Tumor Flashcards
1
Q
Enneking IA
A
low grade intracompartmental
2
Q
Enneking IB
A
low grade extracompartmental
3
Q
Enneking IIA
A
high grade intracompartmental
4
Q
Enneking IIB
A
high grade extracompartmental
5
Q
Enneking III
A
has mets
6
Q
AEIOU and sometimes Y
A
diaphyseal bone lesions: adamantinoma, eosinophilic granuloma, infection, osteoid osteoma/osteoblastoma, Ewing’s, mYeloma/lYmphoma/fibrous dYsplasia
7
Q
MELT
A
vertebra plana: mets/myeloma, EG/ewings, lymphoma/leukemia, trauma/TB
8
Q
distinguishing between simple bone cysts and ABC on plain films
A
ABC are wider than the physis above them; simple bone cysts are not. ABC can look like osteoblastoma?
9
Q
LERNM
A
small round blue cell tumors: lymphoma, ewings, rhabdomyosarcoma, neuroblastoma, myeloma
10
Q
RACES
A
tumors that spread to lymph nodes: rhabdo, angiosarcoma, clear cell sarcoma, epithelioid, and synovial sarc
11
Q
the tumors that FNA is not the best for
A
the LERNM tumors, small round blue cells
12
Q
ewings immunostain
A
CD99
13
Q
lymphoma immunostain
A
CD45, CD20
14
Q
t(12;16)
A
myxoid liposarcoma
15
Q
t(11;22)
A
ewings
16
Q
t(x;18)
A
synovial sarc
17
Q
t(9;22)
A
myxoid chondrosarcoma
18
Q
t(2;13)
A
rhabdomyosarcoma
19
Q
general characteristics of tumors that don’t need XRT
A
low grade,
20
Q
these benign, locally aggressive, soft-tissue tumors have positivity for estrogen receptor B
A
extra-abdominal desmoid
21
Q
condition to associate with multiple rock-hard soft-tissue nodules
A
gardners (familial adenomatous polyposis) is 10,000x more likely to develop desmoid tumors
22
Q
painful, rapidly enlarging soft tissue mass in a young person
A
nodular fasciitis
23
Q
the 2 malignant fibrous tumors
A
malignant fibrous histiocytoma and fibrosarcoma
24
Q
histology of fibrosarcoma
A
herringbone spindle cells
25
histology of malignant fibrous histiocytoma
storiform spindle cells cartwheeling around slit-like vessels
26
difference bt pre and postop soft tissue tumor XRT
postop has fewer postop wound complications, but higher postop fibrosis
27
checklist for observation of a lipoma
No symptoms, and looks uniformly like a lipoma on all MRI sequences. If it is growing or symptomatic, cut it out
28
the histology of neural tumor with MRI snake-egg appearance
neurilemoma (benign schwannoma) has MRI appearance of eccentric mass in peripheral nerve. On histology there are the Antoni A and Antoni B. A has the palisading whorled cells.
29
the exception to the use of chemo in soft-tissue tumors
normally chemo is reserved for use in bone tumors. However, rhabdomyosarcoma is chemo-sensitive
30
this is the most common sarcoma in the young pt
rhabdomyosarcoma (good thing it is chemo sensitive...)
31
phleboliths
hemangioma
32
stuart-treves
lymphedema s/p BRCA mastectomy, leads to angiosarcoma
33
joints most affected by PVNS
knee, hip, shoulder
34
most common location for tumor associated with t(x;18)
synovial sarc is most common in the foot
35
on xrays alone, why synovial sarcoma and hemangioma might be confused
both have mineralization within the lesion, (up to 25% in synovial sarc) but the irregular contour of synovial sarc sets it apart from the round calcifications of hemangioma
36
this is the most common sarcoma of the hand
epithelioid
37
these immunostains are positive in the tumor resulting from SYT-SSX1
keratin and epithelial membrane antigen are positive in synovial sarcoma. SYT-SSX1 and 2 are the fusion proteins from t(x;18).
38
two physical exam findings that are concerning for a sarcoma that has spontaneously bled, or bled after minor trauma
lack of fascial plane tracking, and subcutaneous ecchymosis suggests that the bleeding is being contained by a pseudocapsule
39
scoliosis due to osteoid osteoma
lesion on the concave side, thought to be from paravertebral muscle spasm
40
MRI vs CT for osteoid osteoma
CT provides better contrast bt the lucent nidus and the reactive sclerosis
41
mgmt of osteoblastoma
curretage, or marginal resection
42
two exceptions to the rule of chemo for bone tumors
parosteal osteosarcoma and chondrosarcoma. Remember chondrosarc because for chemo to work there has to be fast turnover, and cartilage doesn't regenerate quickly
43
logic for using chemo in bone tumors
kills micromets, and sterilizes the reactive zone around the tumor
44
these are associated with multiple enchondromas of Maffuccis
soft tissue angiomas
45
risk of malignancy in Olliers
30%
46
concern in 10% of pts with EXT1 and EXT2 gene mutations
development of secondary chondrosarcoma. higher risk in EXT1
47
epiphyseal lesions
chondroblastoma, giant cell, clear cell (femoral head)
48
mgmt of chondroblastoma
curretage, bone grafting
49
rate of metastasis in benign chondroblastomas
2% will mets to the lungs
50
these metaphyseal fibrous defects can be observed
if an NOF is radiographically characteristic and has low risk of pathologic fx, you can watch them. If they are painful or involve >50% of the cortex, they need curettage and bone grafting
51
histology of MFH
abundant foamy cytoplasm, storiform fibrous tissue
52
recurrence rate in chordoma
high; how often can you get wide margin around the spine? So add radiation if necessary
53
appearance of vertebral hemangiomas
vertical striations
54
surgical mgmt of lymphoma
usually reserved for mgmt of fractures
55
medical mgmt of myeloma
bisphosphonates
56
rate of metastasis in giant cell
2% will mets to the lungs (interesting, bc this is other epiphyseal lesion along with chondroblastoma, which also has 2% mets rate to lungs)
57
mgmt of giant cell
curettage, adjunct therapy, reconstruction (bone graft, PMMA, etc)
58
when bone marrow biopsy is part of the treatment plan
in the staging of ewings. presumably to look for micromets, which portend the same prognosis as macromets
59
histology of adamantinoma
glandular appearance
60
75% of pts with ABC are this age
under 20 yo
61
histology of ABC
cavernous blood-filled spaces without endothelial lining
62
how mgmt might differ for UBC of the proximal femur and proximal humerus
UBC can be treated with aspiration and injection of steroid, but in the femur you would worry about fracture, so that would get curettage, bone graft, fixation
63
histology of EG
nests of bilobed histiocytes
64
genetic mutation in fibrous dysplasia
activating mutation of the GS alpha surface protein: increased production of cAMP
65
this plus skin abnormalities and multiple bone lesions equals McCune-Albright Syndrome
endocrine abnormalities
66
this treatment is never used in the grafting of fibrous dysplasia
autogenous grafting; it gets turned into fibrous tissue too quickly.
67
osteofibrous dysplasia vs fibrous dysplasia
OFD is predominantly a tibial lesion, has rimming Osteoblasts, and involves cOrtical bone
68
quiet Pagets with new onset pain
development of secondary osteosarc
69
osteofibrous dysplasia AKA
ossifying fibroma
70
medical mgmt of pagets dz
aimed at retarding the osteoclasts; bisphophonates and calcitonin
71
perioperative concern with arthroplasty in Pagets
should treat with bisphophonates to decrease bleeding at time of surgery
72
possible explanation for the most common locations of bony mets
Batson's venous plexus
73
mechanism for metastatic bone destruction
tumor releases PTHrP, which stimulates the release of RANKL from the osteoblasts, and G-CSF, both of which lead to osteoclast activation
74
this can differentiate bt benign lipoma and atypical lipomas
cytogenetic testing will show MDM2 ring chromosome
75
these have rimming osteoblasts
osteofibrous dysplasia and osteoblastoma
76
blooming artifact
hemosiderin
77
3 most common benign tumors of the wrist
ganglions, GCT of tendon sheath, and hemangiomas
78
histology of adamantinoma
stringy epithelial cells in fibrous stroma
79
translocation and fusion protein for rhabdomyosarcoma
t(2:13) PAX-FKHR
80
translocation and fusion protein for DFSP
t(17:22) PDGFB?
81
translocation and fusion for myxoid liposarc
t(12:16) TLS CHOP
82
t(12:16) TLS CHOP
translocation and fusion for myxoid liposarcoma
83
this can be stained for to mark desmoid tumors
nuclear Beta catenin
84
2 exceptions to the general mgmt of chondrosarcoma
- LOWgrade chondrosarc in the EXTREMITIES can be curetted and cemented; this is not the case everywhere else, when it gets widely excised.
- dedifferentiated chondrosarc benefits from chemo
85
when NOF is surgically managed and how
if NOF is painful or impending fracture, then it can be curetted
86
4 tumors for which the mgmt is ROUTINELY curettage and bone grafting
chondroblastoma, GCT, CMF, and osteoblastoma. Curette the motherfucking giant blasts
87
main issue with UBC mgmt
recurrence
88
true or false, osteosarc is the only type of secondary Pagetoid conversion
False; there are also chondrosarc and spindle cell sarc variants of malignant transformation in pagets
89
2 lesions that usually resolve by skeletal maturity (may not be the only ones...)
OFD, and UBC in the foot.
90
this can be confused for ABC (not everything with a fluid-fluid level is ABC...) but has immature bone on histo
telangiectatic osteosarcoma
91
this soft-tissue tumor does not need radiation, even if subfascial or >5cm
myxoma
92
gene in stone man (FOP)
ACVR
