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MSK II > bone, joint, soft tissue 2 > Flashcards

bone, joint, soft tissue 2 Flashcards

1
Q

what cartilage tumor is more common in younger people

A

enchondroma

benign

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2
Q

what cartilage tumor is more common in older people

A

chondrosarcoma

malignant

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3
Q

osteochondroma

A

aka exostosis
benign cartilage-capped tumor that is attacehd to underlying skeleton by bony stalk
most common benign bone tumor
85% solitary

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4
Q

osteochondroma morphology

A

sessile or pedunculated
1-20cm
cap is benign hyaline cartilagecovered in perichondrium

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5
Q

osteochondroma x-ray

A

can see mm pull lines

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6
Q

osteochondroma clinical

A

usually stop growing at time of growth plate closure

symptomatic tumors are cured by simple excision

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7
Q

multiple hereditary exostosis

A

5-20% progress to chondosarcoma

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8
Q

chondromas

A

benign tumors of hyaline cartilage that usually occur in bones of enchondral origin

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9
Q

chondromas that arise in medullary cavity

A

enchondromas

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10
Q

chondromas that arise on surface of bone

A

juxtacortical chondromas

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11
Q

enchondromas

A

most common intraosseous cartilage tumros
20-50
appear as soliatry metaphyseal lesions of tubular bones of hand and feet

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12
Q

chondromas xray

A

circumscribed lucencies with central irregular calcifications, sclerotic rim and intact Cx
<3cm

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13
Q

what NONHEREDITARY disorders can cause multiple enchondromas

A

ollier disease
maffucci syndrome
can both be more cellular with cytologic atypia

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14
Q

chondromas clinical

A

growth potential limited
Tx-usually observation or curettage
solitary rarely undergo sarcomatous transformation

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15
Q

maffucci syndrome

A

also have spindle cell hemangiomas

at risk for ovarian carcinomas and brain gliomas

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16
Q

chondrosarcoma

A

malignant tumors that produce cartilage
2nd most common malignant tumor of bone
usually 40+

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17
Q

where do chondrosarcomas commonly arise

A

axial skeleton, pelvis, shoulder, ribs

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18
Q

chondrosarcomas xray

A

calcified matrix appears as foci of flocculent densities

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19
Q

chondrosarcomas clinical

A

painful, progressively enlarging masses
direct correlation btwn grade and behavior of tumor
most present as grade I which rarely metastasize
grade 3- 70% mets to lungs

20
Q

Tx of chondrosarcomas

A

surgical excision

chemo

21
Q

Ewing sarcomas

A

malignant bone tumor with primitive round cells w/o obvious differentiation
now grouped with PNET tumors

22
Q

Ewing sarcomas presentation

A

80% <20
usually arise in diaphysis of long bones and flat bones of pelvis
painful enlarging masses with warmth and swelling and leukocytosis mimicking infection

23
Q

ewings xray

A

destructive lytic tumor with permeative margins that extends into surrounding soft tissue
onion skinning
homer-wright rosettes

24
Q

Tx of Ewings

A

neoadjuvant chemo with surgery and +/- radiation

long term cure 50%

25
Q

giant cell tumor

A 
dominated by multinucleated osteoclast-type giant cells 
aka osteoclastoma
uncommon
benign, but locally aggressive 
20-40
26
Q

giant cell xray

A

soap bubble

27
Q

Tx of giant cell

A

curettage
40-60% locally recur
RANKL inhibitor denosumab

28
Q

giant cell mets

A

4% mets to lungs, but can spontaneously regress and seldom fatal

29
Q

aneurysmal bone cyst (ABC)

A

multiloculated blood-filled cystic spaces
usually first 2 decades
metaphysis of long bones and post vertebral bodies
pain and swelling

30
Q

ABC xray

A

eccentric expansible lesion with well defined margins most are completely lytic and often contain thin shell of reactive bone at periphery
fluid-fluid levels

31
Q

ABC clinical

A

surgery

low recurrence rate

32
Q

lesions stimulating primary neoplasms

A

fibrous cortical defect- small (.5cm)

nonossifying fibromas- (5-6cm)

33
Q

fibrous cortical defects

A

aka metaphyseal fibrous defects
extremely common
30-50% of kids 2+
cast majority arise in distal femur and proximal tibia, almost half are b/l or multiple

34
Q

fibrous cortical defect histo

A

pinwheel

35
Q

clinical fibrous cortical defect

A

asymptomatic detected incidentally
Bx rarely needed
spontaneous resolution

36
Q

clinical nonossifying fibromas-

A

pathologic fracture and may require Bx and surgery

37
Q

fibrous dysplasia

A

benign tumor likened to localized developmental arrest

all normal components are present, just do not differentiate into mature structures

38
Q

fibrous dysplasia clinical patterens

A

monostotic- single bone
polystotic- multiple bones
mazabraud syndrome
McCune-Albright syndrome

39
Q

mazabraud syndrome

A

fibrous dysplaisa (usually poly) and soft tissue myxomas

40
Q

McCune-Albright syndrome

A

polyostotic disease, cafe-au-lait spots, endocrine abnormalities, (precocious puberty)

41
Q

fibrous dysplasia xray

A

ground glass appearance

well defined margins

42
Q

monostotic fibrous dysplasia clincal

A

B=G
usually early adolescence
often stops enlarging when growth plate closes
femur, tibia, ribs, jaw, calvarium, and humerus
usually asymptomatic, but may cause pain, fracture, or leg length discrepancies
Tx- only if symptomatic curettage

43
Q

polystotic fibrous dysplasia clincal

A

manifests earlier then mono
may continue to be symptomatic into adulthood
femur, skull, tibia, humerus, ribs, fibula, radius, ulan, mandible, vertebrae
may require multiple sugeries
bisphosphonates can Tx pain
rarely transforms into sarcoma

44
Q

75% of bone mets are from what

A 
prostate
breast
kidney
lungs
metastatic bone CA much more common then primary bone CA
45
Q

prostate mets

A

usually blastic

46
Q

kidney, GI, and melanoma mets

A

lytic

47
Q

what translocation is assocaited with Ewing sarcoma

A

t(11,22)

MSK II (19 decks)

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