDROMA

29
Q

OSTEOCHONDROMA

  1. What is it?
  2. Where?
  3. Gender?
  4. Years?
  5. Causes what kind of problems?
A
  1. Not true neoplasms
  2. Knee/proximal humerus,
  3. 2:1 males
  4. Second and third decades
  5. Mostly mechanical problems/compression, space occupying
30
Q

OSTEOCHONDROMA

  1. Stops growing when?
  2. IMaging? 2
  3. Tx?
A
  1. Stops growing at skeletal maturity (if they dont then think of something else)
  2. CT first. MRI if unclear
  3. Surgery- completely excise cartilage and perichondrium
31
Q

How big are osteochonrdomas?

A

1-2cm

32
Q

OSTEOID OSTEOMA

  1. Characteristics? 3
  2. Years?
  3. Gender?
  4. Where? 3
A

Benign

  1. Nidus-
    - well demarcated,
    - bone forming,
    - up to one centimeter.
  2. Second/Third decade-
  3. male to female 3:1
    • Long bones lower extremity,
    • cortex,
    • posterior elements lumbar spine

Approximately 10% of benign bone tumors and 2-3% of all primary bone tumors

33
Q

OSTEOID OSTEOMA

  1. Characteristics? 3
  2. Imaging? 2
  3. Tx? 2
A
    • Dull/sharp pain,
    • worse at night,
    • better with aspirin/NSAIDs
  2. X-ray/CT
    • En bloc resection (CT, X-rays)-gotta remove everything/lymph drainage etc
    • Percutaneous radiofrequency ablation
34
Q

UNICAMERAL BONE CYST

  1. Ages?
  2. gender?
  3. Where?
  4. what is different about this?
A
  1. Ages 5-15,
  2. boys 3:1 over girls
  3. 50-60% proximal humerus
  4. Not true cyst
35
Q

UNICAMERAL BONE CYST

  1. Where is it? what does it look like?
  2. Imaging?
  3. Tx? 2 Reoccurrence rates?
A
  1. Central radiolucent lesion metaphyseal side of growth plate, long bones
  2. MRI if unclear
  3. -Curettage/graft-
    20% to 45% recurrence
    -Needle aspiration and several steroid injections at two month intervals-
    10% recurrence
36
Q

What is FCD-NOF?

A

Fibrous cortical defect/non ossifying fibroma

37
Q

Fibrous cortical defect/non ossifying fibroma

  1. Common when?
  2. Neoplastic?
  3. Where?
A
  1. Common in childhood
  2. Non-neoplastic
  3. Metaphysis of long bones (knee)

Approximately 5% of benign primary bone tumors

38
Q

FCD-NOF

  1. Which decades?
  2. Shaped? 2
  3. Tx- if weakening bone?
  4. If fractured? 3
A
  1. First two decades
    • Oval elongated radiolucent,
    • well marginated
  3. If weakening bone then curettage/graft
  4. Fracture-
    - immobilize,
    - observe,
    - sometimes lesion heals

Orthopedic Surgery Ultimate (88 decks)

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