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Flashcards in Tumour Deck (329)
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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