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Flashcards in Tumour Deck (329):
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

31

Episyphyseal lesions?

Chondroblastoma, infection, GCT

32

Does thickness of cartilage cap have an associated with risk of sarcomatous change in osteochondroma?

If so, what is the limit?

Yes, but only in adults (skeletally mature)

In kids, it is an unreliable finding

>2cm is a risk for change to chondrosarcoma

33

What is the main dDx for intramuscular myxoma that you must rule out?

myxoid liposarcoma

34

True or false, lipomas can present with pain?

True

Angiolipoma often present as a painful mass

35

Name some negative prognostic characteristics of osteosarcoma.

1. Poor response to Neo adjuvant chemo (% necrosis)

2. Tumour size (> 8 cm is bad)

3. Patient age (old is bad)

4. Higher stage of Tumor

5. Anatomical site (central is bad)

36

dDx for soft tissue sarcoma?

Soft-tissue sarcoma

hematoma

infection

±HO/MO if within a muscle

37

Chrondroblastomas are located where?

Epiphysis

38

Lifetime risk of malignant transformation for olliers?

 

30%

39

What are characteristics of a metastasis on X-ray?

Lytic

Permeative

Diaphysis/metadiaphysis

Proximal long bone or spine

40

Describe the Enneking system for classifying malignant tumours.

Three factors: Grade, site and metasteses

Grade is high or low

Site is intracompartmental (enclosed by natural barriers) or extracompartmental

41

Parosteal osteosarcoma with invasion into medullary cavity - what is the affect on prognosis?

No effect - still good prognosis

42

Name 2 scoring systems that may help you decide whether to operate on a pathologic spine tumour

Spinal instability neoplastic score

based on: location, pain, type of lesion, spinal alignment, vertebra body collapse, involvement of posterior elements

Score:

0-6: stable

7-12: impending instability

13-18: unstable

Modified Tokohashi Scoring system

based on: Karnofsky performance status, # of extraspinal bony mets, # of vertebral body mets, Mets to major organs, primary site of cancer, palsy

Score

0-8: <6 months life expecancy: conservative + palliative

9-11: life expectancy > 6 months: palliative surgery

12-15: life expectancy > 1 year.  Excisional surgery

I think the principles of these scoring systems are imporant

JAAOS 2015

43

Dx & Treatment?

Parosteal osteosarcoma

These are usually low grade

Treat with Wide-resection only (usually curative)

Chemo generally not indicated unless there is a high grade component

44

Presentation of glomus Tumour

Triad:

  • cold sensitivity
  • point tenderness
  • intermittent severe pain

Also may have a bluish-reddish hue

Occur in subungal region

X-rays will show a scalloped, osteolytic defect

45

Name the 5 subtypes of liposarcoma.

Well differentiated liposarcoma

Myxoid liposarcoma

Pleomorphic liposarcoma

Dedifferentiated liposarcoma

Mixed-type liposarcoma

46

What is the most common sarcoma in the foot?

Synovial sarcoma

47

Soft tissue tumours that mets via LN & to places other than lungs

SCREAM

Synovial sarcoma

Clear cell sarcoma

Rhabdomyosarcoma

Epitheliod sarcoma

Angiosarcoma

Myxoid liposarcoma

48

Name 2 sarcomas for which excisional bx can be performed

Parosteal osteosarcoma

low grade chondrosarcoma

*not sure I would say this on an exam

It's from AAOS CORE2

49

What is a defining feature on histo for extra-articular desmoid tumour?

100% positive for estrogen receptor-beta

50

4 Options for treating PVNS (think techniques)

Arthroscopic synovectomy: best for focal disease

arthroscopic + open synovectomy (ie arthroscopic + open posterior knee approach)

Total joint arthroplasty + synovectomy

Total synovectomy + arthrodesis

± radiation - addition of radiation combined with total synovetomy reduces recurrence to 10-20%

51

Risks for post-radiation fracture

Female

Anterior femoral compartment resection

Age

Periosteal stripping

Radiation dose

osteoporosis

52

2 negative prognostic indicators of CMF

children

lobulated with abundant myxoid material

53

Football player suffered injury after helmet to groin hit.  Residual non-tender mass.

Diagnosis?

Treatment?

Myositis ossificans

Non-operative - most resolve in a year or so

If recalcitrant, excise, but not before it matures (> 6 months)

Note x-ray: it calcifies from outside in, vs. tumour, which goes inside out

54

Olliers is characterized by:

A) multiple enchondromas, hemangiomas, lymphangiomas

B) multiple enchondromas in a unilateral distribution

C) auto-dominant transmission, multiple enchondromas and osteochondromas

B

55

What colour is bone matrix on staining?

Pink

56

What findings differentiate chondrosarcoma from a benign lesion?

1) myxoid matrix - may still have chondroid matrix, but generally the more myxoid the higher the grade

 

2) cortical thinning or thickening

 

3) soft tissue mass

 

4) invasion of haversian system

57

 

5 tumors that can have an associated ABC?

 

  1. giant cell tumor
  2. chondroblastoma
  3. fibrous dysplasia
  4. chondromyxoid fibroma
  5. NOF

58

Fallen leaf sign

what is it

what is it pathognomonic for?

Cortical fragment in the bottom of an empty cyst

UBC

59

4 associated conditions of NOF

Jaffe-Campanacci syndrome

Neurofibromatosis

Familial multifocal NOF

ABC

60

What is the treamtnet of low-grade intramedullary osteosarcoma?

Surgial resection only

This is the exception of the usual rule of chemo-sx-chemo for sarcoma

 

61

Components of local staging?

MRI to characterize lesion (of entire bone)

 

Biopsy (can do soft tissue mass)

Send for pathology and cultures

Adequate hemostasis

Good lesional tissue

Use pathology to prognosticate

62

Physical exam for metastasis with unknown origin must include?

Thyroid exam

Lung exam

Abdomen exam

Breast/prostate exam

63

Describe the bones in enchondromatosis?

Dysplastic

They are not normal and can have deformities

64

Young, thirsty kid with these findings.

Diagnosis?

Hans-Schuller-Christian disease (disseminated eosinophilic granuloma)

Classic triad:

Exophthalmos

Diabetes insipidus

Lytic skull lesions

65

What malignant tumour can secondarily arise from a bone infarct, Paget's disease or prior radiation?

Malignant fibrous histiocytoma

(aka Undifferentiated pleomorphic sarcoma)

66

What do you do following unplanned excision of soft tissue sarcoma?

Work up as normal

Local staging to look for extent of tumour bed and contamination

Systemic staging to look for mets

Definitive is re-resection of tumour bed and all associated contaminated compartments

Radiotherapy (controversial whether pre or post-op)

67

Tumour association with poly-vinyl chloride

Angiosarcoma

very aggressive vascular tumour

68

Overall prognosis for multiple myeloma?

What confers the worst prognosis?

Poor

Median survival 3 years from diagnosis

5 year survival: 30%

10 years survival: 10%

Shortest survival in patients with renal failure

69

Name 3 syndromes assocaited with Fibrous Dysplasia

McCune Albright

Mazabraud

Osteofibrous dysplasia

70

What sarcoma has flat epithelial cells on pathology?

Synovial sarcoma

71

What is radiation dose for HO prophylaxis?

6Gy

(vs. 45-60 for soft tissue sarcoma)

72

Genetics for myxoid liposarcoma

t(12;16)

Creates CHOP-TLS fusion protein

73

What physeal zone does osteochondroma/MHE stem from?

Proliferative

74

What Tumor stains for MIC2 antigen?

Ewing's sarcoma.

 

This is how you differentiate it from other small round blue cell tumors.

75

What is the most common malignant bone tumour of the hand?

Chondrosarcoma

THINK: common to have enchondromas in hand, so one of them must transform

76

 

3 non-neoplastic things to consider adding on to the end of a ddx for bone lesion?

 

EG

Infection

Hyperparathyroidism (if older)

77

What is the recurrence rate of osteoid osteoma treated with percutaneous radiogrequency ablation?

10-15%

78

Describe Harington's Criteria

>50% destruction of diaphyseal cortices

>50-75% destruction of metaphysis (>2.5cm)

Permeative destruction of the subtrochanteric fermoal region

persistent pain following irradiation

79

Treatment of osteofibrous dysplasia?

nonoperative - observation

bracing if deformity interfering with walking

OR if you need correction of deformity (osteotomy)

80

Cause of Paget's

Thought to be a slow viral infection by paramyxovirus or RSV as most are spontaneous

There is a small group of heritable Paget's also

81

What kind of matrix does ewings usually have?

None

82

Poor prognostic indicators for EG

involvement at young age

rapid disease progression

organ involvement (eg pituitary, lung, hematopoietic, or liver involvement);

*organ dysfunction carries an especially poor prognosis

83

Older than 40 , blastic lesion DDx (4)?

Metastases (prostate)

Bone island

Bone infarct

Osteoblastoma

Infection

84

Name two enchondroma syndromes.

1. Olliers

2. Maffuccis

85

Classic findings of Hans-Christian-Schuller Disease

Disseminated form of EG

Triad:

Skull lesions

diabetes insipidus (thirst)

Exopthalmos (double vision)

86

Osteolysis in tumour is caused by the action of what cytokine on what cell?

RANKL on osteoclastic cells (not on tumour cells)

87

Genetically, how does osteofibrous dysplasia differ than regular fibrous dysplasia?

It doesn't have the Gs alpha activating mutation

88

Name the basic biopsy principles.

1. Biopsy through (single) involved compartment

2. Use extensile incision (usually longitudinal)

3. Meticulous hemostasis

4. Do not create multiple planes

5. Bring out drains in line with incision (so the tunnel can be removed with definitive resection)

6. should biopsy soft tissue component of bone tumour if possible

7. round holes in bone, not square

8. do not exanguinate before tourniquet

9. avoid nv structures

89

Compare pre vs. post operative radiation for soft tissue sarcoma:

Pre/neoadjuvant RTx:

Lower dose

Lower field (b/c you haven't contaminated it with surgery)

Lower rates of fibrosis

Also lower rates of edema and joint stiffness, but not statistically significant (Lower overall functional rates if they had fibrosis, edema and stiffness)

HOWEVER: higher risk of wound infection

 

Generally, neoadjuvant (pre) RTx is better, even tho wound complications are higher

SR2 study: know this data - it's canadian

 

90

6 lesions on the posterior elements of spine

G: giant cell tumour (although most commonly in vertebral body)

O: osteoblastoma

T: tuberculosis

A: aneurysmal bone cyst (only one PURELY found posteriorly)

P: Paget disease

E: eosinophilic granuloma

GO TAPE

91

4 posterior element tumours

ABC

osteoid osteoma

osteoblastoma

osteochondroma

92

What systemic pathology (ie non ortho) do people with Paget's disease get?

high output cardiac failure

due to increased turnover of bone

93

What percentage of vertebral body tumours are malignanet?

75%

94

 

What bone metasteses are not redio sensitive?

 

Which is the most readio-sensitive?

 

1) GI and Renal

 

2) Prostate

95

Classic spine finding in eosinophilic granuloma

Name 1 other classic finding

Vertebra plana aka platyspondia

Multiple punched out/lytic cranial lesions (ask for skull x-ray)

96

Which side of the spine in an osteoid osteoma normally found in?

Concavity of the spine

97

Histology of ewings sarcoma?

Small round blue cells

98

How do you classify UBC?

Active - in continuity with physis

Latent - bony bridge between UBC and physis

99

Most common location of mets in soft tissue sarcoma

Lungs

They can mets to LNs, but lungs are still most common

100

Survival rate of chondrosarcoma

Directly correlates with histological grade:

Grade 1: 90%

Grade 2: 60-70%

Grade 3: 30-50%

De-differentiated: 10%

101

What are the main steps in treatment of malignant bone tumour?

1. Neo adjuvant chemotherapy

2. Re-stage with imaging for response to therapy and operative planning

3. Surgery - limb sparing vs. amputation

4. Post-operative chemotherapy - use pathology to prognosticate

102

Treatment?

Chordoma

Wide resection is standard of care

± radiation if:

positive margins

inoperable tumour

103

What is the most common cause of painful scoliosis in the adolescent population?

osteoid osteoma

104

5 complications with treatment of UBC

recurrence

fracture

embolizatio of injected material

local reaction to injected material

growth disturbances

105

What kind of tumour results from malignant transformation of a chronic OM?

what is the treatment?

SCC

Treat with wide excision/amputation + adjuvant chemo/rads

Prognosis is poor with late diagnosis, good with early

 

106

Patient comes in post-MVC with a pathologic fracture through this.  Dx as ABC.  What is your plan?

Non-operative fracture management

Once healed, then proceed with intralesional curettage

Remember to treat path fractures non-op!

107

4 predisposing genetic factors for intramedullary osteosarcoma

Rb +

p53

Rothmund thomson syndrome

LiFraumeni syndrome

108

60 yo F with constitutional symptoms, pain palpable mass.  (see picture)

Dx & treatment

Lymphoma

Treatment is surgical stabilization, chemo, radiation

*Lymphoma can have a soft tissue mass!

*lymphoma: small round blue cell

109

What do the terms onion skinning and sunburst refer to on radiographs? Which Tumors are each characteristic of?

Types of periosteal reaction

Onion skinning = ewings

Sunburst = osteosarcoma

110

Age range for GCT?

20-40

111

indications for excisional bx

superficial to fascia

Not overlying NV structure

excise AND LEAVE BEHIND FASCIA

112

"Pop corn densities" are useful in differentiating what secondary malignancy from its benign precursor?

Secondary chondrosarcoma from enchondroma.

113

What is the histo of periosteal osteosarcoma

osteoid + chondroblastic matrix

If no osteoid, will be classified as chondrosarcoma

114

 

What tumor shows predilection for the distribution shown in this figure?

 

Giant Cell Tumor

115

Desribe AJCC classification system

Soft soft tissue tumours:

See picture

116

Name 5 signs/symptoms that are concerning for chondrosarcoma, you know, that may be in a stem of a question

Deep Endosteal scalloping (>2/3)

Pain/progressive pain

Night symptoms/constitutional symptoms

Periosteal reaction

Soft tissue extension

Lysis of prior chondroid mineralization

117

Ddx for multiple giant cell containing lesions?

Multifocal GCT

Browns Tumor

118

Management of hypercalcemia

Fluids (200-300mL/hr initially, then maintaining u/o 100-150mL/hr)

Calcitonin

Bisphosphonates

Can use denosumab if refractory to bisphosphonates

LOOP DIURETICS ARE NOW NOT RECOMMENDED

119

dDx for Benign Latent Lesion (3)

Osteochondroma

NOF

Enchondroma

120

Treatment for suspected low-grade chondrosarcoma (instead of enchondroma)

intralesional curettage

121

Histopathology of GCT?

Multinucleated giant cells.

 

May see bone.

 

Mononuclear stromal cells

122

Where is the most common place for sarcomas to metastasize?

1. Lungs

2. Another bone

123

What is Denosumab?

RankL inhibitor.

This is a ligand for the Rank receptor and acts as a signal for bone removal.

Denosumab is an analogue and used in GCT tumours to prevent bone turnover.

124

General treatment approach for bone sarcoma?

1. Neo adjuvant chemotherapy, multi-agent

2. Re-stage with imaging to assess for interim progression/metastases and pre-op planning

3. Wide resection

4. Chemotherapy - use response to pre-op chemo to prognosticate (% necrosis of surgical pathology) and target therapy

125

Name & decribe the possible life threatening complication of hemangioma

Kasabach-Merrit syndrome

entrapped platelets in the hemangioma leading to a possible fatal coaguloapthy

126

Phases of Paget's disease

Lytic: osteoclastic resorption

Mixed: resorption & compensatory bone formation

Sclerotic: bone formation predominates

All 3 may exist at same time so Paget's can look lytic, mixed or sclerotic (like OM its a mimicker)

127

Differential for small round blue cells on histology?

Ewing's sarcoma

Lymphoma

Osteomyelitis

Multiple myeloma

Histiocytosis

Rhabdomyosarcoma

Neuroblastoma

(LERN'M)

128

 

What tumor shows predilection for the distribution shown in this figure?

 

Osteoid Osteoma

129

What happens to NOF as the patient grown and reaches skeletal maturity

Migrate to diaphysis as patient grows AND GET LARGER

Will then usually self-resolve (become sclerotic and then go away) as the patient reaches skeletal maturity

130

Local Recurrence rate for well differentiated vs. high grade?

Well differentiated: 10%

High grade: 20%

131

Benign tumours that can metastasize to lungs (2)

GCT

Chondroblastoma

132

 

Epiphyseal Lesion with this biopsy.

 

Diagnosis?

 

Clear cell chondrosarcoma

133

7yo M severe pain after ice skating.

How do you treat?

UBC (fallen leaf sign)

Weight bearing area

Treat with bone grafting and internal fixation

134

What is the most common soft tissue sarcoma in kids?

Rhabdomyosarcoma

135

On an exam, what tumour has codman's, what has onionskinning?

Codman's: osteosarc

Onion-skinning; Ewings

136

2 risk factors for malignant transformation of osteochondroma

Cartilage cap >2cm in adults (some say >0.9cm is a risk factor)

Sessile lesions

 

 

137

What primary cancer diagnosis is associated with the shortest life expectancy after pathologic fracture?

Lung cancer

138

Medical managmeent for fibrous dysplasia?

bisphosphonate

decreases pain and bone turnover

139

How do you differentiate between ABC/GCT vs. UBC on x-ray

UBC is not as expansile

It generally doesn't go past the width of the physis

140

Which chondrosarcoma variant is typically epiphyseal?

Clear cell chondrosarcoma

141

Osteosarcoma: poor prognostic indicators:

Advanced stage of disease (most prognostic of survival)

Mets on presentation

Axial location/mets

Skip lesions

Poor response to chemotherapy (>98% necrosis is a GOOD sign)

Increased LDH and/or ALP

Tumour site & size

Expression of P-glycoprotein

Vascular involvement

Margins

Site & size of tumour

Type of sarcoma (parosteal better than intramedullar/conventional)

 

 

142

Imaging for metastasis with unknown origin?

Chest X-ray

X-ray of involved bone

Any painful extremities

Bone scan

If suspect myeloma, skeletal survey

Consider MRI of bone lesion

Ct chest/abdo/pelvis

143

What is a unique treatment option of neuroblastoma?

In young kids, nonoperatiave as they may spontaneously regress

144

4 extraosseous findings in fibrous dysplasia

cafe-au-lait spots

precocious puberty

intramuscular myxoma

Chereubism

145

Define the stages and survival for AJCC

IA

IVB

IA:

low grade

<8cm

No LN

No mets

5 year survival 98%

IVB:

Any tumour with mets to site other than lungs

5 year survival 30%

146

 

What tumor shows predilection for the distribution shown in this figure?

 

Ewings Sarcoma

147

What is the primary difference between sarcomas and carcinomas? (In terms of lineage)

Carcinomas = epithelial Sarcomas = mesemchymal

148

What is the most important factor for 5 year disease free survival in soft tissue sarcoma?

What happens if this is not achieved?

Size of operative margin

larger margin = better b/c it avoids microscopic contamination

If you have + margins, must take back for re-resection of tumour bed

149

What is the most common malignancy of bone?

What is the most common primary malignancy of bone?

 

What is the most common malignancy of bone?

Mets

What is the most common primary malignancy of bone?

myeloma

150

Describe Mirel's score

151

What mutation is characteristic of fibrous dysphasia?

G-Protein mutation

152

Treamtent of leiomyosarcoma?

Surgical resection and CHEMO

Although effet is variable, some studies show better outcomes with surgical resection + chemo.  No role for radiation except if you can't get margins

This is one of the exceptions of regular ST sarcoma treamtent of surgery and radiation

Recall: synovial sarcoma may be respnsive to chemo also, but in that one you use RTx

153

Knee pain and this picture.  Previous aspiration showed hematoma.

Diagnosis & management?

PVNS

clue: affects both sides of the joint and causes OA like destruction (cysts)

Debridement ± radiation

154

What % of plexiform neurifibroma's transform into neurifibrosarcoma?

10%

155

Post-op radiation after prophylactic surgery for impending pathologic fracture has what 3 goals

Decrease pain

slow progression

treat remaining tumour burden not removed at surgery

156

Recurrence for PVNS?

30-50% - high

Therfore for treatment, may start with minimally invasive (arthorscopi) but make patient aware you may have to open later on

157

Diagnosis & treatment?

Synovial chondromatosis

(calcified stippling affecting both sides of joint)

Treatment:

Arthroscopic debridement (symptomatic treatment)

158

Why do you take out a retroperitoneal lipoma?

It has a higher chance of being a liposarcoma

159

Dosing side effects of wound healing post external beam radiation

<45 Gray: usually leads to uncompliated tissue healing

45-55 Gray: tissue heals but with problems

>60 Gray: tissue will likely not heal

160

Jaffe-Companacci syndrome

Congenital syndrome of:

multiple NOFs

cafe-au-lait pigmentation

mental retardation

heart, eyes, gonads involved

161

What tumour is associated with Dupuytrens, Ledderhose and Garrods?

What other inherited condition is it associated with?

Extra-abdominal desmoid tumour

familial adenomtaous polypsis (FAP)

162

Indications for non-excisional bx

>5cm

deep to fascia

surrounds NV structure and NOT a lipoma

overlies bone

Hx of "treated" carcinoma

unclear diagnosis

163

What are Birbeck granules diagnostic of?

Eosinophilic granuloma

164

You should embolize mets from which lesions?

RCC

Thyroid

Hepatocellular carcinoma

165

Local recurrence rate of chordoma?

50% (very high)

Proton-photon beams may help decrease this

166

Inheritance pattern of enchonromatosis (Ollier's/Maffuci)?

No inheritance pattern

MHE is AD though

167

What primary bone malignancies are more likely in patients over 40?

Plasmocytoma (solitary myeloma)

Primary lymphoma of bone

Chondrosarcoma

MFH

168

Genearlly, what do soft tissue sarcomas look like on MRI?

Dark on T1

Bright on T2

169

Management of pathologic fracture through enchondroma?

Cast with delayed curettage until after healing

170

dDx for Benign Active lesion (6)

Fibrous dysplasia

UBC

EG

Osteoid osteoma

Chondroblastoma

Painful enchondroma

171

GCT location mainly?

Prox tibia, distal femur, proximal humerus, distal radius

 

I.e. Where a lot of growth occurs

172

Poor prognostic indicators for Ewing's (5)

spine and pelvic tumors

tumors greater than 100cm3

< 90% necrosis with chemotherapy

elevated lactic dehydrogenase levels

p53 mutation in addition to t(11:22) translocation

173

Diagnosis & Treatment?

Schwannoma

Classic "String Sign" (Soap on a rope)

Marginal excision

Try not to damage nerve to preserve function

174

Best cure rate of SCC?

Moh's microsurery

175

t(12;16)(q13;p11.2) (CHOP transcripton factor)

Myxoid liposarcoma

176

Treatment for solitary plasmacytoma

External beam irradiation alone

± surgical stabilization

177

What is the approach to neoadjuvant chemotherapy for pre-operative malignant bone tumour?

Multiagent chemotherapy:

1. Methotrexate

2. cisplatin

3. Doxorubicin

4. Ifosfamide

178

Most common complication of TKA & THA in Paget's popuation?

TKA: malalignment

THA: excessive bleeding

Therefore, treat medically before elective hip/knee surgery to decrease bleeding risk

179

What is the most common subungla malignancy?

SCC

180

GNAS mutation is associate with what condition?

Polyostotic fibrous dysplasia

Mcune Albright syndrome

181

What percentage response to chemo is a good prognostic indicator?

>98%

182

Where do neurofibrosarcoma's arise?

From a peripheral nerve or from a neurofibroma (malignant transformation)

183

What must you do to gain adequate margins when resecting a chordoma?

Sacrifice the nerve roots

184

You suspect soft tissue sarcoma but MRI is indeterminant.

Your core biopsy comes back as hematoma only

Next step?

Open biopsy

CANNOT resect this tumour if you suspect soft tissue sarcoma as many of the core's come back as hematoma

185

Recurrence of chondrosarcoma is directly related to what?

Increased telomerase activity

186

In synovial chondromatsis, is the cartilage normal?

No - metaplastic

187

Benign bone lesion in spine is usually what?

Osteoblastoma

188

Does radiation have a role in treatment of Ewing's sarcoma?

Yes, if wide resection is technically difficult or if a Tumor was inadequatly resected based on pathology

189

Synovial sarcoma is a misnomer. What percentage of these tumours actually arise is a major joint?

10%

190

At what age does metastases become more common than primary bone malignancy?

40

191

Diagnosis?

Chondroblastoma

classic:

chondroid matrix

epiphyseal crossing into metaphysis

lots of surrounding edema

dDx: clear cell chondrosarc

192

 

How can you differentiate schwannoma from neurofibroma on MRI?

 

Schwannoma is eccentric and separate from nerve.

 

Neurofibroma is central with the nerve runnign through it.

193

What is the most important factor in preventing local recurrence of a tumour?

adequacy of surgical margin

194

Treatmet for symptomatic, large NOFs

curettage & bone graft

195

This patient is having leg pain unresponsive to conservative mangaement.

Diagnosis?

Treatment?

Paget's disease

Treatment with metaphyseal osteotomy with plate fixation

(Metaphyseal > diaphyseal, plate > IMN - Parvizi)

196

3 Manifestations of fibrous dysplasia

McCune Albright

Mazabraud

Osteofibrous dysplasia

 

197

Treatment of lymphoma

Multiagent chemotherapy ± local radiation

± surgical fixation for instability/pathologic fractures

198

Accuracy of core biopsy done in the office?

80%

199

What is the classification system for GCT?

Campanacci:

I: Intramedullary lesion confined to bone

II: Thinned, expanded lesion

III: Cortical breach

200

Name 3 reasons why prophylactic fixation is better than fixing an actual pathologic fracture

Shorter OR time

Less morbidity

Quicker recovery

201

You diagnose myxoid liposarcoma.  How do you stage?

CT chest, abdo, pelvis

(not just CT chest)

Myxoid liposarcoma specifically has the tendency to spread to areas other than lungs

202

2 differentiating factors from myositis ossificans and tumour

Calcifies from outside - in (vs. tumour - inside out)

Intramuscular origin

203

What Tumor has characteristic fluid levels on MRI?

ABC

204

Most common site for bony mets

Most common site for pathologic fracture secondary to mets to bone

Most common site: thoracic spine

Most common site of pathologic fracture due to mets: proximal femur

205

Treatment algorithm for soft tissue sarcoma

Radiation + wide excision

Whether you do pre-vs. post op radiation is controversial with pros and cons

206

Risk of metasteses with Liposarcoma by grade?

  • Low grade (well differentiated) =
  • High (undifferentiated) = 50%

207

Cell type of synovial sarcoma

Usually biphasic with spindle cells (fibrous) & epithelial cells

NOT SYNOVIAL CELLS

208

 

Lifetime risk of malignant transformation for multiple hereditory exostosis?

 

10%

209

Name the radio-resistant tumours

(TUMOR)

Thyroid 

Undifferentiated soft tissue tumour & chondrosarcoma (Except mesenchymal and dedifferentiated??)

Melanoma 

Osteosarcoma 

RCC 

210

What is the most common solid tumour of childhood?

Is it malignant or benign?

Neuroblastoma

Malignant

211

Patient with RTC symptoms and solitary enchondroma found on imaging.  Plan?

Treat mechanical symptoms of RTCT. 

No need to treat incidentally found enchondromas as they normally have nothing to do with adjacent joint mechnical symptoms

If enchondroma is truly symptomatic, then intralesional curettage

212

Distal radius lytic lesion DDH? (4)

GCT

Abc

Chondrosarcoma

Telientatic osteosarcoma

213

Poor prognostic indicators in osteosarcoma (11)

advanced stage of disease (most predictive of survival)

response to chemotherapy (as judged by percent tumor necrosis of resected specimen)

  • >98% is a good prognostic indicator, but doesn't say what's bad

tumor site and size

expression of P-glycoprotein

tumor cells can pump chemotherapy out of cell with MDR expression

present in 25% of primary lesions and 50% of metastatic lesions

high serum alkaline phosphatase

high lactic dehydrogenase

vascular involvement

surgical margins

type of chemotherapy regimen

214

Genetic translocation association with osteosarcoma?

None

no translocation

However it has associted mutations: p53, Rb

215

dDx for path with giant cells

GCT

ABC

telangiectatic osteosarcoma

conventional osteosarcoma

216

Metastatic Tumor that is blastic?

Prostate

217

A translocation of chromosome 11 and 22 resulting in a chimeric protein is characteristic of what Tumor?

Ewing's sarcoma

 

Translocation results in EWS gene

218

You are working up a malignant looking tumor. It is bright on T2 with liquid, purulent looking gross pathology and no osteointegration matrix. what is it?

Ewing's sarcoma

219

Synovial sarcoma treatment

Same as any other soft tissue sarcoma:

wide resection + radiation

Radiation can be pre or post op (controversial)

UNLIKE other ST sarcomas, chemo may help in synovial sarcoma in both local control and overall survival

 

220

What colour is chondroid matrix on staining?

Blue

221

You're suspicious of multiple myeloma.  How do you stage it?

Skeletal survey

NOT bone scan, b/c they will be cold in 30% (b/c it lacks osteoblastic activity)

222

 

What is the diagnostic criteria for MM?

 

requires one major and one minor (or three minor) criteria for diagnosis

major criteria

biopsy confirmation of plasmacytoma

>10% plasma cells on bone marrow biopsy

serum IgG > 3.5g/dL, IgA > 2g/dL 

urine IgA > 1g/24hr or presence of Bence Jones proteins

minor criteria

10-30% plasma cells on bone marrow biopsy

serum or urine protein levels below those listed for major criteria

presence of multiple lytic bone lesions ("punched out" lesions without evidence of surrounding sclerosis)

decreased serum IgG levels

223

Recurrence rate of UBC

depends on treatment modality but generally up to 25-30% is reasonable

With steroids, some have reported recurrence up to 88%

(JAAOS 2014)

224

What benign tumour is characterized by fatty infiltration of sub synovial connective tissue?

Lipoma aborecens

225

What primaries metastasize to bone?

Lymphoma

Melanoma

 

Visceral carcinomas: Breast Prostate Lung Kidney Thyroid

226

Driving cell behind Paget's?

ostoclasts

227

What primaries are most likely to present as metastasis with unknown origin?

Lung and kidney (because they are more likely to be occult)

228

How do you differentiate between ABC and telangiectatic osteosarcoma on MRI?

It's hard - you can't really

orthobullets says you need bx to truly differentiate

top: TO

Bottom: ABC

229

What part of bone does ewings usually occur?

Diaphysis

230

Most common tumour of hand?

enchondroma

231

What on histo is pathognomonic for Schwannoma?

Verocay bodies

Composed of 2 rows of aligned nuclei in a palisading formation

232

Preferred treatment of EG.  Name 5 modalities

Salvage procedures

Nonop with treatment of mechanical symptoms preferred

  • Obervation alone
  • bracing (if amenable)
  • Low dose radiation (for spinal lesions that cause neuro symptoms)
  • Chemo (diffuse HSC)
  • Corticosteroid injections
  • Bisphosphonates

Operative if fails:

  • Curettage and bone grafting for lesions endangering articular surface
  • Spinal deformity correction

 

233

Dose for adjuvant radiation in soft-tissue sarcoma?

What are complications of 45 Gy vs 60Gy?

45-65Gy

45Gy: woudn has delayed healing

60Gy: wound not expected to heal

234

CD99

Ewing's sarcoma

235

8 lesiosn that can be found in vertebral body

multiple myeloma (most common primary tumor of spine)
           - chordoma
           - osteosarcoma
           - hemangioma
           - giant cell tumor of bone: sacrum;
           - eosinophilic granuloma
                                        - osteosarcoma of the spine
           - osteoid-osteoma and osteoblastoma of the spine

236

dDx for Benign aggressive lesion

Osteoblastoma

GCT

ABC

CMF

Chondroblastoma

±UBC

237

Long term survival of parosteal osteosarcoma when local contrl has been achieved

95%

238

 

What subtype of lipoma is painful?

 

AngioLipoma

239

Poor prognostic indicators in Ewing's

male age >14

fever

anemia

high LDH

axial location

use of radiotherapy without surgery

poor histologic response to chemo

Transcription Type II (Survival benefit with transcription type I EWS/FLI1 mutation)

Poor response to chemo

No effect of pathologic fracture

Local recurrence not as poor prognostic factor as in osteosarcoma ("death sentence" if local recurrence in osteosarcoma)

240

Most common site of mets of osteosarcoma

Lung: most common

Another bone: second most common

 

241

Tumours that mets to bone

breast

lung

thyroid

renal

prostate

*all the paired organs

242

What are the three treatment facets of a MM bone lesion?

 

With a confirmed diagnosis, the treatment of multiple myeloma involves radiotherapy, bisphosphonates +/- surgical stabilization.

 

Surgical stabilization is utilized when there is a complete or impending fracture. 

243

CD31 & polyvinyl chloride exposure is a risk for what?

ANgiosarcoma

rare

244

What is the local recurrence rate with ABC?

Name 1 adjunct that may help decrease local recurrence?

25% local recurrence

High speed burr

Phenol

Less common in older kids

245

Bloodwork for metastasis with unknown origin?

Spep/upep

CBC

Esr

Lytes

Liver enzymes

Psa

Alp

LDH

246

Survival of Chordoma?

60% 5 year survival

25% long term survival

local extension may be fatal

247

What kind of biopsy is contraindicated in chordoma?

transrectal

248

Maffuccis is characterized by:

A) multiple enchondromas, hemangiomas, lymphangiomas

B) multiple enchondromas in a unilateral distribution

C) auto-dominant transmission, multiple enchondromas and osteochondromas

A

249

What does it mean if a Tumor is biphasic?

It contains both epithelial and mesemchymal neoplastic cells

250

For ewings sarcoma, what blood markers should be added to the typical malignant work up and why?

CBC, esr and crp to differentiate it from osteomyelitis

 

In ewings esr will be up (but not crp?)

251

Indications for marginal resection of lipoma (4)

Symptomatic lesions

Rapidly growing mass

Deep to fascia or in retroperitoneum

Spindle cell & pleomorphic variants

252

 

What term is typically used to describe the following genes: p53 and RB-1

 

Tumor suppressor genes.

253

In terms of tumour location, what are apophyses treated like?

Epiphysis

THINK: locations for chondroblastoma (GT apophysis, calcaneal apophysis etc...)

254

3 dDx for anterior tibial liesion

osteofibrous dysplasia

adamantinoma

malignant fibrous histiocytoma

255

 

What tumor am I?

 

Estrogen Beta Positive

Locally invasive but benign

Can treat with Tamoxifen

Associated with FAP and Dupuytrens

 

Extra-Abdominal Desmoid Tumor

256

Lifetime risk of malignant transformation for solitary enchondroma?

 

1%

257

What is special about biphasic sarcomas in terms of metasteses?

They can go to lymph nodes, which is unusual for sarcomas.

 

Also they metastasize to locations other than the lungs.

258

Name 2 types of benign periepheral nerve sheath tumours

What's the difference

Scwannoma: only made up of Schwan cells

Neurofibroma: Arises from Schwann cells but also has other cells (fibroblasts etc)

259

PVNS typically contains which pigment?

Hemosiderin deposits

260

Gene associated with primary ABC?

Tre2

261

3 Predictors of UNSUCCESSFUL treatment of UBC with steroids

active lesion

large size

multiloculated

262

Long standing chronic draining wounds or burn scar are at risk of what?

Transformation into SCC (Marjolin's ulcer)

263

What Tumor is usually epiphyseal in skeletally immature with chicken wire calcifications?

Chondroblastoma

 

Also has mononuclear chondroblasts

264

Name 3 soft tissue tumours that chemo can help with:

Synovial sarcoma

Leiomyosarcoma

Rhabdomyosarcoma (only in paediatric population, not adults)

265

Common presentations in Chordoma?

bladder & bowel changes are common!

palpable on rectal exam

266

What staging investigation must you include in epitheliod sarcoma (and certain other soft tissue sacomas)

Sentinel LN biopsy

267

Li-Fraumeni syndrome:

what germ line mutation & tumour is it associated with

p53

osteosarcoma

also: breast, colon Ca

268

Name 4 vertebral body tumours

hemangioma

GCT

chordoma

multiple myeloma

Lymphoma

269

What is the most common benign radiation induced tumour of bone?

osteochondroma

270

 

Indications for bone marrow biopsy?

(i.e. what tumors necessitate this)

 

  1. Ewings
  2. Multiple Myeloma
  3. Rhabdomyosarcoma

271

Patient is complaining of on and off pain, tenderness to palpation and cold intoleratnce.  This is the clinical picture.  Diagnosis & Management?

Glomus tumour

Classic triad

  • paroxysmal pain
  • exquisite tenderness to palpation
  • Cold intolerance

Treatment: marginal resection is curative

272

Tretment of fibrous dysplasia?

Observation ± bisphosphonates: asymptomatic lesions

Operative with internal fixation and autologous bone graft (symptomatic)

273

What is unique in Ewing's as part of staging?

Bone marrow biopsy

looks for BM mets that would change prognosis

274

Which primary has worst prognosis once mets are present in bone?

Lung

275

How do you differentiate between ABC and telangiectatic osteosarcoma?

Biopsy

 

Telengiectatic osteosarcoma is Slayers Sarcoma because it is Lakes of Blood

276

A 75-year-old man presents with a displaced femoral neck fracture. During your surgical exposure for a hemiarthroplasty, the femoral neck has fractured through a pathologic lesion which is diagnosed as a lymphoma on frozen section. The lesion is located in the center of the femoral neck and the calcar femorale is not involved. Your treatment should include

Hemiarthroplasty & postoperative staging and chemo-radiotherapy as needed

Lymphoma can be treated with chemo-rads for local and distant disease

If it was osteosarc: close and regular sarcoma protocol

277

SYT-SSX1, SYT-SSX2, or SYT-SSX4 translocation (t(X;18)(p11;q11))

Synovial sarcoma

278

Classic spine finding in EG?

vertebra plana

Couldn't find a good picture but can be subtle - remember the SPORC case??

279

What is the risk of malignante transformation of fibrous dysplasia?

1%

into osteosarcoma, fibrosarcoma or MFH

280

 

What is the usual indication for radiation therapy at the following doses?

 

a) 6 Gy

b) 30 Gy

c) 60 Gy

 

 

a) HO prophylaxis

b) Treatment of a boney Met

c) Adjuvant therapy for soft tissue sarcoma

281

Poor prognostic sign in neuroblastoma?

bony mets

282

Name 2 tumours affecting multiple vertebra

metastatic disease

multiple myeloma (remember may be cold on bone scan)

283

Benign aggressive looking lesion.  Must rule out what malignancy?

Telangiectatic osteosarcoma

284

Enchondromas always central metaphyseal t/f?

True

285

Which sarcoma is radio/chemo resistant?

A) liposarcoma

B) osteosarcoma

C) chondrosarcoma

D) Ewing's sarcoma

C) chondrosarcoma

286

What are the three biphasic sarcomas?

1. Synovial sarcoma

2. Angiosarcoma

3. Mixed liposarcoma

287

UBC on MRI?

very Dark on T1

Very bright on T2

288

What percentage of UBCs heal after fracture?

10-15%

(JAAOS 2014 says

289

Which soft tissue tumour is relatively insensitive to both radiation and chemo?

Angiosarcoma

290

Man has radicular buttock pain

MRI shows large nerve lesion in sciatic

What is it likely?

Neurofibrosarcoma (malignant peripheral nerve sheath tumour)

They affect large nerves

Must resect entire affected nerve

291

What type of nerve cells is responsible for the neurofibromas in NF1?

non-myelinating Schwann cells

(vs. myelinating in solitary neurofibromas)

292

What type of resection are you performing with PVNS

Marginal resection is what you're aiming for

(with arthroscopic, probably doing intralesional)

293

Host lamellar bone entrapment is characteristic of what malignancy?

Chondrosarcoma

294

Best UBC lesions to pursue steroid injections

Predictors of success following UBC treated with steroids

approaching skeletal maturity

Not loculated

smaller size

Fracture of inner wall

(radiograhpically active - Can't find a reference - probabyl a POOR sign though.  This contrasts "approaching skeletal maturity")

295

Most common presentation of chondroBLASTOMA

pain

296

Treatment for multiple myeloma

multiagent chemotherapy (mainstay)

bisphosphonates (helps reduce number of skeletal events)

Surgical stabilization

 

297

Orthopaedic Tumours that Spread to LN's

Synovial Sarcoma

epitheliod sarcoma

angiosarcoma

rhabdomyosarcoma

clear cell sarcoma

298

Diagnosis & Treatment?

Adamantinoma

(NOT OFD b/c not confined to cortex - much more malignant.  ALso associated with bowing)

Treatment: wide resection + reconstruction (intercalary graft)

299

Histologically, how do you differentiate ABC from telangiectatic osteosarcoma?

TO: lakes of blood filled mixed with neoplastic cells (top)

ABC: Cavernous blood filled spaces with no endothelial lining (bottom)

300

Describe Mazabraud syndrome

Polyostotic fibrous dysplasia

intramuscular myxoma

 

301

 

What is a Bence Jones Protein?

 

Light chain immonuglobulin found in multiple myeloma.

302

What kind of chondrosarc does enchondrama change into?

low grade chondrosarcoma

303

 

Lifetime risk of malignant transformation for Maffucis?

 

100%

304

Name the 3 manifestations of eosinophilic granuloma and their characteristics

Eosinophilic granuloma

  • Single self-limited lesion in younger patients

Hand-Schuller-Christian disease (HSC)

  • chronic, disseminated form with bone and visceral lesions

Letterer-Siwe Disease

  • Fatal form that occurs in young kids

Can be Monoostotic or Polyostotic

305

 

What tumor shows predilection for the distribution shown in this figure?

 

Lymphoma

306

Recurrence rate of GCT of tendon sheath after marginal excision?

5-50%

307

Treatment for neurofibrosarcoma (malignant peripheral nerve sheath tumour)?

What must you specifically do?

Wide resection

Must resect the entire affected nerve

308

Name the syndromes associted with the spectrum of Langerhans cell histiocytosis

Eosinophilic Granuloma

  • Self-limited in younger patients

Hand-Schuller-Christian Disease

  • Chronic, disseminated form

Lettere-Siwe Disease

  • Fatal for in young kids

309

Do osteochondroma transform into high or low grade chondrosarcoma?

Low grade

310

Which primary can have mets distal to knee and elbow?

Lung

311

Name 1 poor prognostic factor for parosteal osteosarcoma

de-differentiation

312

Indicatios for surgical resection in osteoid osteoma

painful scoliosis

Too close to vital strucures for radiofrequency ablation (neural elements, skin)

313

NOF can be associated with what other tumour

ABC

314

In operative management of fibrous dysplasia, what should you never use

Autograft

It will rapidly be turned into fibrous dysplastic woven bone

315

Benign aggressive lesions? (3)

GCT, ABC, osteoblastoma

316

Seven questions for evaluating bone lesion on x-ray? 

(as per Toronto group)

1.  where is it?

2. how big is it?

3. What is it doing to bone? (destructive? geographic? permeative?etc.)

4.  what is bone doing to it? (sclerosis? periosteal rxn?)

5.  matrix?

6. cortex? (eroded? preserved? neocortex? endosteum?)

7.  soft tissue mass?

317

Which soft tissue sarcomas need chemo?

RSSD

Rhabdomyosarcoma

Synovial sarcoma

Soft-tissue Ewings

de-differentiated chondrosarc

HOWEVER THIS IS CONTROVERSIAL

SAFE ANSWER FOR TREATMENT OF SOFT TISSUE SARCOMA IS WIDE RESECTIO + RADIATION

318

Treatment of this pathologic fracture?

Sling for comfort

Nonop of pathologic fractures through UBC, unless they are in a weight bearing zone (proximal femur)

319

Which way do pedunculated osteochondraom lesions point?

Away from the joint

320

3 poor prognostic indicators for soft tissue sarcoma?

High grade

size >5cm

tumour location below deep fascia

321

how often is ABC associated with another tumour?

30% of the time

322

Synovial sarcoma genetics

t(X;18)

Forms SYT/SSX1 & SYT/SSX2 fusion transcripts

323

Medical treatment options in UBC

Bone graft (poor success with high recurrence rates)

Steroid

autologous bone marrow (controversial - may be better than steroids)

JAAOS 2014

324

Why must you follow chordoma patients long term post resection?

1. High recurrence rate

2. Mets occurs late in disease

Occurs in 30-50% to lung, rarely bone

325

Nonoperative mangement of Paget's

When is it indicated

Bisphosphonates

Calcitonin

Indicated in sympomatic cases

asymptomatic you just treat supportively

326

 

What tumor shows predilection for the distribution shown in this figure?

 

Chondroblastoma

327

 

What extra-articular tumor has pathology similar to PVNS?

 

Giant cell tumor of tendon

328

What are the basic types of soft tissue sarcoma (think histo)

Synovial (sarcoma)

Lipo(sarcoma)

Rhabdomyo(sarcoma)

Fibro(sarcoma)

329

GCT histology?

Mononuclear cells with Uniformly distributed multinucleated giant cells