Tumors 4

Question 1

Ewing’s Tumor: Malignant neoplasm arising from __ cell of __ reticulum. Included histologically as a __ cell lesion in group with myeloma, lymphosarcoma, leukemia, and reticulum cell carcinoma. Next MC primary malignancy of bone after ___.

Answer 1

stem
marrow
round
chondrosarcoma

Question 2

Ewing’s: MC: Sex, age

Answer 2

M>F 2:1

most age 5-30 with peak at 15

Question 3

Ewing’s: MC sites

Answer 3

Long bones in younger patients, flat bones in older

-often diaphyseal

Question 4

Ewing’s: Typical Periosteal Rxn?

Answer 4

Onion skin

• often with large soft tissue component
• GRIM prognosis, improved recently with better chemo.

Question 5

Non-Hodgkin Lymphoma (NHL): Primary NHL may represent tumors of post-germinal center __-cells. WHat is stage 1?

Answer 5

Primary lesion only (node, bone, other)

Question 6

NHL Stage 2

Answer 6

Nodes involved in more than 2 anatomic regions on the same side of the diaphragm

Question 7

NHL Stage 3

Answer 7

Nodes involved on both sides of the diaphragm

Question 8

NHL Stage 4

Answer 8

Bony Mets

Question 9

NHL: 4 grades

Answer 9

Low grade
Intermediate grade
High Grade
Miscellaneous

Question 10

Plasma cell (Multiple) Myeloma (MM): MAlignant proliferation of \_\_ cells with infiltration of \_\_ \_\_
***MC primary malignant bone tumor of bone!***

Answer 10

plasma

bone marrow

Question 11

2 presentations of Plasma Cell (Multiple) Myeloma

Answer 11

MM- 75%
Plasmacytoma (25%)
-Most pts. with plasmacytoma will develop MM

Question 12

MM S&S

Answer 12

Bone pain, esp back and chest- red marrow!
weakness
weight loss
fever, bleeding, and neurologic signs may be present

Question 13

MM: Lab Findings

Answer 13

Serum protein electrophoresis + in 80-90% pts.
Bence-jones proeinuria in 40-60% pts
-lab may be normal w/ plasmacytoma

Question 14

MM: Xray findings; What kind of lesions? Sclerotic margin?

Answer 14

-discrete, well circumscribed lytic lesions without sclerotic margin (punched out)
-vertebral collapse and/or path fx common
-

Question 15

Plasmacytoma: Lesion type? What kind of appearance?

Answer 15

Expansile, geopraphic, lytic

Soap-Bubble appearance

Question 16

Osteosarcoma: 2nd MC primary bone malignancy. __% of all bone malignancies. MC ages? MC sex?

Answer 16

20
75% between 10-25 years
2:1 M:F

Question 17

Osteosarcoma: Elevated __ __

Answer 17

Alkaline Phosphatase

Question 18

Osteosarcoma Subtypes

Answer 18

Conventional
Parosteal
Periosteal
Multicentric

Question 19

Osteosarcoma MC sites:

Answer 19

Knee and prox. humerus- reported everywhere

• Metaphysis
• rare in spine

Question 20

Osteosarcoma pattern distribution

Answer 20

50% sclerotic
25% lytic
25% mixed
-soft tissue mass w/ calcification and/or ossification
-bone to bone metastasis not common
-multiple primaries rare

Question 21

Osteosarcoma lesion pattern

Answer 21

Classically Sunburst/ Spiculated

permeative/ moth eaten

Question 22

Osteosarcoma: treatment

Answer 22

Amputation and chemo

Question 23

Parosteal Osteosarcoma AKA

Answer 23

Juxtacortical sarcoma

Question 24

Parosteal Osteosarcoma: MC ages, MC sites

Answer 24

2nd-4th decade
Almost exclusively long bones
-Usually femur (92%), tibia and humerus
-most of remaining in fibula, radius, and ulna

Question 25

2 types of juxtacortical sarcomas

Answer 25

Parosteal Osteosarcoma | Periosteal Osteogenic sarcoma

Question 26

Parosteal Osteosarcoma: WHat sign is associated with this?

Answer 26

Tumor grows along/around bone, wider than base= "String Sign" of radiolucency between tumor and adjacent cortex -also may be "daughter masses"

Question 27

Parosteal Osteosarcoma: MAtrix of lesion

Answer 27

- non-homogenous, spiculated matrix | - tumor does not outgrow base

Question 28

Parosteal Osteosarcoma: Classic x-ray chatracteristic

Answer 28

cloud like ossification posterior to distal femur

Question 29

Chondrosarcoma: Malignant lesion of ___ origin. May arise in any bone preformed in __. MC sites?

Answer 29

``` chondroblastic cartilage Inominate- 27% Prox. Femur- 22% Ribs- 14% ```

Question 30

Chondrosarcoma: MC Ages

Answer 30

50% > 40 y/o | remaining 50% in 20-40 y/o range

Question 31

Chondrosarcoma: MC sex, clinical manifestations

Answer 31

``` Males 2:1 Palpable, hard mass may be present low grade, local pain slow growing, over years metastasizes late ```

Question 32

Chondrosarcoma: MC sites

Answer 32

Prox. femur and pelvis- 50% Long tubular bones 45% Ribs 15% Shoulder 13%

Question 33

Chondrosarcoma: Lesion type, name of classic calcification?

Answer 33

Geographic, expansile- may be large (remember pic. of the big ass mass on the leg) Calcification of matrix common *"Popcorn" or "Rings and broken rings"