Bone Cysts and Tumors

Question 1

What are bone tumors

Answer 1

can be benign or malignant
most primary tumors are benign
most lesions in children are benign
most benign tumors can be diagnosed based on plain radiographs

Question 2

what is key to diagnosis of bone tumors

Answer 2

age of the patient, history and physical examination, radiographic appearance

Question 3

what is found on an x-ray of a benign bone tumor

Answer 3

well defined
sclerotic border
no cortical destruction
no soft tissue extension

Question 4

what is found on an x-ray of a malignant bone tumor

Answer 4

poorly defined
cortical destruction
moth-eaten
extend into soft tissue
spiculated periosteal reaction

Question 5

what are typical clinical presentations of bone tumors

Answer 5

usually incidental finding
evaluation of symptoms - painless bony mass or pain
pathologic fracture
or part of a metastatic work-up in a patient with known cancer

Question 6

what is a malignant lesion

Answer 6

metastatic disease from another primary source

Question 7

what are the primary bone cancers

Answer 7

Osteosarcoma
multiple myeloma (hematologic)
Ewings sarcoma
chondrosarcoma

Question 8

what is the most common bone tumor in older adults

Answer 8

metastatic cancer - usually hematogenously spread

Question 9

what are the primary cancer sources that contribute to bone cancer

Answer 9

lung
breast
prostate
kidney
thyroid

Question 10

what is the clinical presentation of bone cancer

Answer 10

can be asymptomatic, pain is the most common complaint that develops over weeks, usually localized
pathologic fracture
spinal cord compression (back pain)

Question 11

what are the common diagnostic studies for bone tumors

Answer 11

plain x-rays
bone scan
PET scan
MRI
CT

Question 12

when are x-rays indicated for patients

Answer 12

first step with patients with focal complaint
these tests are not very sensitive and lesion can by lytic or blastic depending on tumor type

Question 13

what is a lytic lesion

Answer 13

destroy bone material (black hone in the bone)

Question 14

what is a blastic lesion

Answer 14

fill the bone with extra cells (abnormal white areas)

Question 15

What is used for a bone scan

Answer 15

bone scintigraphy - technetium 99

Question 16

what type of test is a bone scan

Answer 16

nuclear study - overview of the entire skeleton and is more sensitive than plain films

Question 17

what are the benefits of an MRI for bone tumor

Answer 17

No ionized radiation
more sensitive than bone scan - but not practical for whole body
Excellent for soft tissues - often used to evaluate bony tumors
especially useful for spinal cord compression

Question 18

what are the benefits of CT

Answer 18

often used to guide biopsies
good for evaluating bony detail
dose of radiation

Question 19

what is a PET scan

Answer 19

positron emission tomography - injection of radioactive tracer (FDG)

Question 20

what is being looked at on a PET scan

Answer 20

an increased uptake in areas of increased metabolic activity (cancer) and whole skeleton can be looked at.

Question 21

what should not be looked at on a PET scan

Answer 21

brain, heart, kidneys and infection because they will always light up

Question 22

what is the most common primary malignant tumor in pediatrics

Answer 22

osteosarcoma

Question 23

what is the most common non-hematogenous bone malignancy

Answer 23

osteosarcoma

Question 24

what are the commmon age distrubutions for ostoesarcoma

Answer 24

teens and late 70s

Question 25

when is the peak incidence of osteosarcoma

Answer 25

during adolescent growth spurt

Question 26

what are risk factors of osteosarcoma

Answer 26

Paget's disease of bone (elderly) Previous radiation therapy/chemotherapy inherited conditions like Li-fraumeni syndrome ?molecular theory of insult during period of rapid growth

Question 27

what does Li-Fraumeni syndrome do

Answer 27

turns off the TP53 tumor suppressor gene

Question 28

what are the pediatric risk factors for osteosarcoma

Answer 28

children have no risk factors other than adolescence.

Question 29

what is the presentation of osteosarcoma

Answer 29

pain over several months soft tissue mass (often large and tender) usually do not have systemic symptoms 10-20% have metastatic disease at presentation

Question 30

what is the primary location of osteosarcoma in pediatrics

Answer 30

metaphysis of the long bones (distal femur, proximal tib, and proximal humerus) in kids 50% are in long bones around the knee

Question 31

how does osteosarcoma present on an x-ray

Answer 31

distructive (lytic lesion) moth eaten spiculated periosteal reaction "hair on end" "sunburst appearance" codmans triangle

Question 32

what is codmans triangle

Answer 32

cuff of new bone formation at the edge of the soft tissue mass

Question 33

how is osteosarcoma worked up

Answer 33

imaging is diagnostic - labs are supportive

Question 34

what are the supportive lab results of osteosarcoma

Answer 34

alkaline phosphatease is increased in advanced disease LDH increase in advance disease

Question 35

what is an MRI used for for osteosarcoma

Answer 35

show the entire bone affected

Question 36

what else needs to be looked at in patients with osteosarcoma

Answer 36

CT of chest for pulmonary mets bone/PET scan for bony mets

Question 37

how is osteosarcoma diagnosed

Answer 37

biopsy

Question 38

how is osteosarcoma treated

Answer 38

surgery and chemotherapy

Question 39

what are the survival rates of osteosarcoma

Answer 39

70% overall used to be 80-90% died of metastatic disease

Question 40

when are benign bone tumors usually found

Answer 40

incidentally and tend to be asymptomatic age is commonly teens and early 20s

Question 41

what are the common types of benign bone tumors

Answer 41

osteoid-forming tumors (osteoid osteoma, osteoblastoma) cartilage-forming tumors (ostochondroma, enchondroma) bone cysts (simple and aneurysmal) fibrous lesions (fibrous dysplasia)

Question 42

what is an osteoid osteoma

Answer 42

bone-forming benign tumor, no malignant potential typically found ages 10-20 in Males>females

Question 43

where are osteoid osteomas usually found

Answer 43

long bones of the extremities (femur is the most common)

Question 44

what is the common presentation of osteoid osteoma

Answer 44

pain at night quickly relived with NSAIDs

Question 45

how is an osteoid osteoma diagnosed

Answer 45

plain x-rays and rarely needs biopsy

Question 46

what is the treatment of osteoid osteoma

Answer 46

resolve spontaneously; surgical excision and radio-ablation is curative

Question 47

what is the most common benign bone tumor

Answer 47

osteochondroma

Question 48

when do ostoechondromas usually occur

Answer 48

between ages 10-20 around knee or proximal humerus

Question 49

what is an osteochrondroma

Answer 49

cartilage-capped bone spur usually near the growth plate growing away rare possibility of malignant transformation - multiple lesions increases risk of malignancy

Question 50

what is the presentation of osteochondromas

Answer 50

painless mass or pain with compression of nearby structures decreased range of motion fractures

Question 51

how are osteochondromas treated

Answer 51

usually observation

Question 52

what is an endochondroma

Answer 52

non-cancerous bone tumor beginning in the cartilage may happen as one or multiple tumor

Question 53

where do endochondromas usually present

Answer 53

hand tumor

Question 54

what is the population of patients with endochondromas

Answer 54

M=F between ages 10-20 with variable symptoms that may resemble other medical problems

Question 55

what is the treatment of endochondromas

Answer 55

individualized for each patient but the options are surgery, bone grafting or watchful waiting

Question 56

when is fibrous dysplasia of the bone seen

Answer 56

it is rare, M=F diagnosed earlier in children

Question 57

what is fibrous dysplasia

Answer 57

normal bone marrow is replaced with fibrous tissue (abnormal scar-like connective tissue) causes bone formation that is weak and prone to expansion can be part of larger disorders

Question 58

what other disorders can be associated with fibrous dysplasia

Answer 58

McCune-albright syndrome, Mazabroud syndrome, Jaffe-Lichtenstein syndrome

Question 59

what causes fibrous dysplasia

Answer 59

underlying cause is unknown but possibl related to mutation of GNAS1 gene

Question 60

what are the typical symptoms of fibrous dysplasia

Answer 60

depend on specific bones involved but may be asymptomatic

Question 61

what is the treatment of fibrous dysplasia

Answer 61

symptomatic management

Question 62

how is fibrous dysplasia diagnosed

Answer 62

history and physical CT and MRI, bone scan to determine the extend of the disease and bone biopsy

Question 63

what is a bone cyst

Answer 63

fluid-filled cavity that forms in the bone and can occur at any age but is more common in kids and adolescents

Question 64

where are bone cysts typically found

Answer 64

can develop in any bone but usually affect eh long bones 9most often humerus and femur)

Question 65

what is the treatment of bone cysts

Answer 65

treatment is based on size, location and risk of fracture watchful-waiting and surgery are the primary treatment options

Question 66

what is common with unicameral bone cyst presentation on x-ray

Answer 66

fallen fragment sign

Question 67

when are bone cysts biospied

Answer 67

when the diagnosis is uncertain and to confirm diagnosis before treating

Question 68

how are benign bone tumors managed

Answer 68

most patients should be seen by ortho many asymptomatic lesions can be followed with serial exams and x-rays