Ginger Holt Video Flashcards
(125 cards)
1
Q
Sarcomas are tumors of?
A
connective tissue
2
Q
sarcomas typically mets vis
A
hematogenous spread and not nodal spread, mets to chest and lungs
3
Q
age less than 5 benign
A
Osteomyelitis
Osteofibrous Dysplasia
4
Q
age < 5 malignant
A
LCH (Letter-Siwe)
LCH (hand schuller)
Metastatic Neuroblastoma
5
Q
age < 30 malignant
A
ewings
osteosarcoma
6
Q
age < 30 benign
A
Osteoid Osteoma Osteoblastoma Chrondroblastoma ABC LCH Osteofibrous Displasia Non-Ossifying Fibroma
7
Q
> 30 malignant
A
Chondrosarcoma Mets Lymphoma Myeloma Chordoma Adamantinoma
8
Q
Age > 30 benign
A
GCT
Paget’s DZ
9
Q
DX? Diurnal pain, relief with NSAIDS (aspirin non selective)
A
Osteoid Osteoma
*soft tissue sarcomas are deceptively painless
10
Q
11,22
A
Ewings
11
Q
X-18
A
Synovial Sarcoma
12
Q
SSX1-SYT
A
Synovial Sarcoma
13
Q
RB and p53
A
Osteosarcoma
14
Q
EXR/CRP
A
Ewings and Infection
15
Q
SPEP/UPEP
A
Myeloma
16
Q
PSA
A
Prostate
17
Q
p53 is on chromosome ?
A
17
18
Q
retinoblastoma gene is on chromosome
A
13
19
Q
Limb salavage surgery/Wide excision
(not necessarily amputation is tx for what?
A
Chondrosarcoma Adamantinoma Chordoma PARosteal Osteosarcoma Soft tissue sarcoma
20
Q
ORIF + radiation for which processes
A
Mets (Prostate, Breast, Lung Kidney, Thyroid)
Lymphoma
Myeloma
21
Q
RFA
A
Osteoid Osteoma
22
Q
Intra-lesional resection is ok for which tumors…
A
GCT
ABC
NOF
LCH
23
Q
Doxorubicin toxicity and mech of ACTION
A
Cardiac toxicity
anthracycline antibiotic
Cytostatic agent
24
Q
after doxorubicin tx of bone sarcoma patient needs what study
A
echocardiogram
25
Preop radiation dose for soft tissue sarcoma
50 Gy
26
Postop radiation dose for soft tissue sarcoma
60-66 Gy
27
radiation dose for mets
25-30 Gy
| *whole bone/surgical field needs radiation
28
Downside to preop radiation therapy
periop wound healing complications
29
Downside to postop radiation therapy
LARGER FIELD, long term fibrosis, and bone fractures, higher rate of radiation induced sarcomas
30
Heterotopic bone ppx dosage
5GY single dose, 4 hours before or within 72 hours after
| ortho bullets says < 550cGY not effecting and says dose i 700cGy
31
ADVANTAGE OF preop radiation
lower dose and smaller field
32
remove tumor but don't have wide cuff of tissue=
marginal resection
33
marginal resection is OK for which sarcoma
Liposarcoma
| Schwannoma
34
most common type of sarcoma resection, takes normal cuff of tissue
wide resection
| *limb salvage surgery
35
removal of entire compartment as a form of tumor resection
radical or amputation
36
In order most common sites for metastatic disease spread
Lung
Liver
Bone
37
In order most common sites of spread for bone mets
Spine
Proximal Femur- most comon site of fracture
Humerus-second most common site of fracture
38
most common carcinomas that metastasize to bone
```
BLT with a Kosher Pickle
breast
lung
thyroid
kidney
prostate
```
39
order of tumor workup
```
History
Local staging- Xray, CT scan
MRI,
systemic staging
biopsy
```
40
ap xray of every bone in the body
Skeletal Survey
41
next step in DIAGNOSIS of myeloma
SPEP/UPEP
42
next step in STAGING of myeloma
Skeletal Survey
43
next step in staging of presumed metastatic lytic lesion of bone
CT of Chest, Abdomen and Pelvis
44
for OSA, CSA, EWS, STST you need ct of what only
CT chest, not CAP
45
whole body bone scan needed for staging in which cases
OSA
EWS
METS
46
Bone marrow biopsy needed for staging in what cases
mYeloma with mets, and EWINGS
47
Smooth muscle actin +
Leiomyosarcoma
48
Desmin + (skeletal muscle)
Rhabdomyosarcoma
49
S-100 + (neural)
Schwannoma, MPNST
50
CD34/CD31 + (endothelial cells, vascular tumors)
Hemangioma
| Angiosarcoma
51
Beta Catenin+ (Wnt signaling)
fibromatosis, extra-abdominal desmoid
52
CD99+
ewings/PNET
53
IHC: Keratin+
Epithelial sarcoma
Synovial Sarcoma
Carcinoma
54
IHC: EMA (epihelioid membrane antigen)
Epithelioid Sarcoma and Synovial Sarcoma
55
IHC: MYo-D1, Myogenin+
rhabdomyosarcoma
56
IHC: Vimentin +
Soft tissue sarcoma
57
osteosarcoma translocation
unknown
58
11,22
ewings
59
ews-FL1
ewings
60
12,16
| q13, p11
myxoid liposarcoma
61
TLS CHOP
Myxoid liposarcoma
62
2,13
alveolar rhabdomyosarcoma
63
pax3-FKHR
alveolar rhabdomyosarcoma
64
12,22
clear cell sarcoma
65
EWS, ATF1
clear cell sarcoma
66
x,18
synovial sarcoma
67
SSX1-SYT
synovial sarcoma
68
9,22
myxoid chrondrosarcoma
69
ews-CHN
myxoid chondrosarcoma
70
gene in McCune Albright syndrome
GNAS
71
tumor of mcune albright
polyostotic fibrous dysplasia and precocious puberty
72
gene of li-fraumeni
p53
73
tumor of li fraumeni
osteosarcoma and rhabdomyosarcoma
74
Fibrous displasia + soft tissue myxomas
Mazabraud syndrome
| GNAS 1
75
multiple non ossifying fibromas, giant cell granulomas of the jaw, with cafe au lait spots
Jaffe campanacci
76
RECQL4 gene, sun sensitive rash with prominent poikiloderma and telengectasias, osteosarcomas
Rothmund-Thompson
77
Multiple enchondromas- PTHR1 gene, chonrdrosarcomas
Ollier's dz
78
multiple enchondromas, angiomas, CNS, pancreatic, and ovarian malignancies
Maffucci's
79
```
kids less than 5
Langerhans cell histiocystosis
exopthalmos
diabetes insipidus
lytic skull lesions
```
Hand-Schuller-Christensen
80
FATAL LCH in infants
Letterer Siwe
| LCH plut visceral and bone disease
81
Benign Enneking uses what numerus
Arabic numerals
| 1,2,3
82
Enneking malignant system uses what numerals
ROman Numerals
| I, II, III
83
Most common stage of enneking when they present with a primary bone cancer
IIB
High grade = II
Extracompartmental -T2 and thus T1= Intra-compartmental
Mets=0, M1 is with mets
84
What makes something grade III enneking?
mets, distal or regional
85
AJCC key size for bone tumor
>8cm
86
AJCC key size for soft tissue tumor
>5cm
*ANY LESION > 5CM OR (1.5CM IN HANDS/FEET) NEEDS 3D IMAGING
BEFORE FNA/BIOPSY
87
NF1 PREDISPOSES TO WHICH STS
MPNST
88
Gardner's familial polyposis PREDISPOSES TO WHICH STS
Low grade fibrosarcoma
89
radiation therapy PREDISPOSES TO WHICH STS
high grade sts
90
Stewart treves PREDISPOSES TO WHICH STS
Lympedema and /angiosarcoma
91
Dioxin (agent orange) PREDISPOSES TO WHICH STS
high grade sts
92
can have fluid degeneration sts
Synovial sarcoma
93
Biphasic cell population, epithelioid nests forming lumina and containing mucin with contrasting spindle cells running in fascicles
synovial sarcoma
94
fat with immature liboblasts, MDM2+, ring chromosomes
liposarcoma
| marginal excision + radiation
95
fat juxtaposed to high grade elements
de-differentiated lisosarcoma
| wide excision + radiation
96
herringbone pattern
fibrosarcoma
| *gardner's familial polyposis
97
Spindle cells in a whirling, storiform pattern, crop circles, S100+
MPNST- NF1
| radiation + surgery
98
lymph node mets
```
ESARC or RACES
epithelioid
Synovial
Angio
Rhabdomyo
clear cell
```
99
Most common pediatric STS
| Very responsive to chemo
Rhabdomyosarcoma
100
epithelioid nests
spindle cells
rudimentary vascular channels
CD34+
Angiosarcoma
101
small round blue cells, desmin +, chromosome 2,13, PAX, FKHR
rhabdomysocarc
102
treatment of rhabdomyosarcooma
chemo
wide excision
+/_ radiation for + margins
103
MC sarcoma of hand
epithelioid
| WIDE ESCISION
104
INVASIVE tumor, affecting multiple compartments, spindle cells in collagenous stroma, invades muscle, BETA CATENIN +, ESTROGEN RECEPTOR
FIBROMATOSIS, EXTRA ABDOMINAL DESMOID TUMOR
wide resection _ rdiation
105
egg on a string
schwannoma
along the nerve, follow the nerve
106
nuclear palisading, verocay bodies, antoni A/antoni B
Schwannoma
107
phleboliths
vascular malformation
| sclerotherapy if small
108
Due to neoplastic mononuclear phagocyte
CSF1 gene
1p13
PVNS
nodular-complete excision
diffuse- complete synovectomy (typically arthroscopic, then open from back and resect if needed
109
rice bodies
synovial chondromatosis
| excise nodules, complete synovectomy
110
most common sts of foot
clear cell sarcoma
| synovial sarcoma
111
Prostaglandin that causes pain in osteioid osteoma
PGE2
112
continuation of osteioid osteoma, Age < 30, not relieved by NSAIDS
Osteoblastoma
| Not self limiting in growth
113
> 2 cm in size
mixed lytic blastic
diaphyseal lesion
woven bone with NON MALIGNANT RIMMING OSTEOBLASTS
OSTEOBLASTOMA
114
TX OF OSTEOBLASTOMA
INTRALESIONAL EXCISION/CURETTAGE
115
MIRELS CRITERIA (4)
*8 or greater, ppx fixation required
Site (pertrochanteric=3)
Pain (functional pain=3)
Character/type Blastic=1, mixed=2, lytic =3
Size = >2/3 bone diameter
116
Low grade surface osteosarcoma with good outcomes
PAR osteal
par=stuck on bone
117
high grade surface osteosarcoma with intermediate outcomes
PERI osteal
118
treatment of parosteal osteosarcoma
wide excision
119
worst outcomes to best in order for the 3 types of osteosarcoma
Conventional Intramedlluary Osteosarcoma (worst)
Periosteal osteosarcoma
Parosteal osteosarcoma (best)
120
DIFFERNCE BETWEEN TELANGIECTATIC OSTEOSARCOMA VS ANEURYSMAL BONE CYST?
ABC DOES NOT EXPAN PAST THE PHYIS
TELANGIECTATIC CAN HAVE GIANT CELLS
121
IHC common in skeletal mets
Keratin
CK7 (breast and lung cancer)
TTF1 (lung cancer)
122
benefits of bisphosphonate therapy in mets tx
reduces rate of skeletal events (but denosumad is superior at this)
reduces lysis and associated hypercalcemia
123
worst heal rate of path fracture
lung-0% heal rate
124
Can do metastatectomy
thyroid, kidney
125
preoperative embolization necessary
renal cell and thyroid
