CHAPTER 20 Bone Pathology Flashcards
(169 cards)
0
Q
Malignant bone forming tumors
A
Primary osteosarcoma
Secondary osteosarcoma
1
Q
Benign bone forming tumors
A
Osteoma
Osteoid osteoma
Osteoblastoma
2
Q
Benign cartilaginous tumors
A
Osteochondroma
Enchondroma
3
Q
Malignant cartilagenous tumors
A
Chondrosarcoma
4
Q
Miscellaneous tumors
A
Osteoclastoma “Giant Cell Tumor” (Benign)
Ewing Sarcoma (Malignant)
5
Q
Benign bone neoplasms:
A
Fibrous cortical defect "non-ossifying fibroma" Fibrous dyslpasia Osteoid osteoma Osteochondroma Enchondroma Giant cell tumor "Osteoclastoma"
6
Q
Malignant bone neoplasms:
A
Osteosarcoma
Chondrosarcoma
Ewing sarcoma “small cell tumor”
7
Q
Bone tumors b/w age 10-20:
A
Benign:
Osteoid osteoma
Osteoblastoma
Malignant:
Primary osteosarcoma
Ewing sarcoma
8
Q
Bone tumors b/w age 10-30:
A
Osteochondroma
9
Q
Bone tumors b/w age 20-40:
A
Giant cell tumor
10
Q
Bone tumor b/w age 30-50:
A
Enchondroma
11
Q
Bone tumors >40:
A
Secondary osteosarcoma
12
Q
Bone tumors b/w age 40-60:
A
Chondrosarcoma
13
Q
Developmental anomaly of bone
A
Dysostoses
14
Q
MC defective ossification of fetal cartilage is
A
Dysostosis
16
Q
An alteration of this gene causes alterations ring embryonic development
A
Homeobox gene
17
Q
Developmental anomaly of bone resulting in problems with mesenchymal migration
A
Dysostosis
18
Q
Syndrome associated with dysostoses
A
Klippel-Feil Syndrome
19
Q
Mutations that interfere with the development, growth, homeostasis of bone or cartilage
A
Dysplasia
20
Q
Defective development, failure to function normally,
Absent or incomplete development,
Abnormal fusions,
Supernumerary digits
A
Aplasia
21
Q
MC inherited connective tissue disorder (1 in 20,000 births)
A
Osteogenesis Imperfecta
22
Q
AKA “Brittle bone disease”
A
Osteogenesis Imperfecta
23
Q
Which type of Osteogenesis imperfecta allows for a normal life span and is it autosomal dominant or recessive
A
Type 1- Autosomal dominant
24
Q
Dysostosis caused by mutation in a-1 or a-2 chain of type 1 collagen failing to produce mature bone or premature breakdown
A
Osteogenesis imperfecta
25
MC cause of dwarfism (1per 10,000 in US)
Achondroplasia
26
Which type of osteogenesis imperfecta leads to death in utero and is it autosomal dominant or recessive
Type 2 - Autosomal recessive
27
Decreased collagen synthesis in Achondroplasia that inhibits chondrocytes is caused by a point mutation of ____________?
FGFR3 (Fibroblast growth factor receptor)
28
Form of dysostosis that has decreased collagen synthesis which leads to decreased growth plate expansion
Achondroplasia
29
Of the 20% incidence of achondroplasia that is inherited is it autosomal dominant or recessive?
Dominant - Associated with higher paternal age
30
Is Achondroplasia is most often spontaneous or hereditary?
80% Spontaneous
31
In Achondroplasia DEATH can result from
Brain stem compression
(All have some foramen magnum stenosis)
Can also result from cardiovascular abnormalities
32
Achondroplasia involves the shortening of proximal or distal extremeites
Proximal
33
Spinal abnormalities of due to Achondroplasia
Bullet vertebrae
Hyper lordosis/kyphosis at birth
Scoliosis
Central canal stenosis
34
make card on
thanotropic dwarfism
35
Decreased osteoclast-mediated bone resorption,
| Dysfunctional bone demineralization that causes "stone like" bone is characteristic of what dysostosis
Osteopetrosis
36
Dysostosis that is the accumulation of a group of rare genetic disorders
Osteopetrosis
37
Is Osteopetrosis acquired of congenital
Congenital
38
Cranial nerve palsies from foramina stenosis is associated with which dysostosis
Osteopetrosis
39
What happens to the medullary cavity in Osteopetrosis
Medullary cavity fills with bone causing deranged hematopoesis
40
Deranged hematopoesis from Osteopetrosis filling the medullary cavity can lead to
Hepatosplenomegaly
Recurrent infections
Anemia
41
TX for Osteopetrosis
Stem cell replacement
42
Most important form of osteopenia that has decreased bone mass with simultaneous increased porosity (fragility)
Osteoporosis
43
2 categories of Osteoperosis
1. Localized
| 2. General
44
Is osteoporosis acquired or congenital?
Acquired
45
Localized Osteoporosis
Disuse
46
General Osteoporosis (Entire skeleton) primary and secondary causes
Primary (MC): Senile, Postmenopausal
Secondary: Various causes
* Metabolic bone disease
* Nutrient deficiency
* Drug exposure
47
Types of dysostoses
Aplasia
| Dysplasia
50
MC impacted area of Osteoperosis
Trabecular bone: Vertebral body, femoral neck, calcaneus
51
Age related bone loss is considered
Primary (Generalized) Osteoperosis
52
Senile Osteoporosis can begin as early as what age
Mid-20's
53
In senile osteoporosis are both osteoblast and osteoclast activity reduced?
No, only a decrease in GF and osteoblast activity as part of a normal biological phenomenon
osteoclast retain normal activity
54
Average bone loss per year with osteoporosis is
0.5% per year
55
Visual hyperkyphotic hump associated with Osteoporosis
"Dowager's" hump
56
Postmenopausal (Generalized) Osteoporosis bone loss is caused by
decreased estrogen accelerating bone loss
57
% of Postmenopausal women that suffer from an osteoporotic fracture
50% (compare to 3% of men of equal age)
59
How to combat osteoporosis
Ca++ & Vit D supplementation with regular resistance exercise
60
Bone law associated with increased bone loss due to inactivity
Wolff's Law
61
Risk associated with osteoporotic fractures
```
Pneumonia (Thoracolumbar compression fx)
Pulmonary embolism (Femoral neck)
```
62
Possible treatment for post menopausal osteoporosis
estrogen therapy
63
Are x-rays a good diagnostic tool for osteoporosis
No, requires 30-40% bones loss before visible with x-ray
64
Also known as "Osteitis Deformans"
Paget disease
65
% of U.S. population with Paget Disease
3%
66
Regional osteoclast activity with excessive bone formation is what disease
Paget disease
67
Excessive bone formation in Paget disease leads to
Disorganized lamellar bone
Misshapen/Enlarged bone
Lack of bone strength
68
Bone appearance of Paget disease
"shaggy"
69
Paget disease usually takes place at what stage of life
Mid-Late adulthood
70
Paget disease etiology
Unknown
71
Hypothetical theory of Paget disease
Paramyxoviridae antigens on osteoclast may stimulate activity
72
Is Paget disease MC symptomatic or assympomatic
Asymptomatic (70-90%)
| Noticed through routine x-ray
73
Paget disease lesions are most often solitary or multiple?
Multiple (85%)
74
Paget disease most often affects
Axial skeleton or Femur
| pelvis, sacrum,skull
75
Fractures in Paget disease are referred to as
"chalkstick fx"
76
Sample analysis confirming Paget disease "osteitis deformans" display
Increased serum alkaline phosphatase
| Increased urinary hydroxyproline
77
Risk factors for Paget disease
Males 2x more likely than women
>50yrs
Caucasians: Europeans, Australians, New Zealanders, U.S.
78
Tx for Paget disease "osteitis deformans"
bisphosphonates
79
bone cell arrangement pattern associated with Paget disease
"Mosaic pattern"
80
Ivory vertebrae sign is most commonly associated with
1. Paget disease
2. Metastatic cancer
3. Lymphoma
81
Vit D deficiency leads to
Rickets (Children)
| Osteomalacia (Adults)
82
How are people Vit D defiecient
Dietary deficiency or abnormal metabolic uptake
83
What happens to bone with Vit D deficiency
Increased immature bone that does not mineralize causing bone softening/fractures
84
Abnormal growth plate mineralization in childhood is what condition
Rickets
85
Remodeled bone that is under mineralized in adults is what condition
Osteomalacia
86
Osteomalacia can also be associated with
Hyperparathyroidism
87
Excessive PTH secretion is called
Hyperparathyroidism
88
MC cause of excessive PTH
Adenoma (80%)
89
Explanation of hyperparathyroidism
Too much PTH secretion increases bone breakdown (osteoclast)
and renal tubule absorption of Ca++ along with Vit D synthesis by kidneys leads to too much calcium in the blood (Hypercalcemia)
because PTH is meant to maintain serum Ca++ but it is overactive in Hyperparathyroidism
90
MC non-malignant cause of hypercalcemia
Hyperparathyroidism
91
Clinical findings with Hyperparathyroidism
MC is Renal stones,
peptic ulcers,
salt and pepper skull (x-ray)
92
The excessive osteoclast activity with Hyperparathyroidism impacts skeletal homeostasis causing resorption of cortical and trabecular bone, what is it replaced with and what tumor may be produced because of it?
Replaced with loose connective tissue
| May produce a "Brown tumor"
93
Primary and secondary Hyperparathyroidism are:
Primary- autonomous PTH production
Secondary- Renal disease
94
Can the reduction of PTH reverse the condition of Hyperparathyroidism?
Yes
95
Pathologic Fx is
a Fx at site of previous disease
96
Stress Fx is
Fx that develops slowly over time
97
Fracture repair is as follows
(Week 1) Ruptured vessels > fibrin mesh > inflammation > fibroblast > soft tissue callus
(Weeks 2-3) Woven bone deposition > chondroblast
(Weeks 6-8) Endochondral ossification > boney callus
(Week 8 and on) continued remodeling
98
Avascular Necrosis is AKA?
Osteonecrosis
99
Ischemia leading to bone infarction is
Osteonecrosis
100
Mc cause of Osteonecrosis
Vascular disruption following Fx
Also possible causes: Corticosteroids, thromboemboli, vasculitis, irradiation, diabetes, alcohol, sickle cell
101
Osteonecrosis may lead to what other pathology
Osteoarthritis
102
MC sites of Osteonecrosis
Hip or Shoulder (Ball and socket joints)
Also: Knee, elbow, wrist, ankle
103
Creeping substitution is defined as?
New bone building upon old in Osteonecrosis
104
Bone marrow inflammation (marrow infection) is known as
Osteomyelitis
105
MC causes of Osteomyelitis
Pyogenic Osteomyelitis = Pyogenic bacteria (Staphylococcus aureus)
Tuberculosis Osteomyelits = Mycobacterium tuberculosis
106
Most cases of acute Osteomyelitis in ADULTS are caused by
Bacteria (MC Staphylococcus aureus)
107
Neonate Osteomyelitis is associated with which bacteria
E. coli & Group B Streptococci
108
Individuals with sickle cell disease develop Osteomyelitis from which organism
Salmonella spp.
109
What % of cases of Osteomyelitis have an unidentified causal agent?
50%
110
The 3 mechanisms of infection for Osteomyelitis
1. Hematogenous spread (Blood) is MC
2. Adjacent joint of soft tissue infection
3. Trauma: compound Fx or surgery
111
Features of pyogenic osteomyelitis
Fever, malaise, throbbing pain
112
Pyogenic osteomyelitis is diagnosed via
biopsy
113
Involucrum is
Reactive woven/lamellar bone deposited around infected bone
114
Sequestrum is
Dead bone at site of infection
115
Draining sinus
Rupture of the periosteum that leads to an abscess in surrounding soft tissue
116
Skeletal Tuberculosis is AKA
Tuberculosis Osteomyelitis
117
What % of patients with lung tuberculosis develop Tuberculosis Osteomyelitis
1 - 3%
118
Granulomas, caseous necrosis, & bone destruction are associated with what bone pathology
Tuberculosis Osteomyelitis
119
When TB spreads to the spine is called
Pott's disease
120
Pott's disease can cause what
Neurologic deficits from spinal canal stenosis following extensive vertebral destruction
121
MC primary bone cancers (sarcomas)
1. MC Osteosarcoma
2. Chondrosarcoma
3. Ewing Sarcoma
122
MC benign bone tumor
Osteochondroma & Fibrous cortical defects
123
Do benign tumors outnumber malignant tumors?
Yes, but increase in malignant in elderly
124
Do most bone tumors occur early or late in life?
early
125
Bone forming tumors (4)
1. Osteoma
2. Osteoid Osteoma
3. Osteoblastoma
4. Osteosarcoma
126
A slow growing , benign, non-invasive superficial bone forming exophytic tumor MC found on the head/neck around 40-50 yrs old
Osteoma
127
Benign bone forming tumors found 2x more likely in males thats well circumscribed (central "nidus" radiolucency with rim of sclerosis) near the cortex are
Osteoid Osteomas & Osteoblastoma
128
A benign bone forming tumor b/w age 10-20 yrs that is <2 cm in diameter occurring in the PROXIMAL FEMUR or TIBIA that MC causes NOCTURNAL PAIN and RELIEVED BY ASPIRIN
Osteoid Osteoma
129
A benign bone forming tumor b/w the age 10-20 yrs that is larger 2-6 cm in diameter arising from the VERTEBRAL COLUMN (spinous & transverse process) with MILD POORLY-LOCALIZED PAIN that is NOT responsive to aspirin and may be excised
Osteoblastoma
130
Aggressively MALIGNANT bone forming tumor arising from mesenchymal tissue that has hematogenous metastasis
Osteosarcoma
131
TYPICAL MALIGNANT bone forming tumor MC in ADOLESCENTS <20 yrs often in METAPHYSIS of LONG BONES
Primary Osteosarcoma
132
ATYPICAL MALIGNANT bone forming tumor in >40 yrs of age occurring in METAPHYSIS of LONG BONES often secondary to bone disease such as Paget
Secondary Osteosarcoma
133
MC location os Osteosarcoma
MC is Knee (60%)
Hip (15%)
Shoulder (10%)
134
Periosteal reaction of cortex from Osteosarcomas
"Sunburst"
135
Aggressive, painful, rapidly enlarging bone tumor with a large destructive lytic/blastic lesion involving periosteum and medullary cavity with a characteristic codman triangle
Osteosarcoma
136
What portion of Osteosarcomas metastasize to lungs by the time of DX and how is it spread
10-20% by hematogenous metastasize
137
Prognosis of Primary Osteosarcomas
Favorable with 60-70% long term survival rate
| Amputation to salvage limb or chemo
138
Prognosis for Secondary Osteosarcoma
Grave, poor response to therapy
139
Comprised of hyaline and myxoid benign (MC) or malignant tumors
Cartilage forming tumors
140
3 types of cartilage forming tumors
1. Osteochondroma
2. Chondroma
3. Chondrosarcoma
141
Exostosis is AKA
Osteochondroma
142
MC BENIGN slow growing cartilage forming tumor that seizes once bone growth is finished at mature age (10-30 ys) that is MC in the KNEE and can often have multiples or be solitary (sporadic)
Osteochondroma
143
Enchondroma is AKA
Chondroma
144
A BENIGN (HYALINE) cartilage forming tumor occurring between 20-50 yrs old MC in the tubular bones of HANDS with a WELL CIRCUMSCRIBED LUCENCY & RING OF SCLEROSIS (O-Ring)
Chondroma AKA "Enchondroma"
145
Multiple lesions associated with a Chondroma is known as
Ollier Disease (Enchondromatosis)
146
Chondromas most often affect which portion of hand
Proximal Phalanges
147
A PAINFUL PROGRESSIVELY ENLARGING MALIGNANT cartilage forming tumor occurring b/w age 40-60 at may THICKEN or ERODE CORTEX of (PELVIS, SHOULDERS, & RIBS) but RARE in extremities is
Chondrosarcoma
148
% of Chondrosarcomas that metastasize
70% MC to lungs then bone
149
Miscellaneous Fibro & Fibro-osseous tumors
1. Fibrous Cortical Defect
a) Non-ossifying Fibroma
2. Fibrous Dysplasia
150
Left over tumors
1. Ewing Sarcoma
2. Primitive Neuroectodermal Tumor (PNET)
3. Giant Cell Tumor
151
Benign lesions thought to arise from periosteal injurybut not a true neoplasm and < .5cm diameter
Fibrous Cortical Defect
152
A larger 5-6cm Fibrous Cortical Defect
Non-Ossifying Fibroma
153
Eccentrically located within Metaphysis MC the distal femur that usually asymptomatic and will transition to cortical bone by adolescence
FCD & NOF
154
Is a biopsy recommended with FCD & NOF's
No, unless there is a pathological Fx
155
Benign fibro-osseus tumor that causes failure of bone differentiation
Fibrous Dyspalsia
156
3 clinical patterns of Fibrous Dysplasia
1. Monostotic - single bone involvement
2. Polyostotic - multiple bone involvement
3. Polyostotic + cafe-au-lait spots + endocrinopathy
AKA "McCune-Albright syndrome"
157
MC clinical pattern of Fibrous Dysplasia
Monostotic (70%) and asymptomatic
158
25% of FD cases that have sever deformation
| MC in Femur, Calvaria, Tibia, Humerus
Polyostotic
159
3% of FD cases
Polyostotic with Endocrinopathy = McCune-Albright syndrome
160
McCune-Albright syndrome is MC in male or female
Female
161
Ground glass x-ray appearance is associated with
Fibrous Dysplasia (FD)
162
Small round cell tumors of bone that have the same chromosomal translocation that mimics an infection and has an "onion-skinning" appearance occurring in ages <20 ys (80%)
Ewings Sarcoma & Primitive Neuroectodermal Tumor (PNET)
163
Undifferentiated small round cell tumor that the 2nd MC pediatric bone sarcoma (1st is Osteosarcoma)
Ewings Sarcoma
164
Differentiated (neural) small round cell tumor that has characteristic Homer-Wright Rosettes
PNET
165
Caucasians are 9x more likely to develop these tumors
Ewings Sarcoma & Primitive Neuroectodermal Tumor (PNET)
166
Ewings Sarcoma & Primitive Neuroectodermal Tumor (PNET) are MC in the
Femur then pelvis
167
Giant Cell Tumor of bone is AKA
Osteoclastoma
168
Bone tumor occurring b/w 20-40 ys with osteoclast type giant cells in the epiphysis long bones near the knee with a soap bubble appearance on x-ray
Giant Cell Tumor
169
What % of Giant Cell Tumors metastasize to lungs
2%
170
What is more common? Primary bone cancer or Secondary from metastasis
Secondary
171
Secondary metastasis MC from (Adults)
75% from prostate
| then breast, kidney, lungs
172
MC site of secondary metastasis
Axial skeleton, proximal femur, or humerus
