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Flashcards in Bone tumors Deck (88):
1

What are the four pieces of information critical in diagnosis of a mass in bone?

Age, sex, location, radiographic appearance (NOT histo)

2

What malignant tumors occur in the diaphysis?

Ewing's sarcoma, chondrosarcoma

3

What benign tumors occur in the diaphysis?

Endosarcoma, fibrous dysplasia

4

What malignant tumors occur in the metaphysis?

osteosarcoma, juxtacortical osteosarcroma

5

What benign tumors occur in the metaphysis?

osteoblastoma, osteochondroma, non-ossifying fibroma, osteoid osteoma, chondromyxoid fibroma, giant cell tumors

6

What benign tumors occur in the epiphysis?

Chondroblastoma and giant cell tumors

7

What are the 3 distinctive fibrous dysplasia patterns?

monostotic: single bone
polyostotic: multiple bones
McCune Albright syndrome: polyostotic, cafe au lait skin pigmentation, endocrinopathies

8

What kind of fibrous dysplasia may transform to osteosarcoma?

polyostotic disease

9

_____ is a benign lesion with localized developmental arrest. All components on bone are present but do not mature.

Fibrous dysplasia

10

Where in the bone is fibrous dysplasia usually seen?

Diaphysis

11

How does fibrous dysplasia look on x-ray?

ground-glass lucent appearance with well-demarcated borders. Can appear moth-eaten

12

Describe the histology of fibrous dysplasia.

Loose, whorled "Chinese Characters" pattern of FIBROBLASTIC tissue with irregular spicules of bone. Lack osteoblastic activity--> lots of collagen. Can undergo cystic degeneration.

13

How common are fibrous cortical defects?

Very- 30-50% of all children less than 2 y/o have these.

14

Where in the bone are fibrous cortical defects seen?

metaphysis of femur and proximal tibia

15

How many lesions are present with fibrous cortical defects?

1/2 are bilateral or multiple

16

What is a nonossifying fibroma?

A fibrous cortical defect that is bigger than 5-6 cm

17

How does fibrous cortical defect look in X-ray? What age is it usually presented in?

"Ice cream scoops" eccentric, sharply delineated, metaphyseal lesion with dense sclerotic borders. Usually adolescents.

18

Clinical features of fibrous cortical defect?

Seen in adolescents, few or no symptoms except pain, usually found incidentally on xray, fractures can occur through thinned cortex

19

Gross pathology of fibrous cortical defect

granular and brown or dark red, eccentric, sharply delimited

20

What is the histological appearance of nonossifying fibroma?

Storiform- woven mat

21

Describe solitary bone cysts.

benign, fluid-filled cyst, thing lytic bone lesion,that is not a true neoplasm but a growth abnormality and is usually asymptomatic.

22

Where are solitary bone cysts usually seen?

humerus or femur (2/3)

23

Who do solitary bone cysts usually occur in?

children and adolescents, usually male

24

Symptoms of solitary bone cysts

usually asymptomatic but can contribute to pathological fracture

25

____ are very bloody, cystic lesions that appear like a "sponge filled with blood" that can contribute to fractures.

aneurysmal bone cyst

26

What does an aneurysmal bone cyst look like histologically?

Clotted blood and highly vascularized tissue. Giant cells could be present as well.

27

T or F. Aneursymal bone cyst is a true tumor.

F

28

Where do aneurysmal bone cysts usually arise?

Arise from surface of the bone. Long bones and vertebral column

29

What age group can present with aneurysmal bone cysts?

children and young adults

30

How fast to aneursymal bone cysts grow?

usually slow, but can rapidly expand

31

What may be encountered in surgery with aneurysmal bone cysts?

brisk bleeding.

32

What are the benign primary bone neoplasms?

osteoma, osteoid osteoma, osteochondroma/chondroma, fibroma, giant cell tumor

33

When is the greatest frequency of benign primary bone neoplasms?

first3 decades of life

34

Do benign primary bone neoplasms undergo malignant transformation?

rarely EXCEPT FOR CHONDROMA--> CHONDROSARCOMA

35

Describe osteoma.

Benign primary bone neoplasm. Bone forming tumor. Round tumors that project from sub- or endosteal surfaces of cortex. Slow growing usually of little significance unless they cause obstruction

36

Describe the number of lesions seen in osteoma.

usually solitary. multple seen in Garnder's syndrome which involves GI tract

37

____ is a benign primary bone neoplasm of osteoblasts.

osteoid osteoma

38

Size of osteoid osteoma lesion

less than 2 cm

39

Age group presenting with osteoid osteoma

teens and twenties

40

Location of osteoid osteoma

50% involve tibia and fibula, usually cortical.

41

Describe symptoms associated with osteoid osteoma.

Painful- produce PGE2 and have characteristic pattern of pain. They are more commonly painful at night and they are relieved by aspirin. Intake of alcohol causes a massive increase in pain.

42

Sex predominance of osteoid osteoma

M 2:1

43

Describe osteochondroma

benign, cartilage capped tumor that is attached to underlying skeleton by a stalk. Involves displacement of growth plate in endochondral bone.

44

What genetic condition exists with osteochondroma

Mutliple hereditary exostosis. AD that rarely gives rise to chondrosarcoma

45

What do osteochondromas look like on x-ray

cauliflower at epiphyseal plate

46

___ are benign tumors of hyaline cartilate

Chondroma

47

What kind of chondroma arises in medullary cavity of tubular bones like hand and feet?

enchondroma

48

What kind of chondroma arises on the surface of bones?

Juxtacortical

49

How many lesions are usually seen with enchondromas?

usually solitary

50

What part of the bone is enchondroma usually associated with?

metaphysis of tubular bones of hands and feet

51

What are they syndromes of multiple enchondromas?

1. Ollier disease: non hereditary syndrome of multiple formation enchondromas
2. Maffucci syndrome: multiple enchondromas form as well as soft tissue hemangiomas

52

What do enchondromas cause?

pathologic fracture of phalanx

53

What do enchondromas look like radiologically?

radiolucent nodules of hyaline cartilage scalloped endosteal surface

54

What age group do you see giant cell tumors in?

20s to 40s

55

Where do giant cell tumors occur

most commonly around the knee, can also be wrist

56

Describe giant cell tumors

multinucleated osteoclast type giant cells. Benign but uncommon. Locally aggressive and can undergo cystic degeneration

57

Does histology help in diagnosis of giant cell tumors? What should you watch out for?

yes- look for multinucleated giant cells. But you dont want to miss TB.

58

Are you more likely to get malignant primary bone tumor or secondary?

secondary

59

Half of primary malignant bone tumors are derived from what?

blood forming cells and connective tissue cells like, the commenest condition being MM

60

Sites from which metastases occur to the bone are:

breast, prostate, lung, kidney, thyroid cancers

61

____ is the most common primary bone tumor

osteogenic sarcoma

62

Where is osteosarcoma commonly seen?

knee joing

63

Where is chondrosarcoma seen?

trunk and limb girdles

64

Where is ewings sarcoma usually seen?

diaphysis of bone

65

75% of osteogenic sarcomas occur in what age group?

people under 20

66

There is a peak of osteogenic sarcomas in the elderly that have what?

Paget's disease or irradiation

67

What cancer associations can be made with osteogenic sarcoma?

Retinoblastoma, Rb, M2M2, 20% have lung metastases at presentation

68

Symptoms of osteogenic sarcoma

Painful lesions that are progressively enlarging and cause fracture. Often these come to attention because of some other sporting injury.

69

What is different about the location of osteogenic sarcomas in the elderly?

seen in bones of pelvis and skull

70

radiological appearance of osteosarcoma (osteogenic sarcoma)

Lifted periosteum forms triangular shell of reactive bone; CODMAN TRIANGLE. Prominant bone formation that extends into soft tissue.

71

Age group for chondrosarcoma

35-60

72

____ is the 2nd most common primary malignant bone tumor.

Chondrosarcoma

73

Chondrosarcoma may arise with preexisting ____.

enchondroma

74

XRAY appearance of chondrosarcoma

can traverse joint spaces, appears lytic but isnt, scalloped endosteal surfaces

75

Age group of Ewing's sarcoma

white 10-15

76

85% of Ewing's sarcoma have what genetic signature?

PNETs: t(11:22)--> relate them to neuroectodermal tumors

77

Survival rate of Ewing's sarcoma?

75% 5yr survival with surgery and chemo

78

Where do Ewing's sarcomas occur?

diaphysis of long bone- arise in medulla

79

What do ewings sarcomas look like on x-ray?

onion skin

80

______ is a small round blue cell tumor

Ewings sarcoma

81

What do Ewings sarcoma look like histologically?

Small round blue cells, glycogen rich, Homer-wright rossettes: tumor cells are arranged in a circle about a central fibrillary space- possible neural differentiation

82

_____ are the most common tumors in bone

metastatic bone tumors

83

in adults, over 75% of metastatic bone tumors arise from _____.

prostate, breast, lung, and kidney

84

What metastatic bone tumors are common in children?

neuroblastoma, wilms tumor, osteosarcoma, ewing sarcoma, and rhabdomyosarcoma

85

Describe metastatic bone tumors

usually multifocal, vertebrae, pelvis, ribs, skull, sternum, lytic, blastic, or mixed lytic and blastic

86

_____ secrete substances that promote bone resorption

metastatic bone tumros

87

What do metatstatic bone tumors from renal cancer look like

white neoplasms with red centers that bleed easily and can have hemosiderin

88

Breast carcinoma metastases are mostly ____.

sclerotic