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MM Test 3 > B6.067 Bone Tumors > Flashcards

B6.067 Bone Tumors Flashcards

1
Q

benign lesions in 0-5

A

eosinophilic granuloma (EG) (osteomyelitis)

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2
Q

malignant lesions in 0-5

A

leukemia (ALL)
mets (neuroblastoma)
limited but significant ddx

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3
Q

benign lesions in 5-10

A

unicameral bone cyst
non-ossifying fibroma (NOF)
osteochondroma

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4
Q

malignant lesions in 5-10

A

Ewing sarcoma

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5
Q

what is an NOF

A

non ossifying fibroma

developmental abnormality where scar tissue is present in place of bone

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6
Q

benign lesions 10-20

A

osteoid osteoma
bone cysts
chondroblastoma

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7
Q

malignant lesions 10-20

A

osteosarcoma

Ewing sarcoma

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8
Q

benign lesions in adults

A

enchondroma

giant cell tumor

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9
Q

malignant lesions in adults

A

chondrosarcoma
metastasis
lymphoma
myeloma

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10
Q

most common symptom of bone tumors

A

pain

nerve endings in the periosteum respond to compression of tumor

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11
Q

do soft tissue tumors present with pain?

A

not unless they run into the bone

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12
Q

characteristics of pain to examine

A 
duration
-weeks/months : tumor
-days/ weeks: inflamm
mechanical vs resting
recent trauma or injury
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13
Q

what are 2 different etiologies of soft tissue mass

A

bone tumor extending into soft tissue
OR
tumor of the soft tissue

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14
Q

2nd most common symptoms of bone tumor

A

soft tissue mass

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15
Q

characteristics of soft tissue masses to examine / ddx

A

days/weeks after injury: myositis ossificans
painful mass over days: infection
enlarging painless mass: soft tissue tumor
enlarging painful mass: bone tumor
progressive hematoma after trauma : tumor

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16
Q

why is a progressive hematoma after trauma worrisome

A

should NOT continue to grow under normal circumstances
likely caused by tumor angiogenesis factor producing friable blood vessels around the tumor
these more likely to continue to bleed than normal BVs without tumor growth

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17
Q

evaluation of possible bone tumor

A 
size of mass
neuro status (involving nerve?)
tenderness
range of motion of adjacent joints
local/distant nodes
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18
Q

would you see node involvement in osteosarcoma?

A

NO
spread via blood, not to nodes
see lung involvement most commonly

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19
Q

most common location of bone tumors

A

metaphysis

intramedullary

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20
Q

vertebral body is similar to the ______ of long bones

A

metaphysis

more likely tumor location

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21
Q

posterior spinal elements are similar to _______ of long bones

A

diaphysis
more cortical bone
less common tumor location

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22
Q

types of tumor margins

A

geographic
moth-eaten
permeative

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23
Q

concerning tumor margin patterns

A

moth eaten
permeative
cannot demarcate the transition between normal and abnormal bone
both are present, but no clear line

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24
Q

geographic tumor margin

A

sharp transition between abnormal and normal bone

benign

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25
what to look for on radiographs of bone tumors
what is tumor doing to bone? what is bone doing to tumor? what is in the matrix or the lesion?
26
options for what could be the matrix composition inside a tumor of the bone
no matrix = fluid, blood, fibrous tissue dense = bone, osteonecrosis "popcorn" = cartilage "ground glass" = osteoid
27
when do you use MRI
assess soft tissues and bone marrow extent
28
when do you use CT
bone integrity mineralization pattern systemic involvement assessment (metastasis)
29
when do you use a bone scan
determine degree of activity of known bone involvement or to look for other areas of bone involvement (assessing for mets in bone sarcomas or other sites of disease in polyostotic benign lesions)
30
do sarcomas typically have multiple bone lesions?
no
31
what are some diseases that can present with multiple bone lesions
``` osteochondroma metastases leukemia enchondroma fibrous dysplasia Langerhans cell histiocytosis non-ossifying fibromas/ fibrous cortical defects ```
32
xray findings in osteosarcoma
permeative margin dense area of bone growth soft tissue expansion possible (fuzzy white outline)
33
Tc99 bone scan findings on osteosarcoma
increased uptake in location of tumor
34
how do you excise a osteosarcoma?
WIDE margins | tumor + normal tissue around it
35
histo features of osteosarcoma
mitotic figures in tumor cells surrounded by pink osteoid substance
36
common locations for osteosarcoma
``` areas around growth plates knee (50%) hip (15%) shoulder (10%) jaw (8%) ```
37
most common primary malignant bone tumor
osteosarcoma
38
age distribution of osteosarcoma
bimodal distribution 75% in pts < 20, most commonly when kids have rapid growth period other peak between 60s-80s, usually a result of a preexisting lesion
39
genetic predisposition to osteosarcoma
mutations in p53 and RB hereditary RB are 1000x more likely to develop osteosarcoma MOST PEOPLE DONT HAVE AN IDENTIFIABLE MUTATION THO
40
associations with osteosarcoma in adults
``` bone infarcts chronic osteomyelitis Paget radiation bone neoplasia WORSE in adults...many die ```
41
progressive knee pain in kiddos
osteosarcoma until proven otherwise | even if there was trauma
42
treatment for osteosarcoma
start on systemic chemo immediately, even if lung and bone scans do not show mets could be micromets that aren't visible DOES NOT respond to radiation surgical excision of primary tumor
43
what determines reconstructive potential of a limb after tumor excision?
amount of soft tissue structures intact nerve and muscles need to be able to power the extremity amputation f this stuff isn't left
44
what is true of ambulating with a prosthesis?
work well but require more energy than walking with a reconstructed extremity important if patient has compromised cardiac or pulm status
45
options for reconstruction
allograft - frozen from bone bank megaprosthesis - joint replacement where segments can be added to grow w patient rotationplasty
46
what is the general rule of thumb about using a megaprosthesis
don't use in patients < 7-8 you lose growth plates cant grow enough to keep up with patient, will lead to large limb length discrepancy
47
who is a good candidate for a rotationplasty?
younger kids > older kids | younger kids will have less psychiatric concern with having to completely learn how to use a new limb
48
what happens in a rotationplasty
connect tibia to proximal femur with heel on anterior of patient ankle functions as a knee joint
49
advantages of rotationplasty
``` better psych outcomes in young patients limited phantom pain standing/walking on weight bearing surfaces (soles of feet used to pressure, don't get torn up in prosthetic) control for limb length discrepancy good activity level more durable in kids than endoprosthesis ```
50
xray findings in chrondrosarcoma
expansile lesion | characteristic punctate calcifications (popcorn)
51
what is a 4 corner amputations
arm clavicle scapula usually try really hard to save upper extremities but you gotta do what you gotta do ya know
52
normal cartilage histo
group of 2-3 cells per lacuna | lots of pink matrix between cell groups
53
enchonroma
benign cartilage tumor
54
enchondroma histo
increased cellularity from regular cartilage matrix still present tho normal nuclei
55
chondrosarcoma histo
decreased matrix increased cellularity abnormal nuclei with multiple mitotic figures
56
most common primary bone tumor in adults
chondrosarcoma
57
common locations for chondrosarcoma
shoulder girdle | hip/pelvis
58
treatment of chrondrosarcoma
surgical excision | chemo for rare variant, but in general doesn't respond to chemo
59
additional imaging needed in chondrosarcoma
CT chest to check for lung mets | needed in all sarcomas
60
imaging findings in Ewings sarcoma
permeative lesion MRI shows extensive marrow involvement subperiosteal edema
61
treatment options for Ewings
surgical resection or radiation | radiation can damage growth plate in kids
62
histo of Ewings
small/round blue cell tumor | sheets of small cells with inconspicuous cytoplasm
63
epidemiology of Ewings
most patients are < 20 second most common bone tumor in kids (after osteosarcoma) more common in Caucasians slightly more common in boys
64
symptoms of Ewings
pain, fever, leukocytosis SUPER important to distinguish from osteomyelitis can appear identically until biopsied
65
where does Ewings occur
diaphysis/metaphysis of long bones
66
Ddx of Ewings based on histo
metastatic neuroblastoma metastatic rhabdomyosarcoma lymphoma
67
genetics associated with Ewings
85% t(11;22) 5-10% t(21;22) 1% t(7;22) in ALL cases: fusion of EWS gene on chromosome 22 to a member of the ETS family of transcription factors (most commonly FLI1)
68
EWs-FLI1 fusion gene
acts as a dominant oncogene constitutively active transcription factor that stimulates cell proliferation
69
prognosis of Ewings
75% 5 year survival | 50% long term cure
70
hardest location of Ewings to cure
pelvis | hard to excise
71
epidemiology of soft tissue tumors
much more common than bone tumors most are benign lipoma most common
72
how to determine origin of soft tissue tumor
evaluate initially with plain films to determine if mass is coming from bone or soft tissue and to evaluate for any mineralization within the lesion
73
epidemiology of soft tissue vs bone malignancies
malignant primary bone tumors occur in younger patients | malignant soft tissue tumors are more common among adults
74
most common location of synovial sarcoma
buttock | if u said synovium you truly SUCKKKKK
75
epidemiology of synovial sarcoma
3rd most common type of soft tissue sarcoma (most common among teenagers)
76
appearance of synovial sarcoma on MRI
mass that is made of something between fat and fluid
77
histo of synovial sarcoma
typically biphasic tumor -spindle cells -glandular epithelial cells can have monophasic, spindle cell variant (in men) that is only detected by translocation
78
genetics associated with synovial sarcoma
t(X;18)
79
treatment of synovial sarcoma
radiation therapy | wide resection

MM Test 3 (31 decks)

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