Tumors of Bone and Cartilage (C-Hand) Flashcards Preview

MS/Rheum > Tumors of Bone and Cartilage (C-Hand) > Flashcards

Flashcards in Tumors of Bone and Cartilage (C-Hand) Deck (82):
1

Malignant tumors occurring in the diaphysis

Ewing’s sarcoma and chondrosarcoma

2

Benign tumors occurring in the diaphysis:

enchondroma and fibrous dysplasia

3

Malignant metaphysis lesions:

osteosarcoma and juxtacortical osteosarcomas

4

Benign conditions and tumors of metaphysis:

1. non-ossifying fibroma

2. osteoid osteoma

3. giant cell tumors

4. osteoblastoma

5. chondromyxoid fibroma

6. osteochondroma

 

(NO-GO-ChO)

5

Benign epiphysis lesions:

chondroblastoma and giant cell tumors

6

Fibrous dysplasia: 3 Patterns

1. monostotic: single bone involved
2. polyostotic: multiple bones involved
3. McCune Albright syndrome: polyostotic, café-au-lait skin pigmentation, endocrinopathies

7

Fibrous dysplasia: histology

loose whorled pattern of fibroblastic tissue with irregular spicules of woven bone; May contain small islands of cartilage

8

Fibrous dysplasia: XR

 large expansile medullary mass with lucent ground-glass appearance and well demarcated borders

9

Fibrous dysplasia is characterized by:

benign localized developmental arrest; all components of bone are present but do not mature

10

What pattern of fibrous dysplasia may transform to osteosarcoma?

polyostotic

11

Microscopically, what may be seen in Fibrous dysplasia?

poorly formed islets of bone ("Chinese character")

12

Common location of fibrous dysplasia?

shoulder

13

Are fibrous cortical defects common?

yes: present in 30-50% of all kids >2y/o

14

Fibrous cortical defects: XR

"scooped out" lesion with dense borders surrounding it

**buzzowords = scalloped and sclerotic margins

15

Where fibrous cortical defects located?

lower femur and upper/lower tibia

**~1/2 are bilateral or multiple

16

What is the expected outcome of fibrous cortical defect?

spontaneous resolution

17

Fibrous cortical defects that are > 5-6 cm:

nonossifying fibromas

18

Epidemiology of fibrous cortical defects

Adolescents with few or no symptoms except pain (usually found incidentally on radiography)

19

Fibrous cortical defects: gross pathology

Eccentric, sharply delineated, metaphyseal lesions

Granular or dark red

20

Fibrous cortical defects: likely pathogenesis

developmental defect

21

Possible injury related to fibrous cortical defect? 

fractures through thinned cortex

22

Non-ossifying fibroma: microscopically 

woven mat or storiform pattern

23

Solitary bone cyst: pathogenesis

developmental abnormalities

24

Solitary bone cyst: Epidemiology + clinical presentation

Asymptomatic

Children and adolescents (usually male)

25

Solitary bone cysts: gross pathology

benign, fluid-filled, lytic bone lesions with thin bone margins

26

Solitary bone cysts: typical location

humerus or femur

27

Aneurysmal bone cysts: gross pathology

bloody, cystic lesions; "sponge filled with blood"

28

Aneurysmal Bone Cyst: location

surface of bone--usually in long bones and vertebral column (but may occur anywhere)

*(usually slow-growing, but may present with rapid expansion)

29

Aneurysmal Bone Cyst: microscopic pathology

rich capillary bed 

**bleeding risk!!

30

Aneurysmal Bone Cyst: Epidemiology

Children and young adults

31

Benign tumors which may contribute to pathological fracture (3):

solitary bone cyst

aneurysmal bone cyst

fibrous cortical defect

32

When do Benign Primary Bone Neoplasms often present?

1st 3 decades of life

33

When are Benign Primary Bone Neoplasms removed?

if they cause pain

34

How are Benign Primary Bone Neoplasms often discovered?

incidental XR

35

What type of Benign Primary Bone Neoplasm may undergo malignant transformation?

chondromas

36

How are Osteoma's characterized?

round, slow-growing bone-forming tumors

37

Osteoma: growth patterns

1. project from sub- or endosteal surfaces of cortex
2. Usually solitary (multiple = Gardner’s syndrome)

38

Osteoid osteoma: clinical presentation + Epidemiology

Painful, generally < 2 cm lesion occuring most commonly in teens + twenty-something's; more often in M > F (2:1)

 

39

Osteoid osteoma: location

1. cortical (rather than medullary)

2. 50% = tibia and fibula

40

What causes the main symptom of Osteoid osteoma? What makes it better/worse?

--Pain due to production of prostaglandin E2  

--Worse: more commonly painful at night; Intake of alcohol >> massive increase in pain

--Better: aspirin

41

Osteochondroma: synonyn

exostosis

42

How are Osteochondroma characterized?

--benign cartilage capped tumors.  

--tend to be attached to underlying skeletal system by a stalk  

43

What effects do Osteochondroma have on the skeletal system?

Displacement of growth plate in endochondral bones

44

What is multiple hereditary exostosis?

autosomal dominant Osteochondroma, which may rarely give rise to chondrosarcomas

45

 How are chondroma's characterized?

Benign tumor of hyaline cartilage

46

Where do Enchondromas arise?

medullary cavity, often in tubular bones of hands and feet

**usually solitary

47

Where do Juxtacortical chondromas  arise?

on the surface of bones

48

Nonhereditary syndrome characterized by formation of multiple enchondromas:

Ollier disease 

49

Syndrome characterized by formation of multiple enchondromas and soft tissue hemangiomas:

Maffucci syndrome

50

Enchondroma: XR

Radiolucent nodules of hyaline cartilage + scalloped endosteal surface

51

Giant Cell Tumor of Bone: Epidemiology

patients in their 20's - 40's

52

Giant Cell Tumor of Bone: Primary lesion location? secondary lesion location?

1. around knee

2. bones of wrist

53

How are Giant Cell Tumor of Bone characterized?

--benign, uncommon and locally aggressive 

--Multinucleated osteoclast type giant cells

--commonly undergo cystic degeneratio 

54

Half of Malignant Bone Tumors are derived from:

blood forming cells and connective tissue cells

55

Most common bone tumors?

Secondary (Metastatic)

56

Sites from which metastases occur to the bone are characteristically:

Breast, prostate, lung, kidney and thyroid

57

Most common primary malignant bone tumor?

Osteosarcoma

58

Osteosarcoma: Clinical presentation + Epidemiology (typical)

painful lesions, typically in knee joint, in patients <20; often come to attention due to secondary injury (during sports, etc)

59

Osteosarcoma occurs less frequently in what patient populations?

 elderly, pt's w/ Paget disease of bone or pt's w/ hx of radiation

60

Where does osteosarcoma present in older patients?

bones of the pelvis and the bones of the skull 

61

What conditions are osteosarcoma often associated with, clinically?

fractures, Retinoblastoma (Rb, MDM2), lung metastasis at diagnosis

62

Osteosarcoma grows into:

soft tissue surrounding the bone

63

What is the Codman triangle of periosteal elevation?

triangular shell of reactive bone formed by lifted periosteum;  characteristic but not pathognomonic of osteosarcoma

64

Chondrosarcoma: clinical presentation + Epidemiology

lesion often in axial skeleton, in patients ages 35-60

65

Chondrosarcoma: location

Axial skeleton: trunk, pelvis, vertebrae, ribs (rarely involves extremities)
in diaphysis or metaphysis

66

Second most common primary malignant tumor?

Chondrosarcoma

67

Chondrosarcoma: treatment

Surgery (insensitive to chemotherapy)

68

Chondrosarcoma may arise in association with:

a preexisting enchondroma

69

Malignant bone neoplasms characteristically:

"do not respect joint spaces"

70

Chondrosarcoma: microscopically

cells that mimic chondrocytes ("float" within ~chondroid matrix)

high nuclear cytoplasmic ration, nuclei and abundant mitotic figures

71

Ewing Sarcoma: Epidemiology

White children, ages 10 to 15

72

Ewing Sarcoma: microscopicaly

--very high nuclear cytoplasmic ratio (mostly nucleus) = "blue cell tumor"

--glycogen rich cells which tend to form small structures called Homer-Wright rosettes (tumor cells arranged in a circle around a central fibrillary space)

73

85% of Ewing Sarcoma have genetic signatures, which show they are related to:

(What is the genetic signature?)

peripheral neuroectodermal tumors

t(11,22)+

74

Ewing Sarcoma: gross pathology

onion skin appearance = layers of reactive periosteum and neoplasms

75

Ewing Sarcoma: location

Arise in medulla, primarily in diaphysis of long bones

76

Ewing Sarcoma: treatment and prognosis?

 surgery and chemotherapy = 75% five year survival rate

77

Most common tumors in bone?

mets

78

In adults > 75% of skeletal metastasis originate from:

prostate, breast, lung, and kidney

79

In children, skeletal metastasis originate from:

neuroblastoma, Wilms’ tumor, osteosarcoma, Ewing sarcoma (extraosseous) and rhabdomyosarcoma

80

What is a common characteristic of metastatic bone tumors?

Usually multifocal, affecting marrow-rich areas (vertebrae, pelvis, ribs, skull and sternum)

81

Metastatic Bone Tumors: XR

lytic, blastic or mixed lytic and blastic

82

Metastatic Bone Tumors secrete:

substances that promote bone resorption