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Flashcards in Tumour Deck (329)
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1

Labs to order in multiple myeloma workup

Serum labs:

  • Anemia
  • increased Cr
  • hypercalcemia
  • ESR (increased)
  • SPEP (M-spike)

Urine

  • Proteinuria
  • UPEP (Bence-JOnes protein)

 

2

What is a Bence-Jones protein?

Light chain immunoglobulin found in multiple myeloma

can be kappa or lambda light chain

UPEP will show monoclonal light chains

3

 

Lifetime risk of malignant transformation for solitary osteochondroma?

 

1%

4

Most common benign tumour of childhood?

NOF

5

 

Two important differences between Maffucis and Olliers?

 

Maffucis has hemangiomas

 

Maffucis has higher risk of secondary malignant transformation (100% vs. 30%)

6

Which type of liposarcoma does not require adjuvant radiotherapy?

Well differentiated liposarcoma

7

Can you do limb salvage in osteosarcoma in a patient with a pathologic fracture?

Yes

However increased rates of local recurrence and decreased survival overall in these patients

8

Adult Patient with osteochondrama has acute onset of pain at the location of lesion.  What do you suspect?

Sarcomatous transformation

9

Treamtent for osteosclerotic myeloma

Chemo + radio+ plasmapheresis

Generally no surgery needed

 

(This is a form of MM associated with POEMS)

10

What is the multidrug resistance gene (MDR)

Pumps chemo out of cancer cells

Present in 25% of primaries

50% of mets

Very poor prognostic indicator

11

What primary is very vascular, requiring embolization of lesions primary to ORIF?

RCC

Thyroid

12

What does GCT look like on MRI?

Dark on T1 and T2

13

 

List 4 types of surgical resection in terms of margins.

 

  • intralesional (you cut into the tumor)
  •  marginal (you resect directly at the interface between tumor and normal tissue)
  • wide (you resect the tumor with a cuff of normal tissue surrounding the tumor)
  • radical (you resect the entire compartment from which the tumor arose)

14

Ddx for lytic lesion in greater than 40 year old

1. Mets

2. MM

3. Lymphoma

4. Metabolic (browns Tumor)

5. Sarcoma

15

General treatment of soft-tissue sarcoma

En-bloc resection + adjuvant radiation

16

Diagnosis?

Melorheostosis

Periosteal formation of new bone

Looks like dripping candle wax

Benign but painful

Symptomatic treatment ± excision

17

 

Name these translocations!!

1. t(2;13)

2.  t(11;22)

4.  t(X;18)

5.  t(12:16)

 

 

1.  Alveolar rhabdomyosarcoma; t(2;13)

2.  Ewings Sarcoma; t(11;22)

4.  Synovial sarcoma; t(X;18)

5.  Myxoid liposarcoma; t(12:16)

 

18

Who gets Ewing's sarcoma?

White males aged 10-20

19

What blood markers can be used to measure bone turnover?

ALP, LDH

20

What is stone man's disease?

Fibrodysplasia ossificans progressiva

Hallmarks:

  • Progressive and EXTENSIVE heterotopic ossification (muscles, fascia, tendons, ligaments, joint capsules)
  • Congenital malformation of the great toe

Mutation in ACVR1 gene (activin A type I receptor)

21

Enchondromatosis is characterized by:

A) multiple enchondromas, hemangiomas, lymphangiomas

B) multiple enchondromas in a unilateral distribution

C) auto-dominant transmission, multiple enchondromas and osteochondromas

C

22

Poor prognostic indicators in Multiple myeloma (9)

Renal failure (worst)

hypercalcemia

Stage

Type (plasmacytoma has best prognosis)

chromosome 13 deletion or translocation (t4;14), 4(14;16)

circulating plasma cells

increased beta 2 microgloblulin (indicates elevated tumor burden)

decreased serum albumin

increased marrow microvessels

23

Surveillance of soft-tissue & osteosarcoma?

(They are the same)

Physical exam, CXR, CT Chest

1-2 years: 3 months

3-5 years: 6 months

5-10 years: yearly

24

Common locations of ABC?

Femur > tibia > spine

25

What part of an osteochondroma is usually the site for secondary malignant transformation?

Cartilage cap

26

Name the tumours associated with NF1

Wilm's tumour

Optic glioma - part of dx criteria

Neurofibroma
Neuofibrosarcoma

Astrocytoma

meningioma

melanoma

leukemia

rhabdoyosarcoma

pheochromocytoma

carcinoma

pancreatic endocrine tumors

27

Options for fixation of a met? (Be general)

1. ORIF Plate with cement versus nail

2. Arthroplasty

3. Endoprosthesis

28

Describe FU for solitary enchondroma with no concerning features:

serial x-rays

q3-6 months for 1-2 years, then annually

29

 

What is the incidence of post radiation sarcoma in an area previously radiated to treat malignancy?

 

13%

 

(more common if also had chemo)

30

When do osteochondromas stop growing?

At skeletal maturity