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Flashcards in Neoplasms of Bone (Nelsons) Deck (17):
1

What is the most common primary malignant bone tumor in children and teens?

Osteosarcoma is most common
-then Ewings Sarcoma

2

What is more common in children < 10 yo: Osteosarcoma or Ewings?

Ewings

3

Compare and contrast Osteosarcoma and Ewing Sarcoma:
-M:F ratio
-type of cell
-Most common sites
-appearance on xray

M:F ratio:
-both 1.5:1

Type of cell: -osteosarcoma = spindle cell-producing osteoid
-Ewing = undifferentiated small round cell (neural origin)

Most common sites:
-osteosarcoma: metaphyses of long bones
-Ewing: diaphyses of long bones, flat bones

Appearance on xray:
-osteosarcoma: sunburst pattern (sclerotic destruction, less commonly lytic)
-Ewing: primarily lytic, multilaminar periosteal reaction ("onion skinning") = EW ONIONS

4

What are clinical manifestations of malignant bone tumors?

1. Local pain and swelling
2. Fever (more common with Ewing)
3. Limping

5

What is on the ddx for osteosarcoma?

1. Osteomyelitis = can give lytic destruction and periosteal swelling as well
2. Ewing Sarcoma
3. Histiocytosis
4. Lymphoma
5. Bone cyst

6

What is on the ddx for Ewing?

1. Osteomyelitis
2. Eosinophilic granuloma
3. Lymphoma
4. Neuroblastoma
5. Rhabdomyosarcoma

7

Where are the 2 most common sites of mets for osteosarcoma and Ewing?

1. Lungs
2. Bones

8

What is the prognosis for the following:
-osteosarcoma
-Ewing

Osteosarcoma: without mets = 70% cure; with mets at diagnosis < 20% survival

Ewing: without mets = 60% cure; with mets at diagnosis 20-30% survival

9

What is the highest risk period for development of osteosarcoma?

During adolescent growth spurt = association between rapid bone growth and malignant transformation

10

What cancer gives you a significantly increased risk of osteosarcoma?

Hereditary retinoblastoma

11

What abnormalities can you see on bloodwork in a patient with osteosarcoma?

1. Elevated LDH
2. Elevated ALP

***Usually normal CBC and chemistry panel

12

What are the classic clinical manifestations of osteosarcoma?

1. Pain
2. Limp
3. Swelling
-these tumors occur most often in active adolescents so initial complaints may be attributed to a sports injury or sprain
-any bone or joint pain not responding to conservative therapy within a reasonable time should be investigated thoroughly
-usually causes nighttime awakening

13

What is the classic radiographic appearance of osteosarcoma?

Sunburst pattern

14

What is the management of osteosarcoma?

1. Consult ortho - will need MRI of primary lesion, biopsy and surgery
2. Mets work-up: CT of chest and radionuclide bone scanning to evaluate for lung and bone mets
3. Treatment: chemotherapy and complete surgical resection of tumor

15

Which is more often associated with systemic manifestations (fever and weight loss): osteosarcoma or Ewing sarcoma?

Ewing

16

What is the classic radiographic appearance of Ewing Sarcoma?

Onion skinning

17

What is the management of Ewing Sarcoma?

1. Consult ortho - will need MRI of the involved site, bone biopsy and surgical resection
2. Evaluation for mets: CT chest, bone scan, bone marrow aspiration
3. Chemo and surgical resection