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Bone Pathology II > Quiz 2 > Flashcards

Quiz 2 Flashcards

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1
Q

Malignancy of giant cell tumor

A

90% benign
10% malignant
Osteoclastic giant cells
6th most common bone tumor

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2
Q

Giant cell tumor history

A

20-40 yo

More commonly malignant in males

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3
Q

Signs and symptoms of Giant Cell Tumor

A

Intermittent, aching pain
Localized swelling and tenderness
Restricted joint movement
The pathologic fracture that occurs in 30% of people may be the only source of symptoms

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4
Q

Giant Cell Tumor Location

A

Metaphyseal and extending to subarticular (85%)
Distal femur, proximal tibia, distal radius, proximal humerus
Most common benign tumor of the sacrum; patella

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5
Q

Plain film findings of Giant Cell Tumor

A

eccentric, expansile
Thinned cortex and expanded
Aggressive appearance with cortical break and soft tissue mass but no sclerosis or periosteal response

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6
Q

Prognosis and treatment of Giant Cell Tumor

A

No radiographic differentiation of benign versus malignant
Curretage and packing with bone chips or wide local excision
Possible recurrence

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7
Q

What is the most common benign skeletal tumor?

A

Osteochondroma

35% of all benign bone tumors

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8
Q

Signs and symptoms of Osteochondroma

A

Asymptomatic (pushes on vessels or nerves)
May restrict joint motion
Hard, painless mass near joint
Pathologic fracture possible
Pain, rapid growth, growth after maturity may indicate malignant degeneration

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9
Q

Plain film findings of Osteochondroma

A

Bony exostosis
Cartilage cap may calcify
Projects away from the joint
Sessile version produces asymmetric widening

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10
Q

Indications for malignant transformation of benign tumors

A 
>30 y.o.
Pain
Growth after skeletal maturity
Change  on  sequential  studies
Dispersal of calcifications in cap
Osseous  destruction
Soft  tissue  mass
Thickened  cartilaginous  cap, >1.5cm (CT, MRI)
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11
Q

Prognosis and treatment of osteochondroma

A

Most require no treatment
May be resected for cosmetic purposes
Subungal exostosis requires removal

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12
Q

Characteristics of hereditary Multiple Exostosis

A

Multiple osteochondromas (10-100’s)
Dx occurs at 2-10 years old
Painless lumpy joints
25% have malignant degenration

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13
Q

Hemangioma types

A

Cavernous: vertebrae, skull, common
Capillary: flat or long bones

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14
Q

Characteristics of hemangioma

A

Most common benign tumor fo the spine
Seen after 40
Most asymptomatic

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15
Q

In what cases of hemangioma can neurological compromise be possible?

A

Ballooning of vertebral body
Extension of tumor into central canal
Pathologic fracture
Hemorrhage

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16
Q

Plain film findings of hemangioma

A

Commonly in spinal and skull
Spine: vertebral body, courderoy cloth, body expansion is rare
Skull: Lytic lesion with spoke-wheel appearance

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17
Q

DDX list for hemangioma, paget, osteoporosis

A

Hemangioma: Single lesion, normal cortex, occasional body expansion
Paget: Single or multiple lesions, thickened cortex, common body expansion
Osteoporosis: Multiple lesions, thinned cortex, no body expansion

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18
Q

Soft tissue hemangioma presentations

A

Masses frequently contain phelboliths

Maffuci syndrome

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19
Q

Gardner syndrome triad

A

45%
Multiple osteomas
Colonic polyps
Soft tissue fibromas

Polyps are considered premalignant

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20
Q

Bone Island (enostosis)

A

Solitary discrete area of sclerosis
Usually asymptomatic
Any age but more common in adults

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21
Q

Common places for bone islands

A

Pelvis, sacrum, proximal femur

Uncommon in spine

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22
Q

DDx for bone islands

A

osteoblastic metastasis, osteoid osteoma, osteoma

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23
Q

DDX list for osteoblastic metastasis, osteoid osteoma, osteoma against bone island

A

osteoblastic metastasis - Bone scan, no brush border
osteoid osteoma - pain, nidus
osteoma - location, surface contour

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24
Q

Pain characteristics of osteoid osteoma

A

Painful, rigid scoliosis

Classic  symptoms (65-75%):  increasingly severe, deep, aching pain
not relieved by rest, worse at night, relieved by aspirin
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25
Location of osteoid osteoma
Can occur in any bone (most commonly cortical) 70% in long bones, especially proximal femur, 20% phalanges, 10% in spine, mostly neural arch lumbar > cervical > thoracic
26
Plain film findings of osteoid osteoma
80% cortical lesion: lucent round/oval nidus | Intramedullary and intrascapular lesions (hip)
27
treatment for osteoid osteoma
``` Surgical exision (must remove nidus entirely, spinal lesions may require bone grafting after surgery) Commonly treated with radiofrequency ablation being used ```
28
DDX list for painful scoliosis
Osteoid osteoma - sclerotic pedicle Aneurysmal bone cyst - lucent Osteoblastoma - lucent
29
Location and age of osteoblastoma
40% in neural arch of spine 30% in long bone metaphysis, diaphysis 30% hands, feet, skull, face 70% <20 y.o.; 3-78 y.o
30
Signs and symptoms of osteoblastomas
Spinal lesions: painful scoliosis* Pain is typically less severe, not nocturnal, not relieved by aspirin Local tenderness, palpable mass in extremities Local muscle spasm, rigidity, referred pain, spinal stenosis
31
Plain film findings of osteoblastomas
Spine: Expansile lytic lesion, rim of sclerosis, 4-6 cm Extremities: Lytic, expansile; epiphysis usually spared; cortex thinned; lucent nidus >2cm Rapid increase in size
32
Treatment for osteoblastoma
Surgical resection/excision Radiantion/chemotherapy for aggressive or unresectable Percutaneous ablation
33
Enchondroma frequency and age
2nd most common benign tumor Cartilaginous Most common age 10-30 y.o
34
Enchondroma location
50% in hands or feet (most common tumor of phalanges) 50% femur, tibia, humerus, ribs Lesions near axial skeleton more often symptomatic Lesions near axial skeleton higher potential for malignant transformation
35
Radio findings of enchondroma
``` Lytic, geographic Expansile Thinned cortex, endosteal scalloping Metaphyseal-diaphyseal Calcification (cartilage) in 50% No periosteal reaction; no soft tissue mass ```
36
Treatment and prognosis of enchondroma
Malignant transformation is rare but the likelihood increases with multiple lesions Surgical removal for deforming or painful
37
Enchondromatosis can be due to which two diseases?
Ollier Disease: Multiple enchondromas, usually unilateral, monomelic (may cause growth change, shortened limb, severe deformities); Malignant transformation rate 25-50%; Chondrosarcoma Maffucci syndrome: Multiple enchondromatosis soft tissue hemangiomas (venous malformations), phleboliths Rare; malignant transformation rate up to 25%
38
Characteristics of chondrobalstoma
``` Cartilaginous Usually seen before epiphyseal closure Most patients 5-25 y.o. Mild, dull pain Local tenderness, swelling, effusion ```
39
Chondrobalstoma location
Epiphyseal: May extend to metaphysis Apophyseal: Greater trochanter, greater tuberosity, femur, tibia, humerus, tarsals, pelvis 2/3 lower extremity; 50% at knee
40
Appearance of chondroblastoma
``` Lytic, geographic Epiphyseal / Apophyseal Eccentric (most) Sharp zone of transition Rim of sclerosis Calcification in 50% Periosteal response possible (solid) ```
41
Chrondroblastoma ddx with clear cell chondrosarcoma and giant cell tumor
Clear cell chondrosarcoma: Older patients, Larger mass Giant cell tumor: Larger, no sclerotic border, no calcification, skeletally mature (growth plates closed)
42
ChondroblastomaTreatment & Prognosis
Pathologic fracture can occur Growth disturbance / limb length discrepancy Surgical removal (curettage) and bone grafting Local recurrence in up to 20%
43
Nonossifying fibroma and fibrous cortical defect
FCD: 2-8 yo - less than 2cm in cortex NOF: 8-20 yo - greater than 2cm extends into medullary cavity Not true neoplasm Frequent spontaneous resolution over 2-4 years 30-40% of children have FCD
44
Fibrous Cortical Defect/Nonossifying Fibroma lesions and location
Large (>8cm) lesions more likely symptomatic Pathologic fracture possible (only reason for treatment) Most common sites Lower extremity (90% in tibia or fibula) and humerus Also ribs, ilium
45
FCD/NOFRadiographic Appearance
``` Lytic, ovoid Sclerotic border Diametaphyseal, eccentric Thins, may expand cortex Appears sclerotic when healing due to osteoblastic activity Multiple lesions with neurofibromatosis ```
46
Characteristics of simple bone cyst
3% of primary bone lesions Not true neoplasm; fluid-filled cyst Usually found in teenagers: Asymptomatic unless fractured, 2/3 undergo pathologic fracture
47
Simple bone cyst locations
Proximal humerus: 50-60% Proximal femur: 30% - less commonly: talus, calcaneus, iliac wing Metaphyseal, immediately adjacent to physis Latent cysts shift toward diaphysis Central
48
Simple bone cyst radiographic findings
``` Geographic, lytic Short zone of transition Broad-based at physis, narrows toward diaphysis Mild bone expansion “Fallen fragment” sign with fracture ```
49
Simple bone cyst prognosis and treatment
Surgical treatment is recommended due to high fracture rate 30-40% recurrence rate with curettage Steroid injection into cyst reduces recurrence
50
Aneurysmal bone cyst characteristics
Highly expansile (or aneurysmal) cystic cavity filled with numerous blood-filled channels 5-20 y.o. Pain and swelling either acute or more insidious onset Pathologic fracture common
51
Aneurysmal bone cyst location
Long tubular bones 50-60%: Most common benign tumor of clavicle Spine & Sacrum: Posterior arch, painful scoliosis
52
Aneurysmal bone cyst radio findings
``` Highly expansile Lytic, septated Eccentric Markedly thinned cortex Metaphyseal, may extend to epiphysis (only benign tumor to cross growth plate) Periosteal response more common ```
53
Aneurysmal bone cyst treatment and prognosis
Surgical curettage & bone grafting Recurrence rate ~20% Secondary ABC: GCT, osteosarcoma, simple bone cyst, NOF, fibrous dysplasia
54
Intraosseous lipoma characteristics
``` Rarest primary benign tumor Wide age range Asymptomatic Metaphysis; calcaneus Lytic, geographic, sclerotic border “Target” or “doughnut-shaped” sequestrum = central density CT or MRI shows fat matrix ```
55
Paget's disease characteristics
Osteitis deformans Largely asymptomatic Increased osteoclastic activity with immature weak bone
56
Etiologies of Paget's disease
Viral infection + hereditary factors Others: Inflammatory disorder, endocrine disorder, autoimmune disorder, inborn error of connective tissue metabolism, vascular disorder, neoplasm
57
Pagets disease clinical features
Rare before age 40 Localized pain & tenderness Hypervascularity leads to focal increased temperature Increased bone size Deformities/pathologic fracture may occur Polyostotic High-output congestive heart failure may result
58
Phases of Paget's disease
Phase 1: osteoclastic activity Phase 2: osteoclastic + osteoblastic activity Phase 3: osteoblastic activity Phase 4: malignant degeneration (1-3%)
59
Appearance of Paget's disease
``` Usually diagnostic, bone scan can identify additional sites Increased or decreased bone density Coarsened trabeculae Thickened cortex Bone expansion ```
60
Paget's disease location
Usually polyostotic Pelvis, femur, skull, tibia, vertebrae, clavicle, humerus, ribs Lower extremity > upper extremity Right side > left side Spinal: most common at mid lumbar (L3-L4), lower thoracic, upper cervical
61
Paget DiseaseRadiographic Signs
Skull: osteoporosis circumscripta; cottonwool appearance Spine: picture frame vertebra; ivory vertebra Pelvis: brim or rim sign, protrusio acetabuli Femur and tibia: blade of grass or candle flame appearance
62
Complications of paget's disease
Skull: osteoporosis circumscripta; cottonwool appearance Spine: picture frame vertebra; ivory vertebra Pelvis: brim or rim sign, protrusio acetabuli Femur and tibia: blade of grass or candle flame appearance Psuedofractures Stenosis - Spinal, Bone expansion, deformity, pathologic fracture, upper thoracic and lumbar spine m/c Cranial - Hearing loss, cranial nerve compression Malignant degeneration - 1-3%, Higher incidence in humerus, lower in vertebrae, Osteosarcoma, fibrosarcoma, chondrosarcoma, Lytic destruction within Pagetic bone, Cortical destruction, Usually no periosteal response, Soft tissue mass, Cannonball mets to lung
63
Lab changes with Paget's disease
Increased serum alkaline phosphatase possible - produced as bone attempts to rebuild Increased urinary hydroxyproline Normal serum calcium and phosphorus
64
Treatment and prognosis of Paget's disease
Bisphosphonates - Reduces osteoclastic activity Supportive braces Slow progression

Bone Pathology II (3 decks)

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