Flashcards in Avascular Necrosis, Fractures & Infection of Bone Deck (92):
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
What two areas in the body in particular, are capable of having any of the primary bone tumors?
Shoulder and knee
Where can osteosarcoma occur? (3)
Where do osteomas usually occur?
Skull / face
Where do chondromas usually occur?
Where does chondrosarcomas usually occur?
Where are giant cell tumors found?
End of bone--epiphysis
Where do Ewing sarcomas arise?
Diaphysis of long bones
Where in the bone do osteosarcomas occur?
Metaphysis / physis
Where in the bone do chondrosarcomas occur?
Cancer in the diaphysis = ?
Cancer in the epiphysis = ?
Giant cell tumors
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
What is the age range that osteomas typically affect?
What are the x-ray findings of osteomas?
Well delineated nodule
What is the prognosis for osteomas? (3)
Which is larger: osteoid osteomas or osteoblastomas?
True or false: osteoid osteomas and osteoblastomas have the same histological characteristics
What are the s/sx of osteoid osteomas and osteoblastomas?
Which is relieved by ASA: osteoid osteomas or osteoblastomas?
What are the x-ray findings of osteoid osteomas and osteoblastomas?
Central area of tumor (lucency) surrounded by a rim of sclerotic bone
What type of bone surrounds osteoid osteomas: woven or lamellar?
Who is classically affected with osteoid osteomas? Where is it classically?
Young adult males around the knee
Who is classically affected with osteoblastomas? Where is it classically?
What is the prognosis for osteoblastomas?
Good, if totally excised
Osteoblastomas are usually greater than what size?
More than 2 cm
Bone pain not relieved by ASA = ?
What are osteosarcomas?
malignant mesenchymal tumors of neoplastic cells that produce osteoid
What is the most common primary malignancy of bone?
What is the bimodal age distribution of osteosarcomas?
less than 20 and and elderly
Where do osteosarcomas generally arise from?
Metaphysis of long bones of extremities
What MUST you see histologically to diagnose osteosarcomas?
Which gender is more affected with osteosarcomas?
What are some of the conditions that predispose patients to later osteosarcomas? (5)
-Paget's disease of bone
True or false: osteosarcomas that arise later in life 2/2 past bone disease are usually more aggressive
What is the usual clinical presentation of osteosarcomas?
Bone pain, swelling, and pathological fractures
How aggressive is osteosarcomas?
Very--20% with lung mets by dx
What is the treatment for osteosarcomas?
What are the x-ray findings of osteosarcomas?
Large, destructive mixed blastic and lytic mass with infiltrating margins
What is the usual progression of osteosarcomas?
-Adjacent soft tissue
What is Codman's triangle?
Elevation of periosteum produces an angle between surface of the involved bone, and the fascia
What are the two major forms of periosteal reactions to osteosarcomas?
Lamellated ("onion skin")
True or false: the radiographic appearance of periosteal reaction does not reflect the degree of aggressiveness of the tumor
Who usually gets osteochondromas?
Young (10-30 yo) males
Where along bones do osteochondromas usually occur?
metaphysis or near epiphyseal plate
What are the x-ray findings of osteochondromas?
Polypoid growth (mushroom shaped)
What is the prognosis for osteochondromas?
Good if solitary. If multiple, about 10% chance of developing chondrosarcoma
What is the treatment for osteochondromas?
Cut it out
What are the polypoid growths of osteochondromas usually made out of?
Cartilage, bone, and marrow
What is the usual presentation of osteochondromas?
Problems bending their leg or interruption of movement
What are chondromas?
Benign tumors of hyaline cartilage that is usually well circumscribed
If a chondroma is found in the medullary cavity, what are they called? What about in the subperiosteum?
-Medullary cavity = Enchondromas.
-Subperiosteal - juxtachondroma
Where do chondromas usually occur?
Metaphyses of small tubular bones of hands and feet
What is the disease that presents with multiples enchondromas?
What is the most common type of intraosseous cartilage tumor? Which gender is usually affected?
What are the x-ray findings of chondromas?
Well defined stippled Ca
What are the histological characteristics of chondromas?
mature, hypocellular cartilage with bland chondrocytes
What is the prognosis for chondromas?
Good if solitary
If multiple 1/3 develop chondrosarcomas
What is the treatment for chondromas?
Cut it out, but if not complete then may recur
What is the age that is usually affected with chondrosarcomas? What bone is usually affected?
-Pelvic bones and axial skeleton
What are the x-ray characteristics of chondrosarcomas?
Variably calcified, multilobular
What is the prognosis for chondrosarcomas?
Depends on tumor *grade* and size
With what disease in particular are chondrosarcomas more common?
What are the three characteristics that grades are based on?
-Degree of nuclear atypia
What is the classic description of the histology of Ewing sarcomas?
Small, round and blue cells arranged in solid nested aggregates
What are the cell that make up Ewing's sarcoma?
Primitive neural tumors derived from a precursor multipotent mesenchymal stem cell
Where in the bone do Ewing's sarcoma usually arise from?
What is the difference between Ewing sarcomas and primitive neuroectodermal tumors (PNET)
Ewing sarcomas = undifferentiated
PNET = neural differentiation with homer wright rosettes
What is the translocation that often produces Ewing sarcomas? What are the genes that are mutated?
EWS gene on chr 22
FLI1 gene on chr 11
(11+22 = 33 = Patrick Ewing's jersey number)
Who is usually affected with Ewing sarcomas?
boys under 15 yo
Small, round and blue cells arranged in solid nested aggregates = ?
What are the two stains that are positive with Ewing sarcomas?
What is the major histological difference between Ewing sarcomas and PNETs?
PNETs have Homer wright rosettes
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
What are the usual s/sx of fibrous cortical defects?
asymptomatic--usually an incidental x-ray finding
What is the prognosis for fibrous cortical defects?
What are the x-ray findings of fibrous cortical defects?
What is the age range that is usually affected with fibrous cortical defects?
what are the histological characteristics of fibrous cortical defects?
Spindle cells and fibroblasts with multinucleated giant cells
What is the age, site, x-ray characteristics, and prognosis for fibrous dysplasia?
X-ray: radiolucent, in diaphysis
What is the pathogenesis of fibrous dysplasia?
What are the histological characteristics of fibrous dysplasia?
Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation
Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation on histology = ?
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
What is the age range in which giant cell tumors usually occur?Gender?
What are the usual s/sx of giant cell tumors?
How aggressive are giant cell tumors?
True or false: most tumors in the bone are mets
True--20x more common
Most metastatic tumors to the bone are osteolytic or osteoblastic?
What are the two osteoblastic mets?
Prostate and breast
What are the 5 osteolytic bone mets?