Lecture 4 - Bone Tumors and Ganglion Cysts

Question 1

What is the most common tumor arising within the bone?

Answer 1

Multiple myeloma

more of a heme problem than orthopedics

MC malignant tumor of the bone is metastasis

Question 2

Besides MM, what are the 3 most common malignant tumors of the bone?

Answer 2

1) Osteosarcoma
2) Chondrosarcoma
3) Ewing Sarcoma

Question 3

Osteosarcoma pathophysiology

Answer 3

malignant transformation of a normal bone cell near the metaphysial bone line that rapidly grows and divides

MC long bones

starts out as a ball type mass that grows outward

Question 4

What are the most common locations of osteosarcoma?

Answer 4

Distal femur > proximal tibia > proximal humerus > mid/proximal femur

Question 5

What is the epidemiology of osteosarcoma?

Answer 5

1/2 of all bone cancers in those <20 yo

peak incidence 13-16 yo

Boys&raquo_space;> Girls

Question 6

How do pts with osteosarcoma present?

Answer 6

dull, aching pain over the bone involved 
night pain (unilateral though, this is how you can tell the difference between growing pains and this) 

tenderness to palpation of involved area
limited AROM of adjacent joint
limp
muscle atrophy

Question 7

Which imaging studies are done for osteosarcoma?

Answer 7

regional MRI and CT helpful for guiding surgical repair

evaluation for metastatic pulmonary disease
pre-op: all pts get CT
post-op: repeat chest CT q 3-6 months x 2 years

Bone scintigraphy - distant metastatic lesions, local bone involvement

Thallium scintigraphy - monitor tumor response to chemo

Question 8

What is the treatment for osteosarcoma?

Answer 8

pre-operative (neoadjuvant) chemotherapy

Surgical resection (limb salvage or amputation)

Post operative Chemo x 1 year
chest CT every 6 months x 2 years

Question 9

Chondrosarcoma

Answer 9

pathophysiology

cartilage based tumor of the bone

conventional is the MC subtype

Question 10

What are the different grades of chondrosarcomas?

Answer 10

Grade 1 (low grade) 
Grade 2 (intermediate) 
Grade 3 (high grade)

Question 11

What is the epidemiology of chondrosarcoma?

Answer 11

male = female

Peak incidence 50-70 yo

Question 12

What locations are MC involved in chondrosarcoma?

Answer 12

pelvis > ribs > ilium > femur > humerus

Question 13

What is the presentation of someone with chondrosarcoma?

Answer 13

deep, dull, achy pain
chronic (>1 year)
pain at night

Question 14

What is the treatment of chondrosarcoma?

Answer 14

surgical resection

does NOT respond well to chemo and radiation

Question 15

What is the prognosis of chondrosarcoma?

Answer 15

Grade 1 = 90% survival at 5 years
Grade 2 = 81% survival at 5 years
Grade 3 = 29% survival at 5 years

Question 16

Ewing Sarcoma pathophysiology

Answer 16

t(11:22) translocation

fusion protein results in oncogenesis

Question 17

What is the epidemiology of ewing sarcoma?

Answer 17

ages 5 - 30

Question 18

Which locations are commonly involved in ewing sarcoma?

Answer 18

Pelvis > knee > prox humerus > femur diaphysis

Question 19

What is the presentation of pts with Ewing Sarcoma?

Answer 19

Bone pain 
FEVER
NIGHT SWEATS 
WEIGHT LOSS
tender, palpable mass on exam

Question 20

“Hair on End”

Answer 20

Seen on imaging for Ewing Sarcoma

also seen:
“sunburst”
“moth eaten”
“onion skinning”

Question 21

How do you dx Ewing Sarcoma?

Answer 21

MRI for staging
Biopsy to confirm

Labs:
elevated WBC
elevated LDH
elevated ESR

Question 22

What is the treatment for Ewing Sarcoma?

Answer 22

surgery, radiation, chemo

Question 23

What is the prognosis of Ewing Sarcoma?

Answer 23

local 70% t year survival

metastatic 30% 5 year survival

Question 24

Ganglion Cysts path

Answer 24

destruction of mucoid connective tissue

Question 25

What is the epi of ganglion cysts?

Answer 25

excluding skin cancer, tumors of the hand - 95% benign

60% benign skin tumors are ganglion cysts

Question 26

How to pts with ganglion cysts present?

Answer 26

dorsal surface of wrist at scapholunate joint
joint instability, weakness, limited ROM

PE:
normal overlying skin
compressible, movable mass
may be to adherent to bone, joint, or tendon

Question 27

How do you treat ganglion cysts?

Answer 27

noninvasive:
compression
aspiration

Surgical:
open excision
requires post-op immobilization x 7 days