Flashcards in Patho Exam 2:Bone Tumors & Tumor-Like Lesions Deck (55)
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Bone Forming Tumors
Osteoma
Osteoid Osteoma & Osteoblastoma
Osteosarcoma
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Cartilage Forming Tumors
Osteochondroma
Chondromas
Chondroblastoma
Chondromyxoid Fibroma
Chondrosarcoma
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Fibrous & Fibro-Osseous Tumors
Fibrous Cortical Defect & Non-Ossifying Fibroma
Fibrous Dysplasia
Fibrosarcoma Variants
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Miscellaneous Tumors
Ewing Sarcoma/Primitive Neuroectodermal Tumor
Giant-Cell Tumor
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Bone Forming Tumors
Benign:
Malignant
Benign:
Osteoma
Osteoid Osteoma
Osteoblastoma
Malignant
Osteosarcoma
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Osteoma
Osteoma
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what is an Osteoma
Benign & slow growing of cortical dense bone
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what age is most likely to have osteomas?
Middle age
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where are osteomas commonly fount?
Most common on or inside skull and facial bones
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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
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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
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Osteoid Osteoma
Osteoid Osteoma
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what are Osteoid Osteoma
Benign bone tumors with more compression than an Osteoma
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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)
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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)
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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
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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
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Osteoblastoma
Osteoblastoma
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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
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Osteoblastoma
Manifestation
Treatment:
Dull achy pain
Not relieved by ASA
Malignant transformation associated when treated with radiation
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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)
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Osteosarcoma (osteogenic sarcoma)
Location:
-
-elderly:
Metaphyseal of long bones of extremities
>50% occur around knee
Elderly
Flat bones and long bones equally
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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
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Treatment of ostosarcoma?
Differs depending on mutation if tx improperly with the incorrect chemo you can actually make it worse
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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
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Osteosarcoma (osteogenic sarcoma)
Clinical Course
Painful
Progressively enlarging
sudden fracture might be initial symptom
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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
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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
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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
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