Trigger - Bone Disease Flashcards by Billie Roberts

where are places that bone metastases may originate from

breasts
prostate
lungs
thyroid
kidneys

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what do you order to assess if bone cancer has metastasized to the thorax

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If you are planning to biopsy a bone tumor, what imaging would you order

MRI w contrast!!

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benign bone tumor originating from osteoblasts

osteoid osteoma

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what is the MC location for osteoid osteoma

femur!

tibial and humeral shaft also common

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this cancer presents with pain due to a “nidus” secreting prostaglandins

osteoid osteoma

osteoblastoma

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worse with activity and ETOH!!
improves with NSAIDs and ASA

osteoid osteoma

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You have a 25M patient with a limp and referred pain to their knee. Their dull, aching, pain is worse at night, but it gets better if he takes an aspirin. The doctor says he has a benign bone tumor that builds bone. He forgot the name of it. Although this is an atypical presentation of it, the bone tumor you suspect is…

osteoid osteoma

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presents with hip pain with walking that has caused a limp. Pain radiates to the knee and is made better with aspirin or NSAIDs.

osteoid osteoma

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radio-opaque area of a bone that is described as a “bell” surrounded by sclerotic/calcified bone

Osteoid osteoma

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What are indications for ordering a CT w IV contrast after visualizing a osteoid osteoma on XR

XR appears abnormal but nidus isnt visible
residual or recurent tumor present
tumor located in critical area (spine or femoral neck)

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A 19y/o M patient presents with constant dull, aching pain in his left thigh. He reports its worse at night and wakes him from sleep and improves with NSAIDs or aspirin. you order an XR which is clear. what other scans could you order and what would you see

CT w/IV contrast (WITHHHH, doesnt say what youd see)
radionuclide scanning aka bone scan (double density sign)
MRI w/gadolinium (only if cant get CT either)

this is osteoid osteoma

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double density sign on bone scan

osteoid osteoma

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What is the treatment & prognosis for osteoid osteoma

NSAIDs w serial imaging Q 4-6 mo
if uncontrolled pain, limp or scoliosis occur refer to surgery
untreated (nonsurgical) patients will resolve spontaneously

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MC location for this tumor is the posterior column of the spine

spinous processes, lamina, pedicles

osteoblastoma

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This diagnosis has a Nidus that is >2cm and is NOT relieved w NSAID use

osteoblastoma

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XR of lesion on the posterior spine shows Well-circumscribed, radiolucent nidus > 2 cm

osteoblastoma

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CT is indicated in ALL patients dianosed with this disease

osteoblastoma

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If a patient has a osteoblastoma that extends into the soft tissue, bone marrow and spine. What imaging do you order?

MRI

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Tx for osteoblastoma

surgical resection (curettage and burring followed by bone grafting)

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MC solitary benign bone tumor

osteochondroma

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cartilage capped bony projection on the external surface of a bone

osteocartilaginous exostosis

osteochondroma (benign)

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MC in the knee or proximal humerus

adjacent to epiphyseal plates… ceases when growth stops

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osteochondroma

Assocaited with HMO which causes a genetic mutation in the tumor suppressor genes EXT1 and EXT 2

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osteochondroma

hereditary multiple osteochondromas

bone spur extending away from a joint

osteochondroma

A patient with a known osteochondroma comes in for their yearly check up. you note that the tumor has grown, what do you order?

MRI

benign cartilage forming tumors that develop in the bone marrow of long bones

enchodroma | "ENside the bone"

MC in the hands and feet

enchondromas

XR shows centrally located round lesion that is well circumsized with lobulations inside of it. It has a sclerotic border

enchondroma

MC occurs in the epiphysis of proximal humerus

chondroblastoma

Small, well-defined lesions with a sclerotic border than may cross the physis/growth plate

chondroblastoma

what is the management for chondroblastoma

curettage and bone grafting BIOPSY prior to surgery!

this disease can lead to benign pulm mets, monitor with CXR or CT w/ con if very sus.

chondroblastoma

Associated with McCune albright syndrome

fibrous dysplasia

Varus deformity of the proximal femur, a shepherd’s crook

fibrous dysplasia

Spongy-like appearance on CT of of the orbits, jaw, and cranial base might suggest

fibrous dysplasia

ground glass appearance on XR with thin cortical bone and possible bowing

fibrous dysplasia

Must do a bone scan once this disease is diagnosed

fibrous dysplasia

what is the management of fibrous dysplasia

Curettage and bone grafting (adults only) IV bisphosphonates

can present w facial asymmetry due to hemicranial involveemnt

fibrous dysplasia

MC in the tibia and fibula for kids and the mandible in adults

ossifying fibroma

XR shows Cortex thinned with multiple lytic lesions of lucency and well circumscribed intracortical lesions

ossifying fibroma

MC benign bone lesion in children

nonossifuying fibromas

Small, well-defined, eccentric, lytic lesions, found in Distal diaphysis/metaphysis, Can have multiple

non ossifying fibroma

Pathologic fx caused by these may have a fallen leaf or fallen fragment sign. this disease is typically asymptomatic until the pathologic fracture occurs!!

unicameral bone cysts

Well-defined cystic lesion at metaphysis or metadiaphysis that generally involved the ENTIRE diameter of the bone!

unicameral bone cysts

What is the treatment if you are worried about fracture for unicameral bone cysts

aspiration w injection of methylprednisolone or bone marrow. curettage and grafting reserved for very large cysts

benign, rapidly growing but destructive cysts filled with blood

aneurysmal cyst

MC occurs in the tibia and femur

aneurysmal bone cysts

Aggressive, expansile, lytic metaphyseal lesion with sharp borders and an eggshell sclerotic rhim. has a soap bubble appearance

aneurysmal bone cysts

MC MALIGNANT bone tumor

osteosarcoma

XR shows: moth eaten appearance Starburst appearance Codman’s triangle

osteosarcoma

After the age of 50 MC in Pelvic and shoulder girdles

chondrosarcomas

XR: Bony contour is thinned and expanded Endosteal scalloping Lesion often > 5 cm

chondrosarcoma

chromosomal translocation between 11 and 22

Ewing Sarcoma

XR shows: Poorly marginated destructive lesion Onion skin appearance

Ewing Sarcoma

Trigger - Bone Disease Flashcards

(56 cards)