Flashcards in Bone tumors Deck (88)
What are the four pieces of information critical in diagnosis of a mass in bone?
Age, sex, location, radiographic appearance (NOT histo)
What malignant tumors occur in the diaphysis?
Ewing's sarcoma, chondrosarcoma
What benign tumors occur in the diaphysis?
Endosarcoma, fibrous dysplasia
What malignant tumors occur in the metaphysis?
osteosarcoma, juxtacortical osteosarcroma
What benign tumors occur in the metaphysis?
osteoblastoma, osteochondroma, non-ossifying fibroma, osteoid osteoma, chondromyxoid fibroma, giant cell tumors
What benign tumors occur in the epiphysis?
Chondroblastoma and giant cell tumors
What are the 3 distinctive fibrous dysplasia patterns?
monostotic: single bone
polyostotic: multiple bones
McCune Albright syndrome: polyostotic, cafe au lait skin pigmentation, endocrinopathies
What kind of fibrous dysplasia may transform to osteosarcoma?
_____ is a benign lesion with localized developmental arrest. All components on bone are present but do not mature.
Where in the bone is fibrous dysplasia usually seen?
How does fibrous dysplasia look on x-ray?
ground-glass lucent appearance with well-demarcated borders. Can appear moth-eaten
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.
How common are fibrous cortical defects?
Very- 30-50% of all children less than 2 y/o have these.
Where in the bone are fibrous cortical defects seen?
metaphysis of femur and proximal tibia
How many lesions are present with fibrous cortical defects?
1/2 are bilateral or multiple
What is a nonossifying fibroma?
A fibrous cortical defect that is bigger than 5-6 cm
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.
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
Gross pathology of fibrous cortical defect
granular and brown or dark red, eccentric, sharply delimited
What is the histological appearance of nonossifying fibroma?
Storiform- woven mat
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.
Where are solitary bone cysts usually seen?
humerus or femur (2/3)
Who do solitary bone cysts usually occur in?
children and adolescents, usually male
Symptoms of solitary bone cysts
usually asymptomatic but can contribute to pathological fracture
____ are very bloody, cystic lesions that appear like a "sponge filled with blood" that can contribute to fractures.
aneurysmal bone cyst
What does an aneurysmal bone cyst look like histologically?
Clotted blood and highly vascularized tissue. Giant cells could be present as well.
T or F. Aneursymal bone cyst is a true tumor.
Where do aneurysmal bone cysts usually arise?
Arise from surface of the bone. Long bones and vertebral column
What age group can present with aneurysmal bone cysts?
children and young adults
How fast to aneursymal bone cysts grow?
usually slow, but can rapidly expand
What may be encountered in surgery with aneurysmal bone cysts?
What are the benign primary bone neoplasms?
osteoma, osteoid osteoma, osteochondroma/chondroma, fibroma, giant cell tumor
When is the greatest frequency of benign primary bone neoplasms?
first3 decades of life
Do benign primary bone neoplasms undergo malignant transformation?
rarely EXCEPT FOR CHONDROMA--> CHONDROSARCOMA
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
Describe the number of lesions seen in osteoma.
usually solitary. multple seen in Garnder's syndrome which involves GI tract
____ is a benign primary bone neoplasm of osteoblasts.
Size of osteoid osteoma lesion
less than 2 cm
Age group presenting with osteoid osteoma
teens and twenties
Location of osteoid osteoma
50% involve tibia and fibula, usually cortical.
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.
Sex predominance of osteoid osteoma
benign, cartilage capped tumor that is attached to underlying skeleton by a stalk. Involves displacement of growth plate in endochondral bone.
What genetic condition exists with osteochondroma
Mutliple hereditary exostosis. AD that rarely gives rise to chondrosarcoma
What do osteochondromas look like on x-ray
cauliflower at epiphyseal plate
___ are benign tumors of hyaline cartilate
What kind of chondroma arises in medullary cavity of tubular bones like hand and feet?
What kind of chondroma arises on the surface of bones?
How many lesions are usually seen with enchondromas?
What part of the bone is enchondroma usually associated with?
metaphysis of tubular bones of hands and feet
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
What do enchondromas cause?
pathologic fracture of phalanx
What do enchondromas look like radiologically?
radiolucent nodules of hyaline cartilage scalloped endosteal surface
What age group do you see giant cell tumors in?
20s to 40s
Where do giant cell tumors occur
most commonly around the knee, can also be wrist
Describe giant cell tumors
multinucleated osteoclast type giant cells. Benign but uncommon. Locally aggressive and can undergo cystic degeneration
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.
Are you more likely to get malignant primary bone tumor or secondary?
Half of primary malignant bone tumors are derived from what?
blood forming cells and connective tissue cells like, the commenest condition being MM
Sites from which metastases occur to the bone are:
breast, prostate, lung, kidney, thyroid cancers
____ is the most common primary bone tumor
Where is osteosarcoma commonly seen?
Where is chondrosarcoma seen?
trunk and limb girdles
Where is ewings sarcoma usually seen?
diaphysis of bone
75% of osteogenic sarcomas occur in what age group?
people under 20
There is a peak of osteogenic sarcomas in the elderly that have what?
Paget's disease or irradiation
What cancer associations can be made with osteogenic sarcoma?
Retinoblastoma, Rb, M2M2, 20% have lung metastases at presentation
Symptoms of osteogenic sarcoma
Painful lesions that are progressively enlarging and cause fracture. Often these come to attention because of some other sporting injury.
What is different about the location of osteogenic sarcomas in the elderly?
seen in bones of pelvis and skull
radiological appearance of osteosarcoma (osteogenic sarcoma)
Lifted periosteum forms triangular shell of reactive bone; CODMAN TRIANGLE. Prominant bone formation that extends into soft tissue.
Age group for chondrosarcoma
____ is the 2nd most common primary malignant bone tumor.
Chondrosarcoma may arise with preexisting ____.
XRAY appearance of chondrosarcoma
can traverse joint spaces, appears lytic but isnt, scalloped endosteal surfaces
Age group of Ewing's sarcoma
85% of Ewing's sarcoma have what genetic signature?
PNETs: t(11:22)--> relate them to neuroectodermal tumors
Survival rate of Ewing's sarcoma?
75% 5yr survival with surgery and chemo
Where do Ewing's sarcomas occur?
diaphysis of long bone- arise in medulla
What do ewings sarcomas look like on x-ray?
______ is a small round blue cell tumor
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
_____ are the most common tumors in bone
metastatic bone tumors
in adults, over 75% of metastatic bone tumors arise from _____.
prostate, breast, lung, and kidney
What metastatic bone tumors are common in children?
neuroblastoma, wilms tumor, osteosarcoma, ewing sarcoma, and rhabdomyosarcoma
Describe metastatic bone tumors
usually multifocal, vertebrae, pelvis, ribs, skull, sternum, lytic, blastic, or mixed lytic and blastic
_____ secrete substances that promote bone resorption
metastatic bone tumros
What do metatstatic bone tumors from renal cancer look like
white neoplasms with red centers that bleed easily and can have hemosiderin