Neoplasms of Bone (Nelsons) Flashcards Preview

Self-Directed Learning > Neoplasms of Bone (Nelsons) > Flashcards

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

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

Osteosarcoma is most common
-then Ewings Sarcoma


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



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


What are clinical manifestations of malignant bone tumors?

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


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


What is on the ddx for Ewing?

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


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

1. Lungs
2. Bones


What is the prognosis for the following:

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

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


What is the highest risk period for development of osteosarcoma?

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


What cancer gives you a significantly increased risk of osteosarcoma?

Hereditary retinoblastoma


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

1. Elevated LDH
2. Elevated ALP

***Usually normal CBC and chemistry panel


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


What is the classic radiographic appearance of osteosarcoma?

Sunburst pattern


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


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



What is the classic radiographic appearance of Ewing Sarcoma?

Onion skinning


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