Flashcards in Patho Exam 2:Bone Tumors & Tumor-Like Lesions Deck (55)
Loading flashcards...
1
Bone Forming Tumors
Osteoma
Osteoid Osteoma & Osteoblastoma
Osteosarcoma
2
Cartilage Forming Tumors
Osteochondroma
Chondromas
Chondroblastoma
Chondromyxoid Fibroma
Chondrosarcoma
3
Fibrous & Fibro-Osseous Tumors
Fibrous Cortical Defect & Non-Ossifying Fibroma
Fibrous Dysplasia
Fibrosarcoma Variants
4
Miscellaneous Tumors
Ewing Sarcoma/Primitive Neuroectodermal Tumor
Giant-Cell Tumor
5
Bone Forming Tumors
Benign:
Malignant
Benign:
Osteoma
Osteoid Osteoma
Osteoblastoma
Malignant
Osteosarcoma
6
Osteoma
Osteoma
7
what is an Osteoma
Benign & slow growing of cortical dense bone
8
what age is most likely to have osteomas?
Middle age
9
where are osteomas commonly fount?
Most common on or inside skull and facial bones
10
what are the tumor characteristic of osteomas?
Consist of
Some variants have
location:
shape
Difficult to distinguished from
Consist of woven and lamellar bone deposited in a cortical pattern with haversian like systems
Some variants have trabecular bone
From subperiosteal or endosteal surfaces
Round to oval sessile tumor
Difficult to distinguished from REACTIVE BONE looks a lot like osteoid of new bone growth
11
Osteoma
Subtypes
1:
2;
3:
4:
Calvarial and mandibular osteomas
Osteomas of the sinonasal and orbital bones
Bone islands occurring in medullary bone
Surface osteomas of long bones
12
Osteoid Osteoma
Osteoid Osteoma
13
what are Osteoid Osteoma
Benign bone tumors with more compression than an Osteoma
14
what age is likely to have a Osteoid Osteoma
Sex?
Age: Teens & 20s (75% are < 25 years of age)
Males > Females (2:1 to 3:1)
15
Common location for a Osteoid Osteoma
Diaphyseal Cortex of tubular bones of leg
Appendicular skeleton & posterior elements of spine
Femur and tibia involved in 50% of cases (mostly in cortex)
16
what are the tumor characteristic of Osteoid Osteoma?
describe:
Abnormalities in what xsomes?
Has a NIDUS < 2 cm diameter
Central mineralization: Thin irregular trabeculae of woven bone
Stroma contains Osteoclasts and Osteoblasts
Surrounded by reactive bone
Abnormalities of Chr 22 & deletion of 17
17
what are the manifestations of Osteoid Osteoma?
-
-
- pain is relieved by:
What is the treatment?
Manifest with pain (nocturnal)
Pain due to osteoblast production of PGE2
Pain relieved with ASA
Treatment
Radioablation or Surgical excision
18
Osteoblastoma
Osteoblastoma
19
Osteoblastoma
age:
sex:
location
Tumor characteristics:
Chromosomal abnormalities
-
-
Benign
Age: 10-35 years of age
Males = Females
Location: Spine and long bones
Tumor Characteristics
NO Nidus & No bony reaction
> 2cm in diameter
Chromosomal abnormalities
MDM2 gene amplification: receptor of p53
TP53 gene deletion
mdm2 gene which regulates p53 tumor suppressor therefore if increased mdm then decreased p 53
20
Osteoblastoma
Manifestation
Treatment:
Dull achy pain
Not relieved by ASA
Malignant transformation associated when treated with radiation
21
Osteosarcoma (osteogenic sarcoma)
most common:
Age:
sex:
Malignant
Most common Primary malignant tumor of bone (exclusive of myeloma and lymphoma)
Age: bimodal
75% in persons < 20 years
Elderly with predisposing conditions:
Males > females (1.6:1)
22
Osteosarcoma (osteogenic sarcoma)
Location:
-
-elderly:
Metaphyseal of long bones of extremities
>50% occur around knee
Elderly
Flat bones and long bones equally
23
Osteosarcoma (osteogenic sarcoma)
Pathogenesis
Genetic (70%)
Ploidy changes
Chromosomal aberrations: RB & p53
Germline mutations in RB have 1000 fold increased risk
Patients with Li-Fraumeni syndrome (germline p53 mutation) have greatly elevated incidence
INK4a codes for:
p16: cell cycle regulator
p14: aids and abets p53 function
24
Treatment of ostosarcoma?
Differs depending on mutation if tx improperly with the incorrect chemo you can actually make it worse
25
Osteosarcoma (osteogenic sarcoma)
Tumor Characteristics
Identified by anatomic portion of the bone from which they arise:ex:
Classified by:
Classified as
Solitary
Destroy:
Spread in medullary canal:
In most cases:
Identified by anatomic portion of the bone from which they arise: intramedullary, intracortical, or surface
Classified by differentiation: Most are poorly
Classified as primary or secondary:secondary is associated with pre existing condition
Solitary
Destroy surrounding cortices
Spread in medullary canal: Infiltrate the marrow
Histologic variants (osteoblastic, chondroblastic, fibroblastic, telangiectatic, small cell, and giant cell)
In most cases: malignant cells with osteoblastic differentiation producing woven bone
26
Osteosarcoma (osteogenic sarcoma)
Clinical Course
Painful
Progressively enlarging
sudden fracture might be initial symptom
27
what will the X-ray for Osteosarcoma (osteogenic sarcoma) show?
Tumor breaks through cortex and lifts periosteum
Reactive periosteal bone
Codman triangle: triangular shadow between cortex and raised ends of periosteum
28
if a osteosarcoma mets where to and how?
Hematogenous spread: 10-20% at time of dx
Metastases:
98% who die of osteosarcoma have lung mets
29
Osteosarcoma (osteogenic sarcoma)
Treatment
Multimodality
Chemotherapy
Due to metastasis at time of diagnosis.
Chemo with limb sparing surgery: 60-80% 5-year disease free
Surgery
Does not increase 5 year survival
30
