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Trauma Conf/Education > Tumor > Flashcards

Tumor Flashcards

1
Q

What is the characteristic physical exam finding with desmoid tumors (extra-abdominal fibromatosis)?

A

Hard as rock

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2
Q

How might an epithelioid sarcoma present?

A

Small superficial nodule that may ulcerate

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3
Q

What is the reactive zone of a tumor?

A

An interface between the tumor and normal tissues. It contains edema fluid, inflammatory cells, fibrous tissue and tumor-cell satellites

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4
Q

When ordering an MRI to further evaluate a soft tissue lesion, should you order T1 or T2?

A

Both

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5
Q

Where do sarcomas most commonly metastasize?

A

Lung

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6
Q

What are the 2 prerequisites for limb-salvage procedure?

A
  1. Local control of the lesion will be at least equal to that achievable without salvage. 2. The salvaged limb will be functional
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7
Q

How often should MRI be performed after treatment of soft tissue tumor?

A

Baseline MRI 3 mo after sx then at 1 yr intervals for 5 years

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8
Q

How often should chest radiographs and chest CTs be performed after soft tissue tumor treatment?

A

At 3 mo intervals for 2 yrs then at 6 mo for 6 yrs. At 8 yrs get them once/yr

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9
Q

What are the 5 most common tumors that mets to bone?

A

PB KTL (Lead Kettle). Prostate, Breast, Kidney, Thyroid, Lung. Most are lytic lesions, some breast are blastic.

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10
Q

Where is the epicenter of most mets lesions?

A

Intramedullary canal. Rare to be intra or juxtacortical.

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11
Q

After a skeletal lesion has been identified, what should be done next?

A

Bone scan to determine whether lesion is isolated or multiple bones are involved.

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12
Q

What is difference between a stress-riser cortical perforations and open -section defect?

A

Stress riser is a cortical defect that is small than the cross sectional diameter of the bone. It dec torsional rigidity by 60%. Open section is larger than cross-sectional diameter and dec torsional rigidity by almost 90%

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13
Q

Effect of osteoblastic vs lytic lesion on strength and stiffness of bone?

A

Blastic dec stiffness of bone. Lytic lesion dec BOTH strength and stiffness.

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14
Q

What is the characteristic radiographic appearance of a non-ossifying fibroma (metaphyseal non ossifying fibroma)?

A

A lucent lesion that is metaphyseal , eccentric “bubbly” and surrounded by a sclerotic rim.

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15
Q

What is the most common benign bone tumor in childhood?

A

Non ossifying fibroma

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16
Q

What is the demographic, location and treatment for Non-ossifying fibroma?

A

Age 5-15, 80% in LE, most lesions resolve on own and observation is treatment. May need casting if risk of pathologic fracture. Lare symptomatic lesion may require curettage and bone graft

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17
Q

How might you distinguish a NOF from ABC or UBC?

A

NOF has hemosiderin on Histology

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18
Q

What benign lesion that is extremely rare may appear very similar to a NOF?

A

Benign fibrous histiocytoma

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19
Q

This lesion is seen in an 18 yo. Painful lesion. What is it and how treated?

A

Desmoplatic fibroma. Malignant low-grade tumor. Found in metaphysis ages 15-25. Wide surgical resection. Must remove joint in young patients

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20
Q

What is the most common soft tissue sarcma in ages 55-80?

A

MFH (malignant fibrous histiocytoma). This and fibrosarcoma are treated as same entity

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21
Q

Where do most chordomas present?

A

50% occur in sacrum and coccyx

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22
Q

What is a classic histologic appearance of a chordoma?

A

Foamy, vacuolated, physaliferous cells

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23
Q

How might someone with a chordoma present?

A

Insidious onset of back pain. May copmplain of pelvic pain or GI symptoms like constipation or loss of rectal tone.

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24
Q

Where do hemangiomas occur mostly?

A

Vertebral body…some in cranio-facial bones

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25
Q

What does this xray depict?

A

These are the characteristic vertical striations or “honey comb” appearance or “jail bar” appearance of a hemangioma in the vertebral bodies

26
Q

What are the three scenarios in which lymphoma presents in bone?

A

3 ways: 1. as solitary focus 2. as metastatic disease 3. mix bone and soft tissue

27
Q

When is surgery used to treat lymphoma?

A

To stabilize fractures or prophylactically treat them. Treatment for bony lymphoma is multi agent chemo +/-radiation

28
Q

What two tumor markers go along with lymphoma?

A

CD 20 and CD 45

29
Q

What is the radiographic description of lymphoma?

A

large ill-defined diffuse lytic lesions with a subtle mottled appearance

30
Q

Why must chordomas have a long follow up period?

A

Because they metastasize late

31
Q

What is the classic histologic appearance of multiple myeloma?

A

Sheets of plasma cells. When well differentiated the plasma cells have an eccentric nuclues and chromatic “clock faced” appearance.

32
Q

What is this?

A

The classic multiple myeloma histology. Eccentric nucleus with clock face appearance.

33
Q

What are the 3 plasma cell dyscrasias an orthopedist should know about? (myelomas)

A

Multiple myeloma, Solitary plasmacytoma, Osteosclerotic myeloma

34
Q

Radiographic appearance of multiple myeloma?

A

Punched out lytic lesions with ballooned appearance.

35
Q

What is the diagnostic criteria for a solitary plasmacytoma?

A
  • Solitary bone lesion
  • Histologic confirmation of a plasmacytoma
  • Bone marrow biopsy of <10% plasma cells

Important to distinguish from multiple myeolma bc has much better prognois. >50% progress to multiple myeloma.

36
Q

Bence jones protein are associated with what?

A

Multiple myeloma.

Pts may also have renal failure (inc Cr) and hypercalcemia

37
Q

M spike on electrophoresis?

A

Multiple myeloma. Mostly usually IgG, can be IgA or least commonly IgM

38
Q

What is osteosclerotic myeloma?

A

Rare variant of myeloma characterized by bone lesions that are associated with a chronic inflammatory demyelinating polyneuropathy

39
Q

How might someone with Osteosclerotic myeloma present?

A

Usually with sensory symptoms of tingling, pins and needles etc followed by motor weakness. Sensory an motor changes begin distally then progress proximal and are symmetric

40
Q

What is the acronym POEMS?

A

Related to osteosclerotic myeloma describing thier constellation of symptoms.

Polyneuropathy, Organomegaly, Endoncrinopathy, M-protein, Skin changes

41
Q

When there is concern for multiple myeloma, why is a skeletal survery so important?

A

Because bone scan may be “cold” in 30% of people

42
Q

What bone tumor is more common in women than in men?

A

Giant cell tumor

43
Q

What is the appearance and location of giant cell tumor?

A

Usually metaphysis extending to epiphysis and near subchondral bone. Purely lytic destructive lesion.

44
Q

What is the rare, but characteristic appearance of ewings sarcoma?

A

Onion skinn appearance from periosteum being lifted off in layers

45
Q

What chromosomal translocation is always present in Ewings?

A

11:22

46
Q

Histology of Ewings?

A

Small round blue cells

47
Q

What age group do we see Ewings?

A

5-25

48
Q

What workup is always part of Ewings workup that is not usually part of staging for osteosarcoma?

A

Bone marrow biopsy to rule out bone MARROW mets

49
Q

In what age group do we see ABC?

A

75% are <20

50
Q

Characteristics of ABC?

A

Reactive bone lesion with blood filled cavities. Expansile, eccentric and lytic lesion with bony septae (“bubbly appearance”). Classically have thin periosteal rim of new bone. MRI shows Fluid/fluid levels

51
Q

How does UBC usually present?

A

Usually with pain after a minimal trauma. From fracture caused by minor trauma.

52
Q

What age group for UBC and m/c location?

A

Age <20. Location is prox humerus

53
Q

What is the fallen leaf sign

A

“fallen leaf” sign is a pathologic fracture with fallen cortical fragment in base of empty cyst is pathognomonic for UBC

54
Q

Treatment for ABC vs UBC

A

In general ABC requires curettage, and UBC is steroid injection.

55
Q

Which is more expansile, ABC or UBC?

A

ABC may be wider than physis. UBC is generally no wider than the physis

56
Q

What bone lesion has a histology described as alphabet soup and chinese letters?

A

Fibrous dysplasia

57
Q

Pts with fibrous dysplasia may have what type of skin involvement?

A

Yellow or brown spots like cafe au lait spots

58
Q

When bone lesions and endocrine abnormalities, especially precocious puberty, are found together with skin abnormalitites, this is called what?

A

Mcune Albright syndrome. The bone lesions are likely fibrous dysplasia.

59
Q

Gene mutation with fibrous dysplasia?

A

GSalpha

60
Q

Most common location for UBC

A

Prox humerus

Trauma Conf/Education (7 decks)

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