Avascular Necrosis, Fractures & Infection of Bone Flashcards Preview

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Flashcards in Avascular Necrosis, Fractures & Infection of Bone Deck (92):
1

What are the five questions that should be asked with osseous lesions?

1. Pattern of growth?
2. Are the cells of the lesions producing anything?
3. What do the cells look like?
4. Based on cellular features, is the lesion likely benign or malignant?
5. Does the anatomic dx correlate with the clinical picture

2

What two areas in the body in particular, are capable of having any of the primary bone tumors?

Shoulder and knee

3

Where can osteosarcoma occur? (3)

Knee
Hip
Shoulder

4

Where do osteomas usually occur?

Skull / face

5

Where do chondromas usually occur?

Fingers/ wrist

6

Where does chondrosarcomas usually occur?

Axial skeleton:
-Pelvis
-Vertebrae

7

Where are giant cell tumors found?

End of bone--epiphysis

8

Where do Ewing sarcomas arise?

Diaphysis of long bones

9

Where in the bone do osteosarcomas occur?

Metaphysis / physis

10

Where in the bone do chondrosarcomas occur?

Metaphysis

11

Cancer in the diaphysis = ?

Ewing's sarcoma

12

Cancer in the epiphysis = ?

Giant cell tumors

13

What are osteomas, and what are the s/sx?

Rare, benign tumor of mature bone that is usually asymptomatic, but may cause local mechanical problems

14

What is the age range that osteomas typically affect?

40-50

15

What are the x-ray findings of osteomas?

Well delineated nodule

16

What is the prognosis for osteomas? (3)

-Slow growing
-Not invasive
-Not malignant

17

Which is larger: osteoid osteomas or osteoblastomas?

Osteomas

18

True or false: osteoid osteomas and osteoblastomas have the same histological characteristics

True

19

What are the s/sx of osteoid osteomas and osteoblastomas?

Painful lesions

20

Which is relieved by ASA: osteoid osteomas or osteoblastomas?

Osteoid osteomas

21

What are the x-ray findings of osteoid osteomas and osteoblastomas?

Central area of tumor (lucency) surrounded by a rim of sclerotic bone

22

What type of bone surrounds osteoid osteomas: woven or lamellar?

Woven

23

Who is classically affected with osteoid osteomas? Where is it classically?

Young adult males around the knee

24

Who is classically affected with osteoblastomas? Where is it classically?

Teens-20s
Vertebral column

25

What is the prognosis for osteoblastomas?

Good, if totally excised

26

Osteoblastomas are usually greater than what size?

More than 2 cm

27

Bone pain not relieved by ASA = ?

Osteoblastomas

28

What are osteosarcomas?

malignant mesenchymal tumors of neoplastic cells that produce osteoid

29

What is the most common primary malignancy of bone?

Osteosarcomas

30

What is the bimodal age distribution of osteosarcomas?

less than 20 and and elderly

31

Where do osteosarcomas generally arise from?

Metaphysis of long bones of extremities

32

What MUST you see histologically to diagnose osteosarcomas?

Osteoid

33

Which gender is more affected with osteosarcomas?

Younger males

34

What are some of the conditions that predispose patients to later osteosarcomas? (5)

-Paget's disease of bone
-Chronic osteomyelitis
-Prior irradiation
-bone infarcts
-Fibrous dysplasia

35

True or false: osteosarcomas that arise later in life 2/2 past bone disease are usually more aggressive

True

36

What is the usual clinical presentation of osteosarcomas?

Bone pain, swelling, and pathological fractures

37

How aggressive is osteosarcomas?

Very--20% with lung mets by dx

38

What is the treatment for osteosarcomas?

Chemo
Radical surgery

39

What are the x-ray findings of osteosarcomas?

Large, destructive mixed blastic and lytic mass with infiltrating margins

40

What is the usual progression of osteosarcomas?

Extends inward:
-Marrow cavity
Extends outward:
-Adjacent soft tissue

41

What is Codman's triangle?

Elevation of periosteum produces an angle between surface of the involved bone, and the fascia

42

What are the two major forms of periosteal reactions to osteosarcomas?

Lamellated ("onion skin")
Spiculated ("sunburst")

43

True or false: the radiographic appearance of periosteal reaction does not reflect the degree of aggressiveness of the tumor

false-it does

44

Who usually gets osteochondromas?

Young (10-30 yo) males

45

Where along bones do osteochondromas usually occur?

metaphysis or near epiphyseal plate

46

What are the x-ray findings of osteochondromas?

Polypoid growth (mushroom shaped)

47

What is the prognosis for osteochondromas?

Good if solitary. If multiple, about 10% chance of developing chondrosarcoma

48

What is the treatment for osteochondromas?

Cut it out

49

What are the polypoid growths of osteochondromas usually made out of?

Cartilage, bone, and marrow

50

What is the usual presentation of osteochondromas?

Problems bending their leg or interruption of movement

Mass

51

What are chondromas?

Benign tumors of hyaline cartilage that is usually well circumscribed

52

If a chondroma is found in the medullary cavity, what are they called? What about in the subperiosteum?

-Medullary cavity = Enchondromas.
-Subperiosteal - juxtachondroma

53

Where do chondromas usually occur?

Metaphyses of small tubular bones of hands and feet

54

What is the disease that presents with multiples enchondromas?

Ollier disease

55

What is the most common type of intraosseous cartilage tumor? Which gender is usually affected?

chondromas
Males

56

What are the x-ray findings of chondromas?

Well defined stippled Ca

57

What are the histological characteristics of chondromas?

mature, hypocellular cartilage with bland chondrocytes

58

What is the prognosis for chondromas?

Good if solitary
If multiple 1/3 develop chondrosarcomas

59

What is the treatment for chondromas?

Cut it out, but if not complete then may recur

60

What is the age that is usually affected with chondrosarcomas? What bone is usually affected?

-40-60 yo
-Pelvic bones and axial skeleton

61

What are the x-ray characteristics of chondrosarcomas?

Variably calcified, multilobular

62

What is the prognosis for chondrosarcomas?

Depends on tumor *grade* and size

63

With what disease in particular are chondrosarcomas more common?

Ollier's disease

64

What are the three characteristics that grades are based on?

-Cellularity
-Degree of nuclear atypia
-Mitotic activity

65

What is the classic description of the histology of Ewing sarcomas?

Small, round and blue cells arranged in solid nested aggregates

66

What are the cell that make up Ewing's sarcoma?

Primitive neural tumors derived from a precursor multipotent mesenchymal stem cell

67

Where in the bone do Ewing's sarcoma usually arise from?

Diaphysis

68

What is the difference between Ewing sarcomas and primitive neuroectodermal tumors (PNET)

Ewing sarcomas = undifferentiated

PNET = neural differentiation with homer wright rosettes

69

What is the translocation that often produces Ewing sarcomas? What are the genes that are mutated?

t(11;22)
EWS gene on chr 22
FLI1 gene on chr 11

(11+22 = 33 = Patrick Ewing's jersey number)

70

Who is usually affected with Ewing sarcomas?

boys under 15 yo

71

Small, round and blue cells arranged in solid nested aggregates = ?

Ewing sarcoma

72

What are the two stains that are positive with Ewing sarcomas?

-PAS+
-CD99

73

What is the major histological difference between Ewing sarcomas and PNETs?

PNETs have Homer wright rosettes

74

What are fibrous cortical defects? how common are they? Where in the body do they usually arise?

Extremely common developmental defect that arises in the metaphysis of distal femur and proximal tibia

75

What are the usual s/sx of fibrous cortical defects?

asymptomatic--usually an incidental x-ray finding

76

What is the prognosis for fibrous cortical defects?

Resolve spontaneously

77

What are the x-ray findings of fibrous cortical defects?

scalloped appearance--"polyostotic"

78

What is the age range that is usually affected with fibrous cortical defects?

20s

79

what are the histological characteristics of fibrous cortical defects?

Spindle cells and fibroblasts with multinucleated giant cells

80

What is the age, site, x-ray characteristics, and prognosis for fibrous dysplasia?

Age: 10-30
Site: anywhere
X-ray: radiolucent, in diaphysis
Prognosis: good

81

What is the pathogenesis of fibrous dysplasia?

Somatic mutation

82

What are the histological characteristics of fibrous dysplasia?

Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation

83

Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation on histology = ?

Fibrous dysplasia

84

What are giant cell tumors of bone, and where do they occur?

-Tumors that contain numerous osteoclast-like multinucleated giant cells
-epiphyses of long bones, generally around the knee

85

What is the age range in which giant cell tumors usually occur?Gender?

20-55 yo
Females

86

What are the usual s/sx of giant cell tumors?

Arthritic symptoms

87

How aggressive are giant cell tumors?

malignant

88

True or false: most tumors in the bone are mets

True--20x more common

89

Most metastatic tumors to the bone are osteolytic or osteoblastic?

Osteolytic

90

What are the two osteoblastic mets?

Prostate and breast

91

What are the 5 osteolytic bone mets?

Thyroid
Lung
GI tract
Kidney
Melanoma

92

The majority of mets to bone are osteoblastic, osteolytic, or mixed

Mixed