Bone, Cartilage and Soft tissue tumors: Clinical Correlations Flashcards Preview

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Flashcards in Bone, Cartilage and Soft tissue tumors: Clinical Correlations Deck (28)
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1

Examples of common bone lesions. 

Metstatic carcinoma

Multiple myeloma

Lymphoma of bone

Osteosarcoma

Ewing sarcoma

Unicameral bone cyst (UBC)

Aneurysmal bone cyst (ABC) 

Enchondroma

Osteochondroma

Chondrosarcoma 

2

Examples of soft tissue lesions. 

Lipoma

Desmoid

Soft tissue sarcoma

Lymphoma

3

What are some tests/imaging that are helpful for staging a bone lesion?

  • X-ray of entire affected bone
  • Whole body bone scan (or skeletal survey -- multiple myeloma) 
  • CT scan of chest, abdomen and pelvis OR PET/CT
  • Serum protein electrophoresis/Urine Protein Electrophoresis/Serum free light chains--multiple myeloma or plasmacytoma [don't forget about labs!!]
  • Prostatic specific antigen (for prostate adenocarcinoma)

4

What is multiple myeloma? 

A common lymphoid malignancy -- sheets of plasma cells with atypical cell features

5

When does multiple myeloma present in individuals? 

Median age is 70 yo

6

What part of the bone does multiple myeloma affect?

Principally invovles bone marrow and causes lytic lesions throughout the skeleton (most commonly vertebrae, ribs, skull, pelvis, femur, clavicle, and scapula) 

Results in "pathological fractures" 

7

Why does multiple myeloma do what it does? 

Cells produce a monoclonal immunoglobulin, most often IgG.

8

What marker identifies B cells? 

CD20

9

Neoplasms composed of lymphocytes resembling a normal stage of differentiation

Lymphomas

10

Most common type of lymphoma in adults, derived from clonal B cells 

B-cell lymphomas

11

What happens if a soft tissue biopsy results shows glands? 

Probably a metastatic (ie lung) cancer -- primary soft tissue cancers do not show this

12

Most common type of lung cancer in woman and nonsmokers

Metastases early (to bone, brain, and liver) 

Lung adenocarcinomas

13

What is the biological marker that is positive in adenocarcinomas arising in the lungs? 

TTF1

14

What is a potential cause of unicameral bone cysts?

Increased intraosseous pressure

15

Are unicameral bone cysts benign or malignant? 

Benign 

16

What ages do unicameral bone cysts affect? And where do they present in bone? 

Children and young adults

Metaphyseal region of long bones 

Usually proximal femur or humerus 

Present as pathological fracture

17

How do unicameral bone cysts occur? What do they look like pathologically? 

Bone cortex is eroded by the cyst and elicits secondary periosteal new bone formation

Pathology: cyst filled wtih clear fluid and lined with thin fibrous membrane; because of frequent fractures old blood (hemosiderin) and granulation tissue may be present 

18

How do they treat UBC? 

Aspirate inject into them, suck out and put in steriods or Ca/PO4 matrix 

19

What are aneurysmal bone cysts (ABC)?

Eccentric solitary expansile lesion

Benign neoplasm with characteristic translocation 

20

How do ABC's present? Where do they commonly occur? 

Swelling, pain and tenderness

Occur in metaphyseal region of long bones -- but any bone may be involved 

21

What do ABC's look like pathologically? 

Cystic spaces filled with blood but no endothelial cell lining

Between the blood filled speaces are fibrous septa, giant cells and immature bone or osteoid 

22

How are aneurysmal bone cysts treated? 

Embolization/sclerotherapy 

23

When should you NOT try to remove "lipomas" in clinic? 

Bigger than 3 cm or deep mass -- get an MRI 

24

Lipoma

A lipoma is a slow-growing, fatty lump that's most often situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure. It's doughy to touch and usually not tender. You may have more than one lipoma. Lipomas can occur at any age, but they're most often detected during middle age.

 

(Thanks Mayo Clinic)

25

Desmoid Fibromatosis 

Cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body.

Desmoid tumors often appear as infiltrative, usually well-differentiated, firm overgrowths of fibrous tissue, and they are locally aggressive.

 

(Thanks MedScape)

26

Soft Tissue Sarcoma

Cancerous (malignant) tumors that originate in the soft tissues of your body. The soft tissues include muscle, fat, blood vessels, nerves, tendons and the lining of your joints (synovial tissues).

 

(Thanks Mayo Clinic)

27

How are chondrosarcoma's graded? 

Grades 1 - 3

28

What are some take home points about biopsy?

  • Location determined by person doing definitive surgery
  • Avoid contaminating compartments
  • Assume a sarcoma if isolated disease
  • Communicate with pathologist