Bone Tumors Flashcards
(96 cards)
1
Q
characteristics of benign bone tumors
A
- most are asymptomatic
- do not weaken the bone typically
2
Q
characteristics of malignant bone tumors
A
- dull ache
- progresses over time
- worse with activity
- constitutional sx
3
Q
goal of the diagnostic evaluation for bone tumors
A
- establish the tissue diagnosis
- determine the extent of disease
- consider surgical excision with aim to avoid amputation
4
Q
initial imaging study of choice for bone tumor
A
Xray
5
Q
xray findings for benign bone tumors
A
- well defined
- small
- confined to natural barriers
- lack of destruction of the cortex
- lack of extension into the soft tissue
6
Q
xray findings of malignant bone tumors
A
- poorly defined borders
- moth eaten appearance
- spiculated
- extension into soft tissue
7
Q
what is an osteoid osteoma
A
overgrowth of bone tissue arising from osteoblasts
8
Q
MC location for osteoid osteoma
A
femur
9
Q
pathophys of osteoid osteoma
A
nidus surrounded by sclerotic bone is formed as the tissue proliferates and secretes prostaglandins
10
Q
what is a Nidus
A
centrally located, disorganized mixture of small blood vessels, trabecula, and osteoid
11
Q
what are s/s of osteoid osteoma
A
- localized constant aching pain
- worse at night
- improves with NSAIDs or ASA
- atypical juxta-articular presentation
12
Q
what do you see on xray of osteoid osteoma
A
sclerosis around a lucent nidus (<1.5cm)
13
Q
what is seen on bone scan of osteoid osteoma
A
double density
14
Q
what is the management of osteoid osteoma
A
- NSAIDs with f/u serial imaging
- if sx become uncontrolled, refer to ortho
15
Q
what is an osteoblastoma
A
slow growing tumor with nidus >2cm
16
Q
mc location for osteoblastoma
A
posterior column of the spine
17
Q
presentation of osteoblastoma
A
- dull and achy pain not relieved with NSAIDs
- sx depended to tumor location
18
Q
what would you see on xray of osteoblastoma
A
well circumscribed radiolucent lesion with a nidus >2cm
19
Q
how do you diagnose osteoblastoma
A
biopsy
20
Q
what is the management of osteoblastoma
A
surgical resection
21
Q
what are the methods of removal of osteoblastoma
A
- curettage and burring followed by bone graft
- marginal resection
22
Q
what is an osteochondroma
A
benign, cartilage-capped bony projection
23
Q
MC location for osteochondroma
A
knee and proximal humerus
24
Q
t/f osteochondroma occurs adjacent to the growth plate
A
true
25
presentation of osteochondroma
* most asx
* painless mass near a joint
* may have irritation of surrounding tendons, muscles, nerves
26
imaging of osteochondroma
bone spur
27
management of osteochondroma
* asx: none
* sx: surgical excision
28
malignant transformation of osteochondroma is suspected if...
* new onset growth of lesion
* new onset pain
* rapid growth of lesion
29
what is an enchondroma
benign hyaline cartilage forming tumor that develops in the bone marrow of the long bones
30
mass growth of enchondroma occurs from (...) to (...)
metaphysis into diaphysis
31
mc location for enchondroma
hands and feet
32
enchondromatosis
non-hereditary, acquired, genetic mutation resulting in multiple enchondromas often with a unilateral predominance
33
s/s of enchondroma
* most are asx
* widening of bone
* angular deformity
* limb length discrepancy
34
enchondroma increases the risk of (...)
pathologic fractures
35
management of enchondroma
* monitor with exam and imaging
* curettage and bone grafting for sx lesions
36
risk factors for pathologic enchondroma fracture
* weight bearing bone
* >25mm in diameter
* involving >50% of the diameter of the cortex
37
t/f enchondromas are usually self limiting
true
38
enchondromas of the (...) may be complicated by malignant transformation to chondrosarcomas
long bones and pelvis
39
what is a chondroblastoma
benign cartilage forming tumor that usually arises in the epiphyses or apophyses of long bones
40
MC site for chondroblastoma
epiphysis of the proximal humerus
41
s/s of chondroblastoma
* chronic pain that is middle and gradually progressive
* constant and unrelated to activity
* joint stiffness and swelling
42
what would you see on xray of chondroblastoma
small, well defined lesion with a sclerotic border that may cross the physis
43
(...) is indicated before surgery of chondroblastoma if lesion is atypical on imaging
biopsy
44
management of chondroblastoma
curettage and bone grafting
45
complications of chondroblastoma
benign pulmonary metastases
46
what is fibrous dysplasia
* abnormal fibrous tissue and trabecular bone replaces normal bone marrow and bone tissue
* slow growing
47
what genetic condition is associated with fibrous dysplasia
mccune albright syndrome
48
s/s of fibrous dysplasia
* pain/tenderness
* shepherds crook (varus femur)
* scoliosis
* facial asymmetry
49
what is seen on xray of fibrous dysplasia
lytic lesion with ground glass appearance
50
what is the management of fibrous dysplasia
* asx: serial exams and imaging
* sx: curettage and bone graft and IV bisphosphonates
51
what is an ossifying fibroma
destructive, deforming, slow growing, benign fibro osseous lesion
52
MC location for ossifying fibroma
* tibia and fibula in kids
* mandible in adults
53
what are the s/s of ossifying fibroma
* localized, firm swelling in the area
* bowed tibia
* painless
54
what would you see on xray of ossifying fibroma
well circumscribed intracortical lesion
55
what is the management of ossifying fibroma
* asx: repeat imaging and monitor
* sx: resection, curettage, and bone graft after skeletal maturity
56
MC benign bone lesion in kids
nonossifying fibroma
57
what is a nonossifying fibroma
benign, non-aggressive tumor that consists mainly of fibrous tissue
58
s/s nonossifying fibroma
-most are asx
-bone weakness and fracture
59
what would you see on xray of nonossifying fibroma
* small, well defined, eccentric, lytic lesions
* usually in distal diaphysis/ metaphysis
60
management of nonossifying fibroma
* asx: none
* curettage and grafting
61
indications for surgical intervention of nonossifying fibroma
* lesions of >50% of the bone
* lesions in high stress area
62
unicameral bone cysts
non-cancerous fluid filled lesions with fibrous lining
63
what are the s/s of unicameral bone cysts
* asx until pathologic fracture
* growth plate dysfunction and limb length discrepancy
64
what is seen on xray of unicameral bone cysts
* well defined, cystic lesions at the metaphysis
* generally involves entire diameter of bone
-fallen leaf sign
65
what is the management of unicameral bone cysts
* spontaneous resolution after skeletal maturity
* asx: observe and activity restrictions to avoid fractures
* larger cysts: curettage and bone graft
66
if concerned about risk of fracture due to unicameral bone cysts...
aspirate cyst and inject methylprednisolone or bone marrow
67
what is an aneurysmal bone cyst
benign, rapidly growing and destructive blood-filled lesion
68
MC site of aneurysmal bone cyst
tibia
69
s/s of aneurysmal bone cyst
-localized pain, tenderness, and swelling
70
xray of aneurysmal bone cyst
* eggshell
* soap bubble
71
management of aneurysmal bone cyst
* excision, curettage, and bone graft
* surgical arterial embolization to prevent hemorrhage
72
MC malignant bone tumor
Osteosarcoma
73
MC location of Osteosarcoma
metaphysis of long bone
74
risk factors for Osteosarcoma
* prior radiation or chemo
* paget disease, fibrous dysplasia
* genetic predisposition
75
s/s of Osteosarcoma
* pain and swelling
* worsened with activity
* palpable mass
* limping
76
xray of Osteosarcoma
* osteolytic and osteoblastic lesions
* moth eaten appearance
* starburst appearance
* codman's triangle
77
codman's triangle
new bone formation at periosteum
78
what do you utilize after xray to look for multifocal or metastatic disease?
bone scan
79
(...) is utilized for each lesion after identified on bone scan
CT/MRI
80
management of Osteosarcoma
* refer to oncology ortho for biopsy
* pre- and post-op chemo with limb sparing surgery
81
t/f Osteosarcoma responds to radiation
false
82
chondrosarcoma
tumor arising from the chondrocytes
83
s/s of chondrosarcoma
* deep, dull aching pain that is gradually progressive
* worse at night
84
xray of chondrosarcoma
* bony contour seems thinned and expanded
* endosteal scalloping
* >5cm
85
confirm dx of chondrosarcoma
biopsy
86
MC metastasis location of chondrosarcoma
lungs
87
management of chondrosarcoma
refer for surgical excision
88
ewing sarcoma
rare, peripheral primitive neuroectodermal tumor that can proliferate in the bone and or soft tissue
89
ewing sarcoma results from...
translocation of chromosomes 11 and 22
90
mc sites of ewing sarcoma
femur and pelvis
91
s/s of ewing sarcoma
* pain and swelling
* palpable mass
* worse with activity or at night
* constitutional sx
92
what would you see on xray of ewing sarcoma
* poorly marginated lesion
* onion skin
93
management of ewing sarcoma
multidrug chemo with surgery +- radiation
94
s/s of metastatic bone disease
* pain over metastatic location
* pathologic fracture
* anemia
95
diagnosis of metastatic bone disease
* xray first, then other imaging
* biopsy to confirm and determine primary site
96
treatment of metastatic bone disease
* MC radiation + pain meds
* chemo
* bisphosphonates
