Pediatric Tumors

Question 1

Signs/Symptoms of Bone Tumors & Bone Tumor-like Lesions

Answer 1

Persistent skeletal pain & swelling
Limitation of motion
Spontaneous fracture
Proceed with clinical, radiographic, lab & biopsy exam

Question 2

Examples of Osteoblastic Connective Tissue Tumors

Answer 2

Osteoid osteoma

Osteosarcoma

Question 3

Examples of Cartilage Tumors

Answer 3

Enchondromas
Chondromyxoid fibromas
Chondrosarcomas

Question 4

Examples of Bone Tumors

Answer 4

Giant cell
Chondroblastomas
Ewing’s sarcoma

Question 5

Things to Beware of

Answer 5

Night pain
Constant pain
Unusual symptoms
No improvement with conservative management
General symptoms
X-ray findings with lytic or blastic bone changes, soft tissue calcification or periosteal reaction
Unexplained mass

Question 6

Evaluation of Pediatric Tumors

Answer 6

Physical exam
X-rays
Possible: bone scan, CT/MRI, chest x-rays/CT for high risk lesions
Consider: labs, consults/referrals

Question 7

Biopsy of Tumor

Answer 7

Ideal if “ultimate” surgeon performing

Question 8

Treatment of Clearly Benign Tumors

Answer 8

Observation vs. excision/curettage

Question 9

Treatment of Possibly Malignant Tumors

Answer 9

Consider referral to regional cancer center

Question 10

Who is all part of the team at regional cancer centers?

Answer 10

Pathologists
Radiologists
Surgeons
Oncologists
Radiation therapists

Question 11

Classification of Tumors

Answer 11

Bony vs. soft tissue
Benign vs. malignant
Primary vs. metastatic

Question 12

Epidemiology of Osteosarcoma

Answer 12

2nd most common primary bone tumor
High risk mets
Male = Female
Appendicular

Question 13

X-ray Findings in Osteosarcoma

Answer 13

Mixed lytic/sclerotic lesions with cortical destruction

Question 14

Epidemiology of Ewing’s

Answer 14

Highly anapestic

Long bone diaphyses

Question 15

X-ray Findings in Ewing’s

Answer 15

Lytic, moth-eaten, indistinct margins, “onion skin”

Question 16

Prognosis of Ewing’s with Pre-op Chemotherapy

Answer 16

Survival rate: 80-90%

Question 17

Types of Resection with Soft Tissue Tumors

Answer 17

Intra-lesional
Marginal
Wide
Radical

Question 18

Describe Soft Tissue Tumors

Answer 18

Small, superficial cystic lesions: benign/observed

Large, deep solid tumors: studies/biopsy

Question 19

Different Classes with Soft Tissue Tumors

Answer 19

Fibrous
Lipomatous
Smooth muscle
Striated muscle
Vascular
Synovial
Neurologic

Question 20

Determinants of Staging of Soft Tissue Tumors

Answer 20

Tumor grade
Location
Extension
Mets

Question 21

What is the most common cause of bone tumors?

Answer 21

Metastatic disease

Question 22

What cancers primarily have mets in the bones?

Answer 22

Breast
Lung
Prostate
Kidney

Question 23

Most Common Bones for Metastatic Disease

Answer 23

Spine
Ribs
Pelvis
Proximal limb girdles

Question 24

Common Pitfalls with Metastatic Bone Disease

Answer 24

Assume metastatic
Inadequate workup, planning, or fixation
Not knowing when to refer

Question 25

Treatment of Metastatic Bone Disease

Answer 25

Fracture risk Function Palliation

Question 26

Benign Bone Tumors

Answer 26

Osteochondroma Osteoid osteoma Bone cyst Non-ossifying fibroma

Question 27

What is the most common of benign primary bone tumors?

Answer 27

Osteochondroma

Question 28

Most Common Location of Osteochondroma

Answer 28

Knee | Proximal humerus

Question 29

Gender Distribution of Osteochondroma

Answer 29

Males > females | 2:1

Question 30

When does Osteochondroma generally occur?

Answer 30

2nd & 3rd decades

Question 31

When do osteochondromas generally stop growing?

Answer 31

At skeletal maturity

Question 32

What tests can you run if you are unclear on the diagnosis of an osteochondroma?

Answer 32

CT | MRI

Question 33

Treatment for Osteochondroma

Answer 33

Surgery | Excise cartilage & perichondrium

Question 34

Define Nidus

Answer 34

Well demarcated, bone forming, up to 1 cm

Question 35

When do osteoid osteoma generally present themselves?

Answer 35

2nd & 3rd decade

Question 36

Gender Distribution of Osteoid Osteoma

Answer 36

Male > Female | 3:1

Question 37

Most Common Location of Osteoid Osteoma

Answer 37

Long bones lower extremity Cortex Posterior elements lumbar spine

Question 38

Presentation of Osteoid Osteoma

Answer 38

Dull/sharp pain Worse at night Better with aspirin/NSAIDs

Question 39

Tests to Diagnosis Osteoid Osteoma

Answer 39

X-ray | CT

Question 40

Treatment of Osteoid Osteoma

Answer 40

En bloc resection | Percutaneous radio frequency ablation

Question 41

Gender Distribution of Unicameral Bone Cyst

Answer 41

Male > Female 3:1 Age 5-15

Question 42

Most Common Location of Unicameral Bone Cyst

Answer 42

Proximal humerus

Question 43

Describe a Unicameral Bone Cyst

Answer 43

Central radiolucent lesion metaphysical side of growth plate on long bones

Question 44

Test if Unsure on Diagnosis of Unicameral Bone Cysts

Answer 44

MRI

Question 45

When is fibrous cortical defect/non-ossifying fibroma (FCD-NOF) common?

Answer 45

Common in childhood | First 2 decades

Question 46

Where is fibrous cortical defect/non-ossifying fibroma (FCD/NOF) commonly found?

Answer 46

Metaphysics of long bones

Question 47

How to treat if weakening of the bone in fibrous cortical defect/non-ossifying fibroma (FCD-NOF)?

Answer 47

Currettage/graft

Question 48

Treatment of Fractures in Fibrous Cortical Defect/Non-Ossifying Firoma (FCD-NOF)

Answer 48

Immobilize Observe Sometimes lesion heals

Question 49

Malignant Bone Tumors

Answer 49

Osteosarcoma Ewing's Metastatic disease