Patho Exam 2:Bone Tumors & Tumor-Like Lesions Flashcards Preview

Clinical Medication: HEENT > Patho Exam 2:Bone Tumors & Tumor-Like Lesions > Flashcards

Flashcards in Patho Exam 2:Bone Tumors & Tumor-Like Lesions Deck (55)
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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

BONE TUMORS: Cartilage Forming Tumors

BONE TUMORS: Cartilage Forming Tumors