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:
-type of cell
-Most common sites
-appearance on xray
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)
What is on the ddx for osteosarcoma?
1. Osteomyelitis = can give lytic destruction and periosteal swelling as well
2. Ewing Sarcoma
5. Bone cyst
What is on the ddx for Ewing?
2. Eosinophilic granuloma
Where are the 2 most common sites of mets for osteosarcoma and Ewing?
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?
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?
-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?
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?