September 11 Bone Path Flashcards
(41 cards)
What does a sclerotic margin on a bone Xray mean?
Benign, slow growing neoplasm
What does an ill-defined margin on a bone Xray mean?
Malignant tumor
What does solid bone on a bone xray mean?
Malignant matrix forming tumors
What do rings/arcs on a bone xray mean?
Chondroid matrix forming tumors
Ostoid osteoma
- Long bones, femur, tibia, most likely knee
- <2 cm
- Night pain
- Responds to aspirin
- Radiolucent lesion with a sclerotic cortex
What is this?
Cells within an osteoid osteoma or osteoblastoma (hard to tell apart)
New bone cells forming
Osteoblastoma
- tumor in vertebrae, long bone metaphysis
- >2 cm, painful, not responsive to aspirin
Osteosarcoma
- malignant mesenchymal tumor that makes bone
- most common bone sarcoma
- metaphysis of long bone (knee)
- Hematogenous spread to lungs
Patho: mutant RB, p53 (Li Fraumeni), too much MDM2/INK4/p16, Paget disease/bone growth diseases, irradiation
Xray: Codman’s triangle; poorly defined, bone/cortical disruption into soft tissue
Prognosis: avg age 5 and 55-80, M>F; 60-65% live past 3-5 yr due to chemo and surgery
What is this?
Osteosarcoma
Cells in osteoid irregular, tripolar mitosis
Osteochondroma
- most common benign tumor of bone
- metaphysis
- malignancy chance increases with herditary multiple exotoses
- autosomal dominant (EXT 1 8q24 mutations)
Clinically: little bleb off side of cortex with marrow and cartilage cap
What is this?
Osteochondroma
Normal cartilage that has calcification and osteoid forming bone AND marrow
Endochondroma
- Benign hyaline cartilage lesion
- Endochondroma=intramedullary, periosteal=juxtacortical (under periosteum)
- Asym.
- Appendicular skeleton, small bones hands and feet
- Xrays=lytic, lobulated, cortical thinning
- Tx=none unless symptomatic or growth after skeleton matures
What is this?
Endochondroma
Lobules of hyaline cartilage with minimal atypia (no bone formation)
Ollier’s Disease
Multiple enchodromata, regional lesions, skeleton malformation
Multiple chrondromatosis due to pt mutations in IDH1 or IDH2
Maffucci’s Sx
Multiple enchondromata AND angiomata
Skeletal malformation and higher risk for malignancy
Multiple chondromatosis–point mutations in IDH1 or IDH2
Chondrosarcoma
- Malignant tumor; neoplastic cells make cartilaginous matrix
- 2nd most common bone sarcoma
- Older adults ages 60-70
- Central skeleton, humerus, femur
Imagining: medullary calcifications, cortical erosion/destruction, “popcorn”
Variant: de-differentiated=losing chondrad differentiation
What is this?
Chondrosarcoma
More cellular/pleomorphic nuceli than enchondromas
Myoxid changed matrix
Non ossifying fibroma
Common developmental cortical defect
incidental finding in tibia, femur 0-30
related to eccentric/lytic/peripheral sclerosis
What is this?
Non-ossifying fibroma
Dense fibrous tissue with collagen
Fibrous Dysplasia
Developmental arrest of bone
Monostatic=adolescents (rib, mandible, femur)
Polyostatic=infancy/childhood (crippling deformities, facial)
*includes McCune Albright Sx
Clinical: expansile, circumsized, thin cortex; looks like ground glass
What is this?
Fibrous Dysplasia
Randomly orientated woven bone “chinese characters” surrounded by fibroblast stroma
McCune Albright Sx
Polystotic FD with endocrinopathies and cafe au lait spots
- female > male
- sexual precocity, acromeagly, Cushing
- GNAS mutations increase cAMP which increase endocrine gland activity
Ewing Sarcoma/PNET
Second most malignant bone tumor in kids
- adolescents/young adults M>F –> diaphysis long tubular bones, ribs, pelvis
- painful enlarging mass
- Xray=moth eaten medullary lesion with large soft tissue mass; onion skin pattern periosteal growth (lines on xray)
- Pathogenesis: t11;22; EWS on 22q fused with FLI-1 factor on 11q
What is this?
Ewing Sarcoma/PNET
Small round blue cells with neural phenotype and glycogen that stain with CD99; no bone/cartilage matrix
