Bone and Soft TIssue Flashcards

Question

Chondrosarcoma demographics and gross

Answer 1

more central joints DI ugly cortical abN - scalloping, cortical destuction, expansion of bone and many with soft tissue mass

Answer 2

One to three, three high-grade while 2 is intermediate and is treated as high grade

Answer 3

OS will have higher grade nuclei and cartilage formation; metaphyseal lesion in young child with DI aggressive look --> will be OS CS - later in life with pelvic, shoulder girdle and prox humerus/femur

Answer 4

lace like osteoid high grade nuclei many variants

Answer 5

sometimes very little osteoid but very ugly cells with large amounts of blood

Answer 6

Huvos's grading | 1 90% good prognosis

Answer 7

low-grade but may look like oestochondroma with cartilage cap but beware; minimal atypia in spindled cells trabeculae of bone may contain high grade sarcoma of dediff

Answer 8

DI ground glass mineralisation with slcerotic rim | irregular spicules of woven bone with bland spindle cells wit h occ foam cells or myxoid change and fibrosis

Answer 9

GNAS1 gene activation mutation; McCune Albright syndrome - polysostoic fiborus dysplasi, endocrine abN, cutaenous pigmentation Mazabraud's syndrome - fibrous dysplasia and soft tissue myxoma

Answer 10

cortex or corticomedullary cavity with sclerotic margins distal femur, distal tibia and proximal tibia peds plump spindle cells in loose steriform pattern with multinuceated giant cells, foam cells, chronic inflammation

Answer 11

many in pelvic girdle and lower extremities;in bones femur > ilium > fibula metadiaphyseal lesion DI 'onion skinning" and moth-eaten places will move into marrow spaces small round blue cells with sheet-like growth and lobular or filagree in soft tissue

Answer 12

classical - small round blue cells with scant cytoplasm PNET - rosettes and neural atypical - cytological atypia

Answer 13

CD99 - not useful alone, membranous FLI1+ focal + keratin molecular more helpful

Answer 14

older age >17 yo pelvic tumour large tumour >8 cm metastatic disease

Answer 15

``` one of few tumours F>M epiphysis most solitatre but may be multiple 3-5th decades distal femur>proximal tibia>distal radius > sacrum DI look can ugly gross: red mahogany ```

Answer 16

clear cell CS, chondroblastoma, giant cell tumour

Answer 17

multinucelated giant cells evenly distributed; monouclear cells with round to oval nuclei and eosinphilic cytoplasm mitotic activity foam cells, reactive new bone ddx: OS, ABC

Answer 18

may be 1' or 2' to other tumours (chondroblastoma) mkost common in >20 yo distal femur or proximal tibia metaphysis in spine, posterior elements DI fluid levels, cortical destruction, lucency in metaphysis

Answer 19

multiple cyts fibrous septa with spindle cells without atypia, multnculeated giant cells, not enothelial lining osteoid and bony matirx with woven bone calcification seen

Answer 20

``` similar to ABC usually first two decades of life site: prox humerus and prox femur present with path # DI no wider than epiphyseal plate, not expansile ```

Answer 21

ABC higher recurrence, tx surgical | UBC may not be surgical

Answer 22

cyst wall fragments with bland spindlecells wit hfragments of bone irregular masses of degernating fibrin occ calcified

Answer 23

M>F; 5th-7th decades pelvic or skull (skull ones a decade younger); some in spine DI - can be ugly lytic destructive and requent soft tissue mass gray-tan, red brown lobulated growth pattern

Answer 24

``` lobules wit hfibrous sept cords and nests of tumours in pale blue myxoid background round nuclei wht central nucleoli physaliphorous cell chondroid chordoma --> skull ones ```

Answer 25

+ panCK + EMA + brachyury

Answer 26

mostly prox humerus>prox tibia DI: cortex and medullary cavity continuous with underlying bone at site of tendon insertions gross: pedunculated with grey cap

Answer 27

cap: chondrocytes in lacunae in clusters pheripherally and in coluns at base of cap - look like epitphyseal plate stalk - cancellous bone with fat and BM

Answer 28

``` parosteal osteosarcoma chondrosarcoma arising in ostochondroma bizarre parosteal osteochondromatous proliferatoin heterotopic ossification subungal exostosis ```

Answer 29

Granuloma annulare Rheumatoid nodule Infection Necrobiosis lipoidica

Answer 30

Benign self-limited dermatosis characterized by raised annular lesions. It is an otherwise asymptomatic disorder of dorsum of hands and legs, occasionally generalized

Answer 31

morphea, chronic hepatitis C infection, autoimmune thyroiditis, secondary hyperparathyroidism, Plummer’s disease, myelodysplastic syndrome, metastatic carcinoma and rarely associated with diabetes

Answer 32

+CD34, androgen receptors in spindle cells (in men and women)

Answer 33

``` Fat cells Spindle cells with short stubby proviles Ropey collagen Myxoid stroma occasionally Curvilinear or plexiform vasculature May have one or two mitoses but if atypical, consider other entities ```

Answer 34

Vascular tumours Spindle cell lipoma DFSP (vs DF-) GIST solitary fibrous tumour (hemangiopericytoma) epithelioid sarcoma (vs. epithelioid mesotheliojma -) some neural tumours lymphocyte-rich thymoma (vs T cell lymphoma -)

Answer 35

3 distinct components in varying amounts 1) Intersecting bands and trabeculae of mature fibrous tissue, comprising spindle myofibroblasts and fibroblasts 2) Nests and whorls of immature round, ovoid, or spindle cells in loose myxoid stroma and often arranged around small veins 3) Interspersed mature fat

Answer 36

Grade 1: total score of 2-3 points Grade 2: total score of 4-5 points Grade 3: total score of 6-8 points Tumor differentiation: 1 point: resembles normal adult mesenchymal tissue, may be confused with a benign lesion, such as well differentiated liposarcoma 2 points: histologic typing is certain, such as myxoid liposarcoma 3 points: synovial sarcoma, osteosarcoma, Ewing’s sarcoma/PNET, sarcomas of doubtful tumor type, embryonal and undifferentiated sarcomas ``` Mitotic count (count 10 successive high power fields [area of 0.17 mm squared] in most mitotically active areas): 1 point: 0-9 mitoses 2 points: 10-19 mitoses 3 points: 20 or more mitoses ``` Tumor necrosis: 0 points: no necrosis on any slides 1 point: less than 50% necrosis for all examined tumor surface 2 points: tumor necrosis of 50% or more of examined tumor surface

Answer 37

Benign fibrous lesion of dermis or sc arising in first 2 y of life; trunk or other sites; recurrence if incomplete excision. Presents as painless enlarging mass.

Answer 38

Look at infiltration into muscle at edges - negative if scar, will dissect in fasciitis

Answer 39

neural tumour cellular scar keloid fibromatosis (beta catenin)

Answer 40

NF1 | radiation

Answer 41

INK4A and p53 downstream mutation

Answer 42

Fibrous growth with multiple extensions into surrounding tissue Centrally located zones of cartilage formation and stippled calcification Associated osteoclast-like giant cells may be present Calcifications range from fine granules to large masses Chondrocyte-like cells can be arranged in linear columns radiating from pockets of calcification True ossification uncommon Mitoses scarce Calcification increases with age Lesions from infants and small children may lack calcification

Answer 43

Young children usually first two years of life but can be as old as 12 y. Hands and feet as painless growing mass. Prone to local recurrence (40%) as the tumour is highly infiltrative and difficult to excise fully (also cosmetic or functional effect)

Bone and Soft TIssue Flashcards

(69 cards)