Bone tumors

Question 1

What are the different patterns of bone destruction (3)

Answer 1

-Geographic: well-defined, short zone of transition= benign/low grade malignancy

-Moth-eaten: more aggressive, intermediate zone of transition =benign or malignant

-Permeative: poorly-defined, wide zone of transition =malignant

Question 2

What are the different patterns of periosteal reactions (5)

Answer 2

-Single layer: benign but sometimes malignant

-Onion skin: malignant, multiple layers of periosteum

-Sunburst: spiculated rays

-Hair on end: parallel rays

Codman triangle: triangular elevation of periosteum

Question 3

Name benign bone tumors of the foot (11)

Answer 3

FOG MACHINES

F- fibrous dysplasia
O-osteochondroma
G- Giant cell tumor
M-Myeloma
A- aneurysmal bone cyst
C- chondroblastoma, chondromyxoid fibroma, clear cell
H- Hemangioma
I-infection
N- non-ossifying fibroma
E-eosinophilic granuloma, echondroma, epidermal inclusion cyst
S- solitary bone cyst

Question 4

Name malignant bone tumors of the foot (6)

Answer 4

COPE MF
-Chondrosarcoma
-Osteosarcoma
-Periosteal sarcoma
-Ewings Sarcoma
-Multiple Myeloma
-Fibrosarcoma

Question 5

What is the most common, benign, primary bone tumor

Answer 5

Osteochondroma

Question 6

What is the most common, malignant bone tumor

Answer 6

multiple myeloma

Question 7

What primary bone tumors are more frequent in females (3)

Answer 7

Giant cell tumor
ABC
Periosteal osteosarcoma

Question 8

What are the most common cancers that metastasize to foot (4)

Answer 8

-breast
-prostate
-lung
-kidney

Question 9

What bone tumors do not form matrix

Answer 9

Bone cysts
Ewings sarcoma
Giant cell tumor

Question 10

Where are bone tumors typically located (7)

Answer 10

-Epiphysis
-metaphysis
-diaphysis
-centrally located
-eccentrically located within medullary canal
-cortical
-periosteal

Question 11

Which tumors are located in the epiphysis (2)

Answer 11

-Chondroblastoma
-Giant Cell tumor

Question 12

Which tumors are located in the metaphysis(9)

Answer 12

-Enchondroma
-Osteochondroma
-Nonossifying fibroma
-unicameral bone cyst
-Aneurysmal bone cyst
- Giant cell tumor
-Medullary osteosarcoma
-Periosteal osteosarcoma
-chondrosarcoma

Question 13

Which tumors are located in the diaphysis (5)

Answer 13

-Osteoid osteoma
-Osteoblastoma
-Enchondroma
-Ewings sarcoma
-Periosteal osteosarcoma

Question 14

Centrally located (2)

Answer 14

Enchondroma
Unicameral bone cyst

Question 15

Eccentrically located within medullary canal (3)

Answer 15

-Giant cell tumor
-Chondrosarcoma
-Osteosarcoma

Question 16

Cortical (2)

Answer 16

Osteoid osteoma

Nonossifying fibroma

Question 17

Periosteal

Answer 17

Osteochondroma

Periosteal osteosarcoma

Question 18

What are the characteristics of an osteoid osteoma (3)

Answer 18

-benign, osteolytic lesion with central nidus (<1cm) that may have calcifications

-1st- 2nd decade of life

-dull pain, worse at night, relieved with ASA

Question 19

What are characteristics of an osteoblastoma (5)

Answer 19

-Giant osteoid osteoma
-benign tumor that may become malignant
-osteolytic lesion with well-circumscribed nidus (>1.5 cm) that may have multiple calcifications
-2nd to 3rd decades of life
-Less symptomatic than osteoid osteoma, pain not relieved by ASA.

Question 20

What are some characteristics of an echondroma (4)

Answer 20

• benign, well defined, intramedullary, cartilaginous lesion
  -geographic lesions with punctuate calcified matrix
  -3rd/4th decades of life
  -painless swelling unless pathologic fractures

Question 21

What is Ollier disease(3)

Answer 21

Multiple enchondromatosis

may become malignant

1st decade of life

Question 22

What is Maffuccis disease (3)

Answer 22

-multiple enchondromas with soft tissue hemangiomas
-most malignant
-1st decade of life

Question 23

What are characteristics of a chondroblastoma (3)

Answer 23

-benign, geographic, osteolytic, lesions with sclerotic margins
-2nd/3rd decade of life
-pain and joint effusion

Question 24

What are characteristics of an osteochondroma (4)

Answer 24

-most common benign primary bone tumor
-cartilage-capped, hyperplastic bone pointing away from the joint
- 2md/4th decades of life
-suspect malignant transformation with growth after skeletal maturity, pain or cap >2cm

Question 25

What are characteristics of nonossifying fibromas (5)

Answer 25

-benign connective tissue lesion with fibrous replacement of bone
-Expansive, radiolucent medullary lesions
- 1st/2nd decades of life
-Lesions typically resolve with age
-do not biopsy

Question 26

What are the characteristics of a fibrous dysplasia (3)

Answer 26

-benign, geographic, medullary lesion with ground glass matrix
-presents with deformity
-sometimes painful secondary to fracture

Question 27

What are characteristics of a unicameral bone cyst (5)

Answer 27

-benign, geographic, medullary lesion that is fluid filled
-commonly found in calcaneus
-fallen fragment sign: pathologic fracture in which cortex lies within lesion
-1st/2nd decades of life
-asymptomatic until fracture

Question 28

What are the characteristics of an aneurysmal bone cyst (6)

Answer 28

-benign, expansile, lytic lesion with blood-filled cavities
-may extend into soft tissue
-fluid levels sen on MRI
-1st/3rd decades of life
-common in females
-painful, especially with pathologic fractures

Question 29

What are characteristics of giant cell tumor (5)

Answer 29

-benign but locally aggressive, lytic lesions with ground glass, “soap bubble” appearance.
-May destroy cortex and have soft tissue mass
-more common in females
-3rd/4th decades of life
-painful

Question 30

What are the characteristics of a multiple myeloma (5)

Answer 30

-most common primary malignant bone tumor
- punched out lesions or diffusely osteopenic with hair on end radiating spicules
- affect 45-80 year olds
-painful with weakness or neurologic symptoms
-Bence Jones protein found within the urine

Question 31

What are the characteristics of an osteosarcoma (7)

Answer 31

• Most common primary malignant bone tumor
  -sunburst periosteal reaction with Codman triangle and cloud-like
  -2nd/3rd decades of life
  -dull aching pain
• In medullary (bad prognosis)
  -In parosteal (better prognosis)
  -periosteal (slight better prognosis than medullary)

Question 32

What is the most common bone tumor associated with Paget disease

Answer 32

Osteosarcoma

Question 33

What are some characteristics of a Ewings sarcoma (6)

Answer 33

-common, malignant, primary bone tumor
-aggressive, permeative, lytic lesion with hair on end, Codman triangle, and onion skin
- may have large soft tissue mass
-usually under 20 year
-Painful with fever, weight loss and elevated ESR
-Poor prognosis

Question 34

What are characteristics of a chondrosarcoma (4)

Answer 34

-common, malignant, moth-eaten, lesion with medullary and soft tissue calcifications
- may arise from malignant transformation of enchondromas or osteochondromas
-5th/6th decades of life
-painful

Question 35

What study is the most useful in searching for metastatic bone disease

Answer 35

Total skeletal bone scan

malignant lesions will show increased uptake