Bone Tumors

Question 1

Primary or secondary bone tumor is more common?

Answer 1

Primary bone tumors are less common than bone metastases

secondary bone tumors

Question 2

most common primary bone cancer, ?

Answer 2

Osteosarcoma

Question 3

Osteosarcoma is the most common primary bone cancer, • Then ? And?

Answer 3

chondrosarcoma and Ewing sarcoma.

Question 4

Benign or malignant tumor more common?

Answer 4

Benign tumors the commonest, with greatest frequency within the
first three decades of.

• Bone tumors in elderly persons are much more likely to be
  malignant.

Question 5

Etiology of bone tumor ?

Answer 5

Idiopathic •Genetic syndromes •Bone infarcts, •Chronic osteomyelitis, •Paget disease, • Irradiation. •Fibrous dysplasia • Use of metal orthopedic devices.

Question 6

Clinical presentation of bone tumors ?

Answer 6

•Benign lesions : asymptomatic detected as incidental findings. •Others produce pain or a slowly growing mass
. •Pathologic fracture

Question 7

Investigations of bone tumor ?

Answer 7

•Radiologic imaging •Biopsy

Question 8

Bone forming primary bone tumors

Benign ? Malignant ?

Answer 8

• Osteoma
  Osteoid osteoma
• Osteosarcoma

Question 9

Cartilage Forming
Primary Bone Tumors
B / m

Answer 9

Enchondroma/Chondrosarcoma

Question 10

Fibroblastic Tumors
Primary Bone Tumors

Benign Malignant

Answer 10

Fibroma Fibrosarcoma

Question 11

Undetermined Origin
V Primary Bone Tumors
Locally Malignant

Answer 11

Giant Cell Tumor (Osteoclastoma)

Question 12

Secondary Secondary

Answer 12

Metastatic Tumors (The Commonest)

Question 13

Osteoma

Type of lesion ? Most common site? Age?

Answer 13

• Benign lesions • Head and neck, including the paranasal

sinuses, • Can occur elsewhere • Middle age

Question 14

• Mixture of woven and lamellar bone.

Answer 14

Osteoma

Question 15

Cause local mechanical problems (e.g.,

obstruction of a sinus cavity)

Answer 15

Osteoma

Question 16

Do not undergo malignant transformation

?

Answer 16

Osteoma

Question 17

Osteoid Osteoma and Osteoblastoma

Type of lesion ? Age? Gender ?

Answer 17

•Benign neoplasms •The teenage years and 20s, with a male predilection

Question 18

Osteoid Osteoma and Osteoblastoma

Distinguished from each other, primarily by ?

Answer 18

their size, site and clinical presentation.

Question 19

Arise beneath the periosteum in the proximal femur and tibia or posterior spinal elements ?

Answer 19

Osteoid osteomas

Question 20

Less than 2 cm in diameter ?

Answer 20

Osteoid osteomas

Question 21

Localized pain, most severe at night, relieved by aspirin.

?

Answer 21

Osteoid osteomas

Question 22

Larger than 2 cm ?

Answer 22

Osteoblastomas

Question 23

Involves the spine more frequently ?

Answer 23

Osteoblastomas

Question 24

Cause pain not responsive to aspirin.

?

Answer 24

Osteoblastomas

Question 25

Osteoblastomas | Treatment?

Answer 25

Local excision is the treatment of choice.

Question 26

Malignant transformation is rare | ?

Answer 26

Osteoblastomas

Question 27

Shows radiolucent well-defined area, surrounded by a halo of dense reactive bone -X-ray ?

Answer 27

Osteoid osteomas:

Question 28

Gross: lesions are round-to-oval masses of hemorrhagic gritty tan tissue Type of tumor ?

Answer 28

Osteoid osteomas:

Question 29

Microscopically: Nidus, well circumscribed and composed of randomly interconnecting trabeculae of woven bone that are prominently rimmed by benign looking osteoblasts Type of tumor ?

Answer 29

Osteoid osteoma

Question 30

The stroma surrounding the neoplastic bone consists of loose connective tissue that contains many dilated and congested capillaries. Reactive sclerotic bone surrounding the nidus Type of tumor?

Answer 30

Osteoid osteoma

Question 31

composed of haphazardly interconnecting trabeculae of woven bone that are rimmed by prominent osteoblasts. The intertrabecular spaces are filled by vascularized loose connective tissue.

Answer 31

Osteoid osteoma

Question 32

a bone-producing malignant mesenchymal | tumor. ?

Answer 32

Osteosarcoma

Question 33

Most common primary malignant tumor of bone.

Answer 33

Osteosarcoma

Question 34

Osteosarcoma | Age? Gender/ site ?

Answer 34

75% of patients are younger than 20 years of age. • With a second peak occurring in elderly persons, • Men are more affected than women • Most tumors arise in the metaphyseal region of the long bones of the extremities, • 60% occurring about the knee, 15% around the hip, 10% at the shoulder, and 8% in the jaw.

Question 35

essential for diagnosis of ? The production of mineralized or unmineralized bone (osteoid)

Answer 35

osteosarcoma

Question 36

PATHOGENESIS of Osteosarcoma?

Answer 36

1. RB gene mutations occur in 60% to 70% of sporadic tumors. Hereditary retinoblastomas have a thousand-fold greater risk for development of osteosarcoma 2. p53, a gene whose product regulates DNA repair

Question 37

Radiographic imaging: a large, destructive, mixed lytic and blastic mass Tumor ?

Answer 37

Osteosarcoma

Question 38

The tumor frequently breaks through the cortex and lifts the periosteum, resulting in reactive periosteal bone formation. ?

Answer 38

osteosarcoma

Question 39

X A triangular shadow on the x-ray between the cortex and raised periosteum (Codman triangle) •Spread hematogenously; 10% to 20% pulmonary metastases, Tumor ?

Answer 39

osteosarcoma

Question 40

Spread hematogenously; 10% to 20% pulmonary metastases, | Tumor?

Answer 40

osteosarcoma

Question 41

Secondary osteosarcomas occur in?

Answer 41

older adults most commonly in the setting of Paget disease or previous radiation exposure

Question 42

Vriable. Solid- cystic, soft-bony gritty, gray-white tumors, often exhibiting hemorrhage and cystic degeneration Tumor?

Answer 42

osteosarcoma

Question 43

Malignant polygonal cells (osteoblasts), showing criteria of malignancy (vary in size and shape (pleomorphic), hyperchromatic nuclei; bizarre tumor giant cells and mitoses •Osteoid, eosinophilic, lace-like •The formation of bone by the tumor cells is characteristic

Answer 43

osteosarcoma

Question 44

Histologic appearance, with coarse, lacelike pattern of neoplastic bone (arrow) produced by anaplastic tumor cells. Note the wildly aberrant mitotic figures (arrowheads).

Answer 44

osteosarcoma

Question 45

Osteochondroma | Type ? Gender ?

Answer 45

Benign / More in males

Question 46

Composed of bony projections with cartilagenous cap that arises from the surface of the bone. ?

Answer 46

Osteochondroma

Question 47

• Slow-growing masses . • Incidental findings. • Bone protrusion and pain (pressure on nerves). Tumor ?

Answer 47

Osteochondroma

Question 48

rarely progress to to benign although they may recur if if

Answer 48

Solitary osteochondromas

Question 49

Malignant transformation occurs more frequently in?

Answer 49

in multiple hereditary | osteochondromas.

Question 50

• X-ray: cartilage capped bony growth. The medullary cavity and cortex are continuous with that of bone, growth is away from joint

Answer 50

Osteochondroma

Question 51

Grossly: cartilage cap overlying bone ?

Answer 51

Osteochondroma

Question 52

Microscopically: cartilage cap, composed of hyaline cartilage with active endochondral ossification (similar to that of epiphyseal plate). Bony stalk is formed of cortical lamellar bone.

Answer 52

Osteochondroma

Question 53

Chondrosarcoma | Age? Site /

Answer 53

Old age, 4th-5th decade • At medullary cavity of pelvic bone, shoulder, and ribs;

Question 54

Painful, progressively enlarging masses • Destroys the cortex and forms a soft tissue mass. ?

Answer 54

Chondrosarcoma

Question 55

X ray: Ill-defined, thickened shaft, stippled appearance or ossification of cartilage, cortex infiltrated by tumor.

Answer 55

Chondrosarcoma

Question 56

Gross: Cartilagenous growth, hemorrhage and necrosis

Answer 56

Chondrosarcoma

Question 57

Microscopic: Cartilage cells with variable degree of atypia, calcification, myxoid cartilaginous matrix.

Answer 57

Chondrosarcoma

Question 58

Contain osteoclast-type giant cells | (Osteoclastoma) ?

Answer 58

Giant Cell Tumor

Question 59

Giant Cell Tumor Type of lesion? Age?

Answer 59

It is benign but locally aggressive • 20-40 years of age

Question 60

Giant Cell Tumor | Site?

Answer 60

``` Epiphysis and metaphysis of long bone around knee (distal femur and proximal tibia) • Pain esp. joint pain and pathologic fracture ```

Question 61

Gross • large, Red-brown tumor with cystic degeneration

Answer 61

Giant Cell Tumor

Question 62

Microscopic • Composed of uniform oval mononuclear cells that constitute the proliferating component of the tumor. • Scattered within this background are numerous osteoclast-type giant cells having 100 or more nuclei.

Answer 62

Giant Cell Tumor

Question 63

Necrosis, hemorrhage, hemosiderin deposition, and reactive bone formation are common secondary features.

Answer 63

Giant Cell Tumor

Question 64

Primary malignant small round cell tumors of bone and soft tissue ?

Answer 64

Ewing Sarcoma

Question 65

After osteosarcoma, it is the second most common pediatric bone sarcoma. ?

Answer 65

Ewing Sarcoma

Question 66

Ewing Sarcoma | Age ? Site ?

Answer 66

80% are younger than 20 years. • Painful enlarging mass in the diaphysis of long tubular bones (especially the femur) and the pelvic flat bones. • chemotherapy and surgical excision

Question 67

The commonest bone tumor ?

Answer 67

Metastatic Disease

Question 68

Mostly affecting the axial skeleton (red marrow, rich | vascularity) ?

Answer 68

Metastatic Disease

Question 69

Radiographic: purely lytic lesion (kidney and lung tumors), | osteoblastic (prostatic adenocarcinoma), or mixed

Answer 69

Metastatic Disease