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Lecture 14: Bone Tumors Flashcards

1
Q

All the bone tumors that are malignant end in…

A

-Sarcoma

Osteosarcoma, chondrosarcoma, ewing sarcoma

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2
Q

There are only two bone tumors that make more bone. They are…

A
  • Osteoid osteomas (weird sounding bone tumor)
  • Osteoblastoma (bone building tumor)
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3
Q

Primary bone malignant bone tumors come from (), whereas secondary come from ()

A
  • Primary: originated from the bone
  • Secondary: From outside the bone and metastasized in.
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4
Q

There are only two benign bone tumors that actually cause symptoms and increase the risk of fracture. They are…

A
  • Osteoid osteoma
  • Osteochondroma
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5
Q

One would expect a malignant bone tumor to cause () pain that progresses over time.

A

Dull, aching pain

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6
Q

The initial study of choice for a suspected bone tumor…

A

XRAY

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7
Q

A benign bone tumor is characterized by:
* () border
* () zone of transition
* () size or multiple lesions
* () by natural barriers
* Lack of cortical destruction or extension into soft tissue

A
  • Well-defined/sharp borders
  • Sharp zone of transition
  • Small size
  • Confined by natural barriers

Malignant is the opposite. Think spiculated for periosteal reactions.

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8
Q

After XR is obtained for a bone tumor, we would order a CT if we wanted to check for (), but MRI for checking tumor (). We can add on contrast for () planning.

A
  • CT for mets to the thorax
  • MRI for tumor size
  • Add on contrast for biopsy planning.
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9
Q

T/F: Are bone lesions tumors?

A

yes

dont tell the pt tho

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10
Q

You have a 15M with a benign bone tumor in his femur. The doctor says it originated from osteoblasts and is making more bone. You know this is most likely a…

A

Osteoid Osteoma

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11
Q

The characteristic description of osteoid osteoma is a () surrounded by () bone. This center secretes () which cause pain.

A
  • Nidus surrounded by sclerotic bone.
  • Secretes prostaglandins
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12
Q

Osteoid Osteomas cause () pain that is worse at (), and is relieved by () or ()

A
  • Dull, aching pain worse at night.
  • Relieved by NSAIDs or ASA
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13
Q

You have a 25M patient with a limp and referred pain to their knee. Their dull, aching, pain is worse at night, but it gets better if he takes an aspirin. The doctor says he has a benign bone tumor that builds bone. He forgot the name of it. Although this is an atypical presentation of it, the bone tumor you suspect is…

A

Osteoid Osteoma

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14
Q

A nidus typically is less than () cm on XR in osteoid osteoma. If it is calcified, the radiopauqe point it makes is called a ()

A
  • Less than 1.5 cm
  • Bell
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15
Q

Following XR, the preferred next step in evaluating an osteoid osteoma is..

A

CT w/ IV con

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16
Q

You have a patient you suspect has an osteoid osteoma. XR was normal and they can’t get a CT scan. You should order a… () and hopefully it will show a () sign.

A

Bone scan with double density sign (fried egg)

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17
Q

Last resort imaging for Osteoid Osteoma is…

A

MRI w/ gadolinium (only if can’t confirm via XR or CT)

Not as accurate as CT

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18
Q

Your 24M with an osteoid osteoma is doing well on OTC therapy like NSAIDs. The recommended management for him is ….

He starts limping. Your next step is to ()

A
  • Serial imaging Q4-6 months
  • Refer to ortho for surgical intervention
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19
Q

Osteoblastomas have a nidus that is greater than () cm and are MC found in the (). Most appear in ages 10-20 but are slow growing.

A
  • Nidus GREATER than 2 cm
  • MC found in the posterior column of the spine

blast out the back

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20
Q

The two main differences between osteoid osteomas and osteoblastomas are relief via () and () size

A
  • Osteoblastomas are not relieved with NSAIDs
  • Nidus is bigger in osteoblastoma

Bigger nidus = more prostaglandins = more pain

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21
Q

T/F: Spinal osteoblastomas are likely to extend into soft tissue

A

Yes :(

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22
Q

The characteristic finding of an osteoblastoma on XR is a () lesion/nidus that is () cm.

A

Well-circumscribed, radiolucent nidus > 2 cm.

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23
Q

T/F: All patients with suspect osteoblastomas MUST get a CT scan?

A

Yes

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24
Q

MRI in osteoblastoma is best for lesions that extend into surrounding (), (), and ()

A
  • Soft tissues
  • Bone marrow
  • Spine

They don’t make that surrounding reactive zone like osteoid osteomas.

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25
To confirm an osteoblastoma, you must get a ()
Core needle bx via an oncologic orthopedic surgeon | Must check if its malignant
26
The recommended treatment for all osteoblastoma patients is...
Surgical resection | Curettage and burring + grafting usually. Marginal in aggressive. ## Footnote Must do radiation afterwards IF full resection not possible.
27
Overall, the **MC, solitary benign bone tumor** is a
Osteochondroma | OneCommonOma(tumor)
28
This benign bone tumor is MC around the knee and proximal humerus, especially in your 2nd decade. It is a cartilage-capped, bony projection on the external surface of a bone. This describes a ...
Osteochondroma | Osteo K(on) H(oma) ## Footnote Knees and humerus
29
Osteochondromas do not continually grow. They stop when () happens.
Growth plate closure.
30
Usually, osteochondromas appear alone as a painless mass. However, sometimes you can have hereditary multiple osteochondromas (HMO), which is a genetic mutation in what 2 tumor suppressor genes?
EXT1 or EXT2
31
Bone spur extending away from a joint on XR is indicative of...
Osteochondroma
32
Althought CT helps with localization and surgical planning, MRI is preferred if you're looking at () for an osteochondroma
Soft tissue.
33
In asymptomatic osteochondromas, the preferred management is..
Annual monitoring. MRI if any changes occur. | No intervention.
34
Generally, you would only suspect malignant transformation of an osteochondroma if.. () increases risk new () of lesion new () () growth of lesion
* HMO * New onset growth * New onset pain * Rapid growth
35
() are benign cartilage forming tumors that develop in the bone marrow of long bones
Enchondroma | ENside the bone
36
Enchondromas typically involve the () or () and grow from metaphysis to diaphysis.
Hands and feet | En the Hands and Feet
37
Enchondromatosis is a **non-hereditary** () mutation resulting in multiple enchondromas with a () predominance prior to the age of 10.
* Acquired genetic mutation * Unilateral predominance
38
Enchondromas usually hurt because there was a () fracture
Pathologic fracture | They are usually asymptomatic
39
Enchondromas typically show up as () located on XR and well-circumscribed.
Centrally located
40
In uncomplicated enchondromas, a bone scan will show ().
Nothing
41
The purpose of CT/MRI is to check if an enchondroma is...
A chondrosarcoma or bone infarct
42
Your patient with a suspected enchondroma has pain at the site of his tumor. There is no fracture present. Your next step is to...
Biopsy it to rule out chondrosarcoma | Enchondromas can Evolve into chondrosarcomas?
43
Generally, the 3 risk factors for pathologic fracture due to enchondroma is: * () bone * Greater than () mm in diameter * Involving () of the diameter of the cortex
* Wt bearing bone * > 25mm in diameter * Involves > 50% of the diameter of the cortex
44
In a small, asymptomatic enchondroma with low pathologic fx risk, the preferred management is...
Monitoring with exams and imaging.
45
In an enchondroma patient with symptoms or pathologic fracture risk, the preferred management is...
Curettage & bone grafting | Let fx heal first!
46
The two locations for an enchondroma that are riskiest for malignant transformation to chondrosarcoma are () and ()
* Long bones * Pelvis
47
A chondroblastoma originates in the () or () of long bones
Epiphyses or Apophyses of long bones | Outermost portion of bone
48
The MC site for a chondroblastoma to occur is...
Epiphysis of the proximal humerus | Distal femur, proximal tibia
49
Chondroblastomas are (pain/not painful) and have ()
* Mild, progressive, constant pain that is **unrelated to activity** * Joint stiffness and swelling
50
If a chondroblastoma is located on a wt bearing bone, a () may occur
Limp
51
Small, well-defined lesions with a sclerotic border than may cross the physis/growth plate is most indicative of what benign bone tumor?
Chondroblastoma
52
A biopsy of a suspected chondroblastoma should be done () surgery if lesion was atypical on imaging
Prior to surgery
53
The primary and definitive management of chondroblastoma is...
Curettage and bone grafting
54
The main complication of a chondroblastoma is ... monitored via ...
Benign pulm mets, monitor with CXR or CT w/ con if very sus. | Resectable and curable.
55
Abnormal fibrous tissue and trabecular bone replacing bone marrow/bone tissue describes what benign bone lesion?
Fibrous dysplasia
56
What genetic condition is fibrous dysplasia associated with?
McCune-Albright Syndrome
57
Varus deformity of the proximal femur, a shepherd's crook, is seen in what benign bone lesion?
Fibrous dysplasia | They get a lot of bent looking limbs
58
Spongy-like appearance on CT of of the orbits, jaw, and cranial base might suggest...
Fibrous dysplasia
59
* Lytic lesons with ground-glass appearance * Bowing * Thin cortical bone Describe XR findings for what benign bone lesion?
Fibrous dysplasia
60
You must do a bone scan after initial dx of fibrous dysplasia to rule out...
Polyostotic disease
61
For asymptomatic fibrou dysplasia, management is...
Serial exams and imaging
62
For symptomatic fibrous dysplasia patients, you can do () or ()
* Curettage & bone grafting (if older pt) * IV bisphosphonates to prevent bone loss and with pain.
63
In children, ossifying fibroma/osteofibrous dysplasia MC affects the () and () in children aged 1-5. In adults, it typically only affects the ()
* In children: tib and fib * In adults: Mandible | Ossi-tying my Shoes Man!
64
The MC clinical sign of ossifying fibroma is...
Localized, firm swelling in the affected area | Normally painless unless pathologic fx.
65
In a child with ossifying fibroma, you might notice that their tibia is () anteriorly or anterolaterally
Bowed
66
* Cortex thinned with multiple lytic lesions of lucency. * Well-circumscribed intracortial lesions Describe XR findings for what benign bone condition?
Ossifying Fibroma
67
Asymptomatic ossifying fibroma is managed via...
Repeat XR every 6 months
68
Symptomatic ossifying fibroma with pain/deformity is managed via...
Resection, currettage, and bone grafting done AFTER skeletal maturity | Otherwise risk of recurrence.
69
Overall, the MC benign bone lesion in CHILDREN
Nonossifying fibromas
70
* Small, well-defined, eccentric, lytic lesions * Distal diaphysis/metaphysis * Can have multiple Describe XR findings for what benign bone lesion?
Nonossifying Fibromas (NOFs)
71
NOFs only require surgical intervention if * Lesion is () of bone diameter * Lesion is located in a () area like the distal femur
* > 50% of bone diameter * High stress areas
72
Non-cancerous, fluid filled lesions with fibrous linings found in young children describe what cystic tumor?
Unicameral bone cyst | like a camel hump
73
* Well-defined, cystic lesions at metaphysis or metadiaphysis * Generally involves the entire diameter of the bone * Pathologic fx caused by these may have a **fallen leaf or fallen fragment sign** These XR findings describe what bone condition?
Unicameral bone cyst | falling off the camel hump
74
Asymptomatic unicameral bone cysts are managed via...
* Observation with Q4m XR and activity restrictions. * Can aspirate cyst and inject methylprednisolone to speed it up.
75
Surgery is only done in unicameral bone cysts that...
Compromise structural integrity of bone
76
() will occur to unicameral bone cysts after skeletal maturity
Spontaneous resolution
77
Aneurysmal bone cys are benign, rapidly growing but destructive cysts filled with... ()
Blood
78
Aneurysmal bone cysts are the only bone lesion more common in ()
Females | I think, everything has been male from what ive seen
79
The 2 MC sites for aneurysmal bone cysts to occur is the () and the ()
1. Tibia 2. Femur | from the ground up ##FOOTNOTE TIBIA FEMUR VERTEBRAE PELVIS HUMERUS
80
Aneurysmal bone cysts present with () pain, (), and ()
* Localized pain * Tenderness * Swelling
81
* Aggressive, expansile, lytic metaphyseal lesion with sharp borders * **Eggshell** sclerotic rim * **Soap bubble** appearance These describe XR findings of what?
Aneurysmal bone cyst
82
Prior to surgery for an aneurysmal bone cyst, you want to...
Selective arterial embolization to prevent hemorrhage via angiography.
83
The MC MALIGNANT bone tumor is...
Osteosarcoma
84
Osteosarcomas are overgrowths of malignant (), MC found at the () of long bones.
* Osteoblasts * Metaphysis of long bones
85
Osteosarcomas peak in incidence twice: * () adolescence * Over the age of ()
* Early adolescence * Seniors
86
What disease is a RF for osteosarcoma?
Paget disease
87
The first and 2 MC symptoms of osteosarcomas are...
Pain & swelling that **worsen with activity**
88
* Osteolytic and osteoblastic lesions can be seen. * **moth eaten appearance** * Starburst appearance * Codman's triangle All describe XR findings of...
Osteosarcomas
89
You must do a () to look for multifocal/mets in osteosarcoma. If any new lesion is identified, you must then do...
* Bone scans * CT/MRI for every lesion seen on bone scan.
90
Osteosarcoma is confirmed via () and is treated with pre/post-op () and () sparing surgery
* Confirmed via core needle/open biopsy * Pre and post-op chemo * Limb salvage surgery
91
Chondrosarcomas typically appear after the age of () and appear in the () and () girdles.
* After the age of 50 * Pelvic and shoulder girdles
92
Chondrosarcomas cause () pain that gradually progresses and is worse with ()
* Dull, deep aching pain * Worse at night
93
* Bony contour is thinned and expanded * Endosteal scalloping * Lesion often > 5 cm These XR findings are seen in what malignant bone tumor?
Chondrosarcoma
94
Dx of a chondrosarcoma is confirmed via...
Core needle/open biopsy
95
* MRI w/ gad is done preop to check (). * CT () w/ con checks for mets to the () For chondrosarcoma
* Check tumor extent * CT Chest w/ con to check for lung mets (MC)
96
Primary tx of chondrosarcoma is via...
Surgical excision
97
Ewing Sarcoma is due to a chromosomal translocation between () and (). It's origin is from neuro()
* 11 and 22 * Neuroectodermal tumor | Ewing's number is 33, so 11+22 = 33
98
Ewing Sarcoma MC appears in the () and the ()
1. Pelvis 2. Femur
99
Generally, Ewing's sarcoma appears like most malignant bone lesions, such as pain worse with () or (). It is also palpable.
* Worse at night * Worse with activity
100
* Poorly marginated destructive lesion * **Onion skin appearance** These XR findings are suggestive of what malignant bone tumor?
Ewing Sarcoma
101
Ewing Sarcoma is managed via...
Multi-drug chemo + surgery/radiation
102
The top 3 cancers that metastasize to the bone are...
1. Breast 2. Lung 3. Thyroid | BLT
103
The most common approach to metastatic bone disease is () and ()
* Radiation * Pain meds | Chemo, bisphosphonates
104
Biopsy is used for metastatic bone disease to () and determine ()
* Definitive dx * Determine primary site

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