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Flashcards in Bone Tumors Deck (60)
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1

Are bone tumors common? 

Not in comparison to carcinomas and hematopoietic tumors

Malignant bone tumors comprise (0.2%) of all types of cancer 

2

How do bone tumors commonly present? 

Usually non-specific: 

 

Pain

Mass

Pathologic fracture

Asymptomatic 

3

What are some diagnostic factors to think about with bone tumors? 

Age

Sex

Skeletal localization: specific bone, specific area of bone 

Radiographic appearance

4

What age do Osteosarcoma, Ewing's sarcoma generally affect? 

Childhood, adolescence

5

What ages do giant cell tumors generally affect? 

Young adults

6

What ages do Chondrosarcomas generally affect? 

Elderly 

7

What is a slcerotic margin an indication of? 

Benign, slowly-growing neoplasm 

8

What is an ill-defined margin indicative of? 

Malignant, rapidly-growing neoplasm 

9

What does it mean to see solid, ivory-like patterns on radiographs of bone?

Generally seen in malignant bone matrix-forming tumors

10

What does it mean to see rings and arcs on radiographs of bone? 

Generally seen in chondroid matrix-forming tumors

11

What is the most common primary bone tumor? 

Osteochondroma 

12

Benign bone-forming tumors

Osteoid Osteoma & Osteoblastoma

Histologically very similar 

13

Located in long bones, femur & tibia

<2cm 

Night pain

Responds to aspirin 

Radiolucent lesion within sclerotic cortex

Osteoid Osteoma 

14

Located in vertebrae or long bone metaphysis 

>2cm 

Painful

Not responsive to aspirin 

Expansile radio-lucency with mottling 

Osteoblastoma 

15

Malignant mesenchymal tumor in which cells produce osteoid or bone

35% of bone sarcomas 

Osteosarcoma 

16

What population does osteosarcoma generally affect? 

M>F

Mean age: 15  (60% 10-20) 

2nd peak: 55-80

17

Where does osteosarcoma usually reside? 

Metaphysis of long bones (femur, tibia, humerous; flat bones, spine - older pts) 

May be polyostotic -- multiple bone sites (not common) 

Hematogenous spread to lungs is common 

18

Where does osteosarcoma commonly spread hematogenously? 

To the lungs

19

What are some characteristics that may predispose someone to osteosarcoma? 

  • Inherited mutant allele of RB gene: marked increased (1000X) in OS
  • Mutation of p53 suppressor gene: Li-Fraumeni
  • Overexpression of MDM2 (5-10%); INK4 and p16
  • Sites of bone growth/disease (Paget's)
  • Prior irradiation 

20

What are some radiographic findings that are commonly indicative of osteosarcoma? 

  • Poorly delineated
  • Bone destruction
  • Cortical disruption
  • Bone matrix
  • Soft tissue extention
  • Codman's triange: radiographic sign, rapidly growing mass with periosteum trying to grow around it 

21

What is found pathologically with osteosarcomas? 

Infiltrative tumor, extending into soft tissue

Malignant cells producing osteoid 

22

What is the treatment for osteosarcoma? 

Neo-adjuvant chemotherapy and surgical resection (amputation) 

23

What was the prognosis for Osteosarcoma prior to 1970? What is it now, after the advent of chemotherapy? 

Prior to 1970: 5 year survival 20%; most relapsed in lung within 6 months after primary amputation; mets to lung pleura, other bones, CNS

 

Post chemotherapy: 60-65% 3-5 year survival for patients with non-metastatic disease; En-bloc resection following chemotherapy: >90% necrosis -- near 90% survival 

24

Most common benign tumor of bone

Osteochondroma 

25

Where are osteochondromas commonly located in bones? 

Metaphysis of long bones 

26

Is transformation of osteochondroma to malignancy common? 

No -- it's rare (<1%) but increased risk in hereditary multiple exostoses --> Autosomal dominant, commonly secondary to mutations in EXT-1 (8q24) 

27

Benign hyaline cartilage lesion (2 kinds) 

Enchondroma = intramedullary chondroma 

Periosteal chondroma = juxtacortical chondroma (located on the cortical surface under the periosteum) 

28

How do enchondromas usually present? 

Usually asymptomatic, incidental finding. 

Appendicular skeleton; small bones of hands and feet. 

29

How do enchondromas appear on x-ray? In microanalysis? 

X-ray: lytic, lobulated, cortical thinning

Micro: lobules of hyaline cartilage, minimal atypia 

30

How are enchondromas treated? 

Nothing! Unless lesion shows changes:

1. become symptomatic 

2. evidence of recent growth after skeletal maturity