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ABOS PART ONE > Tumor > Flashcards

Tumor Flashcards

1
Q

Enneking IA

A

low grade intracompartmental

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2
Q

Enneking IB

A

low grade extracompartmental

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3
Q

Enneking IIA

A

high grade intracompartmental

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4
Q

Enneking IIB

A

high grade extracompartmental

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5
Q

Enneking III

A

has mets

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6
Q

AEIOU and sometimes Y

A

diaphyseal bone lesions: adamantinoma, eosinophilic granuloma, infection, osteoid osteoma/osteoblastoma, Ewing’s, mYeloma/lYmphoma/fibrous dYsplasia

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7
Q

MELT

A

vertebra plana: mets/myeloma, EG/ewings, lymphoma/leukemia, trauma/TB

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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?

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9
Q

LERNM

A

small round blue cell tumors: lymphoma, ewings, rhabdomyosarcoma, neuroblastoma, myeloma

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10
Q

RACES

A

tumors that spread to lymph nodes: rhabdo, angiosarcoma, clear cell sarcoma, epithelioid, and synovial sarc

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11
Q

the tumors that FNA is not the best for

A

the LERNM tumors, small round blue cells

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12
Q

ewings immunostain

A

CD99

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13
Q

lymphoma immunostain

A

CD45, CD20

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14
Q

t(12;16)

A

myxoid liposarcoma

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15
Q

t(11;22)

A

ewings

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16
Q

t(x;18)

A

synovial sarc

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17
Q

t(9;22)

A

myxoid chondrosarcoma

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18
Q

t(2;13)

A

rhabdomyosarcoma

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19
Q

general characteristics of tumors that don’t need XRT

A

low grade,

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20
Q

these benign, locally aggressive, soft-tissue tumors have positivity for estrogen receptor B

A

extra-abdominal desmoid

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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

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22
Q

painful, rapidly enlarging soft tissue mass in a young person

A

nodular fasciitis

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23
Q

the 2 malignant fibrous tumors

A

malignant fibrous histiocytoma and fibrosarcoma

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24
Q

histology of fibrosarcoma

A

herringbone spindle cells

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25
Q

histology of malignant fibrous histiocytoma

A

storiform spindle cells cartwheeling around slit-like vessels

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26
Q

difference bt pre and postop soft tissue tumor XRT

A

postop has fewer postop wound complications, but higher postop fibrosis

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27
Q

checklist for observation of a lipoma

A

No symptoms, and looks uniformly like a lipoma on all MRI sequences. If it is growing or symptomatic, cut it out

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28
Q

the histology of neural tumor with MRI snake-egg appearance

A

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.

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29
Q

the exception to the use of chemo in soft-tissue tumors

A

normally chemo is reserved for use in bone tumors. However, rhabdomyosarcoma is chemo-sensitive

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30
Q

this is the most common sarcoma in the young pt

A

rhabdomyosarcoma (good thing it is chemo sensitive…)

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31
Q

phleboliths

A

hemangioma

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32
Q

stuart-treves

A

lymphedema s/p BRCA mastectomy, leads to angiosarcoma

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33
Q

joints most affected by PVNS

A

knee, hip, shoulder

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34
Q

most common location for tumor associated with t(x;18)

A

synovial sarc is most common in the foot

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35
Q

on xrays alone, why synovial sarcoma and hemangioma might be confused

A

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

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36
Q

this is the most common sarcoma of the hand

A

epithelioid

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37
Q

these immunostains are positive in the tumor resulting from SYT-SSX1

A

keratin and epithelial membrane antigen are positive in synovial sarcoma. SYT-SSX1 and 2 are the fusion proteins from t(x;18).

38
Q

two physical exam findings that are concerning for a sarcoma that has spontaneously bled, or bled after minor trauma

A

lack of fascial plane tracking, and subcutaneous ecchymosis suggests that the bleeding is being contained by a pseudocapsule

39
Q

scoliosis due to osteoid osteoma

A

lesion on the concave side, thought to be from paravertebral muscle spasm

40
Q

MRI vs CT for osteoid osteoma

A

CT provides better contrast bt the lucent nidus and the reactive sclerosis

41
Q

mgmt of osteoblastoma

A

curretage, or marginal resection

42
Q

two exceptions to the rule of chemo for bone tumors

A

parosteal osteosarcoma and chondrosarcoma. Remember chondrosarc because for chemo to work there has to be fast turnover, and cartilage doesn’t regenerate quickly

43
Q

logic for using chemo in bone tumors

A

kills micromets, and sterilizes the reactive zone around the tumor

44
Q

these are associated with multiple enchondromas of Maffuccis

A

soft tissue angiomas

45
Q

risk of malignancy in Olliers

A

30%

46
Q

concern in 10% of pts with EXT1 and EXT2 gene mutations

A

development of secondary chondrosarcoma. higher risk in EXT1

47
Q

epiphyseal lesions

A

chondroblastoma, giant cell, clear cell (femoral head)

48
Q

mgmt of chondroblastoma

A

curretage, bone grafting

49
Q

rate of metastasis in benign chondroblastomas

A

2% will mets to the lungs

50
Q

these metaphyseal fibrous defects can be observed

A

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
Q

histology of MFH

A

abundant foamy cytoplasm, storiform fibrous tissue

52
Q

recurrence rate in chordoma

A

high; how often can you get wide margin around the spine? So add radiation if necessary

53
Q

appearance of vertebral hemangiomas

A

vertical striations

54
Q

surgical mgmt of lymphoma

A

usually reserved for mgmt of fractures

55
Q

medical mgmt of myeloma

A

bisphosphonates

56
Q

rate of metastasis in giant cell

A

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
Q

mgmt of giant cell

A

curettage, adjunct therapy, reconstruction (bone graft, PMMA, etc)

58
Q

when bone marrow biopsy is part of the treatment plan

A

in the staging of ewings. presumably to look for micromets, which portend the same prognosis as macromets

59
Q

histology of adamantinoma

A

glandular appearance

60
Q

75% of pts with ABC are this age

A

under 20 yo

61
Q

histology of ABC

A

cavernous blood-filled spaces without endothelial lining

62
Q

how mgmt might differ for UBC of the proximal femur and proximal humerus

A

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
Q

histology of EG

A

nests of bilobed histiocytes

64
Q

genetic mutation in fibrous dysplasia

A

activating mutation of the GS alpha surface protein: increased production of cAMP

65
Q

this plus skin abnormalities and multiple bone lesions equals McCune-Albright Syndrome

A

endocrine abnormalities

66
Q

this treatment is never used in the grafting of fibrous dysplasia

A

autogenous grafting; it gets turned into fibrous tissue too quickly.

67
Q

osteofibrous dysplasia vs fibrous dysplasia

A

OFD is predominantly a tibial lesion, has rimming Osteoblasts, and involves cOrtical bone

68
Q

quiet Pagets with new onset pain

A

development of secondary osteosarc

69
Q

osteofibrous dysplasia AKA

A

ossifying fibroma

70
Q

medical mgmt of pagets dz

A

aimed at retarding the osteoclasts; bisphophonates and calcitonin

71
Q

perioperative concern with arthroplasty in Pagets

A

should treat with bisphophonates to decrease bleeding at time of surgery

72
Q

possible explanation for the most common locations of bony mets

A

Batson’s venous plexus

73
Q

mechanism for metastatic bone destruction

A

tumor releases PTHrP, which stimulates the release of RANKL from the osteoblasts, and G-CSF, both of which lead to osteoclast activation

74
Q

this can differentiate bt benign lipoma and atypical lipomas

A

cytogenetic testing will show MDM2 ring chromosome

75
Q

these have rimming osteoblasts

A

osteofibrous dysplasia and osteoblastoma

76
Q

blooming artifact

A

hemosiderin

77
Q

3 most common benign tumors of the wrist

A

ganglions, GCT of tendon sheath, and hemangiomas

78
Q

histology of adamantinoma

A

stringy epithelial cells in fibrous stroma

79
Q

translocation and fusion protein for rhabdomyosarcoma

A

t(2:13) PAX-FKHR

80
Q

translocation and fusion protein for DFSP

A

t(17:22) PDGFB?

81
Q

translocation and fusion for myxoid liposarc

A

t(12:16) TLS CHOP

82
Q

t(12:16) TLS CHOP

A

translocation and fusion for myxoid liposarcoma

83
Q

this can be stained for to mark desmoid tumors

A

nuclear Beta catenin

84
Q

2 exceptions to the general mgmt of chondrosarcoma

A
  • 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
Q

when NOF is surgically managed and how

A

if NOF is painful or impending fracture, then it can be curetted

86
Q

4 tumors for which the mgmt is ROUTINELY curettage and bone grafting

A

chondroblastoma, GCT, CMF, and osteoblastoma. Curette the motherfucking giant blasts

87
Q

main issue with UBC mgmt

A

recurrence

88
Q

true or false, osteosarc is the only type of secondary Pagetoid conversion

A

False; there are also chondrosarc and spindle cell sarc variants of malignant transformation in pagets

89
Q

2 lesions that usually resolve by skeletal maturity (may not be the only ones…)

A

OFD, and UBC in the foot.

90
Q

this can be confused for ABC (not everything with a fluid-fluid level is ABC…) but has immature bone on histo

A

telangiectatic osteosarcoma

91
Q

this soft-tissue tumor does not need radiation, even if subfascial or >5cm

A

myxoma

92
Q

gene in stone man (FOP)

A

ACVR

ABOS PART ONE (11 decks)

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