Test #2 Flashcards by Caleb Spreiter

3rd M/C primary osseous malignancy. Characterized by the formation of cartilage.

Chondrosarcoma

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Chondrosarcoma is the M/C primary malignant bone tumor of what locations?

Hand
Sternum
Scapula

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Secondary chondrosarcoma’s are a result of malignant degeneration of what two tumors?

Enchondroma

Osteochondroma

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What age group/gender are M/C’ly affected by chondrosarcomas?

40-60yoa, Males

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What is the most frequent complaint assoc. w/ chondrosarcoma?

Dull pain w/ an avg duration of several years

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M/C sites of chondrosarcoma?

Distal femur (M/C)
Pelvis
Prox. humerus
Ribs, sternum
Scapula

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Which part of the bone is chondrosarcoma usually found?

Usually metaphyseal but may be diaphyseal

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What are the radiographic features of chondrosarcoma?

Well-marginated, expansile, osteolytic lesion
Cortex may be thick or thin
Punctate, flocculent, circular, ring-like matrix
Occasional periosteal response
May have endosteal scalloping

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What are radiographic signs of an advanced chondrosarcoma?

Cortical destruction

Soft tissue mass demonstrating calcification

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What is high grade vs. low grade differentiation of a chondrosarcoma based on?

Tumor margins
Cortical destruction
Patterns of calcification
Soft tissue involvement

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What are complications assoc. w/ chondrosarcoma?

Slow growing w/ late metastasis hematogenously to the lungs

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What is the ddx assoc w/ chondrosarcoma?

Prox. enchondroma

Giant-cell tumor if calcification is lacking

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M/C benign skeletal growth. Cartilaginous-capped bony growth off the surface of the bone

Osteochondroma AKA Osteocartilaginous exostosis

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How long does an osteochondroma grow?

Till maturity

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What are the 3 types of presentations for an osteochondroma?

Solitary osteochondroma
Multiple osteochondromas
HME (Hereditary multiple exostosis)

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What is the M/C age range for an onsteochondroma?

10-20 years of age

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What is the M/C complaint w/ osteochondroma?

hard painless mass near a joint

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What can osteochondroma degenerate to?

Chondrosarcoma

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What are the M/C locations for osteochondroma?

Distal femur

Prox. tibia

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Where is osteochondroma found in the long bones? Spine?

Metaphysis; Secondary centers of ossification

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What are the M/C locations for a pedunculated osteochondroma?

Knee
Hip
Ankle

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What type of osteochondroma is a osteocartilaginous cap on a long narrow stalk?

Pedunculated

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What type of osteochondroma has a broad base w/ localized widening of shaft?

Sessile

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What is it called when an osteochondroma points away from the joint?

Coat Hanger exostosis

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What is diaphyseal aclasia AKA?

Hereditary Multiple Exostosis (HME)

What is Hereditary Multiple Exostosis?

Multiple osteochondromas mainly in the metaphysis

When is Hereditary Multiple Exostosis M/C'ly discovered?

b/w ages 2-10

What are characteristics of Hereditary Multiple Exostosis?

Hard, painless masses near joint Bone deformity Usually bilateral & symmetrical

What deformity is assoc. w/ Hereditary Multiple Exostosis?

Bayonet hand deformity

What are the characteristics of Bayonet Hand deformity?

Shortening of the ulna Outward bowing of radius Subluxation of radio-ulnar joint

Where is Hereditary Multiple Exostosis M/C'ly found?

Long bones especially of the lower extremity

This is a benign tumor of cartilage. Originates from a cartilage displaced from the epiphyseal plate

Enchondroma AKA Chondroma

What enchondroma locations have greater potential for malignant degeneration?

Lesions located near the axial skeleton

What are two cartilaginous tumors that tend to b/co malignant?

Enchondroma | Osteochondroma

When is the greatest incidence of enchondromas?

b/w 2nd & 5th decade

How is an enchondroma discovered typically?

After a path fx

What is the M/C site for enchondroma?

Short tubular bones of hands

What are the radiographic features of enchondromas?

``` Well marginated geographic lesions Thin or thick cortex Endosteal scalloping Often expansile Matrix calcification ```

What are two characteristics that indicate a cartilaginous tumor?

Matrix calcification | Endosteal scalloping

Multiple enchondromatosis is AKA?

Ollier's disease

What is multiple enchondromatosis (Ollier's disease)?

Osseous dysplasia characterized by hypertrophic cartilage that hasn't been resorbed or ossified normally

What age is multiple enchondromatosis (Ollier's disease) typically found?

Before 10yrs of age

What are the s/s of multiple enchondromatosis (Ollier's disease)?

Marked shortening of the extremities Severe deformity, deforming masses Facial asymmetry

What syndrome is assoc. w/ multiple enchondromatosis (Ollier's disease)?

Maffucci syndrome

What are the characteristics of Maffucci syndrome?

Enchondromas | Cavernous hemangiomatosis

Where is multiple enchondromatosis (Ollier's disease) found?

In Metaphyses & shafts of tubular bones

What are radiographic characteristics of multiple enchondromatosis (Ollier's disease)?

Rounded or linear radiolucencies Lesions are expansile w/ or w/o matrix calcification Bone shortening & deformity d/t eccentric growth

This is an uncommon bone tumor originating from chondroblasts in the epiphyseal cartilage plate

Chondroblastoma AKA Codman's tumor

What is the peak age range for a chondroblastoma?

10-25 yrs of age

What are the s/s of a chondroblastoma?

Joint pain, tenderness, heat, swelling Limitation of motion Weakness, numbness, & muscle atrophy

What are the M/C sites for a chondroblastoma?

``` Distal femur Prox. tibia Upper humerus Femoral head & greater trochanter Distal tibia ```

What are the radiographic signs of chondroblastoma?

Well demarcated, oval or round radiolucency Most are eccentric & may expand the cortex Matrix calcification on occasion Thin, sharply demarcated sclerotic margin is characteristic

Chondroblastoma can mimic what?

A subchondral cyst

What are complications assoc. w/ a chondroblastoma?

Formation of secondary ABC | Malignant degeneration after radiation tx

This is a primary malignant bone tumor that doesn't form neoplastic osteoid or cartilage

Fibrosarcoma

What are the two types of fibrosarcoma?

Medullary or central (M/C) | Periosteal

What are the two M/C malignancies seen in Paget's?

Osteosarcoma (M/C) | Fibrosarcoma

What is the M/C age to see fibrosarcoma?

30-50yrs of age

What is the chief complaint seen w/ fibrosarcoma?

Progressive local pain & swelling

What may be the initial presentation of a fibrosarcoma?

Pathologic fx

Where are the M/C locations to find a fibrosarcoma?

Longs bones in younger pts Flat bones in older pts 50% occur around the knee

What are radiographic signs of fibrosarcoma?

majority eccentric medullary lesions metaphysis that may extend into epiphysis Expanding osteolytic lesion Cortical thinning w/ endosteal scalloping

What is are two characteristic signs of fibrosarcoma?

Cortical disruption w/ large soft tissue mass | May see bone sequestration

What is a complication of fibrosarcoma?

hematogenous metastasis to lungs & central skeleton

What is the ddx for fibrosarcoma?

Giant cell tumor

This is a common benign tumor arising from fibrous tissue

Non-ossifying fibroma

What is the peak age range for a NOF?

8-20 (M>F); Pt < 10 FCD, Pt >10 NOF

What are the S/S assoc w/ NOF?

Mostly asymptomatic Large lesions often cause persistent pain Path. fx may occur

What is the M/C location for a NOF to occur?

Lower extremity (distal tibia/diametaphyseal)

What does a NOF look like radiographicaly?

Eccentric, ovoid radiolucency | Long axis paralleling the long axis of the bone

What is a fibrous cortical defect AKA?

Caffey's defect Subperiosteal cortical defect Fibrous xanthoma

Where does a FCD originate in the bone?

Periosteum of the metaphysis

What is the peak age range for a FCD?

4-8 yrs of age (M>F)

What is the M/C location for a FCD?

pos. med. aspect of the distal femoral metaphysis

What is the radiographic features of a FCD?

Small, ovoid, cortical radiolucency Avg. size is 1-2cm Long axis parallels long axis of the bone Lobulation or slight bulging of the cortex

This is an uncommon, slow growing, midline tumor arising from remnants of the notochord

Chordoma

What is the M/C age for chordoma?

30-70 yrs of age; M>F

What symptoms are assoc w/ a chordoma that has a sacrococcygeal location?

Constipation Urinary dysfunction Perineal pain or numbness

What symptoms are assoc w/ a chordoma that has a spheno-occipital location?

``` Increased intracranial pressure Headache Pontine & bulbar s/s Ocular disturbances hemiparesis Ataxia ```

What is the M/C locations for a chordoma?

Sacrococcygeal Clivus Vertebrae

What is unique about chordomas and joints?

They may cross joints

What is the main ddx for chordoma?

Osteolytic metastasis

This is a quasimalignant tumor that is derived from connective skeletal tissue. AKA osteoclastoma

Giant Cell Tumor

Of the 4 non-malignant painful tumors, Giant cell tumor is the one least likely to involve what area of the body?

The spine

What is the M/C age & gender affected by Giant cell?

20-40 yrs F>M (malignant ones are predominant in males)

What are S/S assoc. w/ a Giant Cell?

Intermediate dull ache Sometimes a palpable, tender mass May affect contiguous joint Path fx may develop

What lab studies should be used to rule out a brown tumor from a Giant Cell?

Serum calcium Serum phosphorus Alkaline phosphatase

What is the M/C location for a Giant Cell?

Distal femur Prox. tibia Distal radius Sacrum (M/C spinal site)

What is the M/C benign tumor of the sacrum?

Giant Cell tumor

What is the M/C neoplasm of the patella?

Giant Cell tumor

Where do malignant Giant Cell tumors tend to show up, especially if male?

Distal radius

What is the classic appearance of giant cell?

Roundish, moderate-sized, expansile, radiolucent lesion extending to the subarticular surface

What are the radiographic features of a Giant Cell tumor?

Margin fairly well defined Cortex is expanded & thin Typically no periosteal response Cortex may be destroyed w/ soft tissue invasion

What is the ddx for giant cell tumor?

``` Metastatic disease (older pt) Plasmacytoma Fibrosarcoma Chrondrosarcoma ABC ```

This is the M/C benign tumor of the spine. Benign tumor arising from newly formed blood vessels

Hemangioma

What is the M/C type of hemangioma?

Cavernous

What are the S/S assoc. w/ hemangioma?

Majority are asymptomatic May complain of vague intermittent pain Compression fx

What are the M/C locations for a hemangioma?

Spine | Skull

What are the M/C locations in the spine for hemangioma?

Lower thoracic | Upper lumbar

What is the M/C bone in the skull for a hemangioma?

Frontal bone

What is the radiographic appearance of a hemangioma?

Corduroy-cloth appearance in spine Usually solitary Sunburst or spoke-wheel appearance in the skull

What is the ddx w/ hemangioma?

Pagets disease | Osteoporosis

This is a fluid filled cyst w/ a fibrous wall

Simple Bone Cyst

What is a SBC AKA?

Unicameral bone cyst Solitary bone cyst Juvenile bone cyst

What are the 2 types of SBC?

Active: adjacent to growth plate Latent: displaced away from growth plate

What is the peak age affect w/ a SBC?

3-14 yrs of age (M>F)

What is the M/C symptom of a SBC?

Path fx

What are the M/C locations of a SBC?

Metaphysis of prox. humerus, prox. femur | Centrally located

What is the classic appearance of a SBC?

Moderate to large expansile lesion broader at the metaphysis than at the diaphysis (truncated cone appearance)

What sign is assoc. w/ a SBC?

Fallen fragment sign

Test #2 Flashcards

(110 cards)