Patient is complaining of on and off pain, tenderness to palpation and cold intoleratnce. This is the clinical picture. Diagnosis & Management?
- paroxysmal pain
- exquisite tenderness to palpation
- Cold intolerance
Treatment: marginal resection is curative
Tretment of fibrous dysplasia?
Observation ± bisphosphonates: asymptomatic lesions
Operative with internal fixation and autologous bone graft (symptomatic)
What is unique in Ewing's as part of staging?
Bone marrow biopsy
looks for BM mets that would change prognosis
Which primary has worst prognosis once mets are present in bone?
How do you differentiate between ABC and telangiectatic osteosarcoma?
Telengiectatic osteosarcoma is Slayers Sarcoma because it is Lakes of Blood
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
SYT-SSX1, SYT-SSX2, or SYT-SSX4 translocation (t(X;18)(p11;q11))
Classic spine finding in EG?
Couldn't find a good picture but can be subtle - remember the SPORC case??
What is the risk of malignante transformation of fibrous dysplasia?
into osteosarcoma, fibrosarcoma or MFH
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
Poor prognostic sign in neuroblastoma?
Name 2 tumours affecting multiple vertebra
multiple myeloma (remember may be cold on bone scan)
Benign aggressive looking lesion. Must rule out what malignancy?
Enchondromas always central metaphyseal t/f?
Which sarcoma is radio/chemo resistant?
D) Ewing's sarcoma
What are the three biphasic sarcomas?
1. Synovial sarcoma
3. Mixed liposarcoma
UBC on MRI?
very Dark on T1
Very bright on T2
What percentage of UBCs heal after fracture?
(JAAOS 2014 says
Which soft tissue tumour is relatively insensitive to both radiation and chemo?
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
What type of nerve cells is responsible for the neurofibromas in NF1?
non-myelinating Schwann cells
(vs. myelinating in solitary neurofibromas)
What type of resection are you performing with PVNS
Marginal resection is what you're aiming for
(with arthroscopic, probably doing intralesional)
Host lamellar bone entrapment is characteristic of what malignancy?
Best UBC lesions to pursue steroid injections
Predictors of success following UBC treated with steroids
approaching skeletal maturity
Fracture of inner wall
(radiograhpically active - Can't find a reference - probabyl a POOR sign though. This contrasts "approaching skeletal maturity")
Most common presentation of chondroBLASTOMA
Treatment for multiple myeloma
multiagent chemotherapy (mainstay)
bisphosphonates (helps reduce number of skeletal events)
Orthopaedic Tumours that Spread to LN's
clear cell sarcoma
Diagnosis & Treatment?
(NOT OFD b/c not confined to cortex - much more malignant. ALso associated with bowing)
Treatment: wide resection + reconstruction (intercalary graft)
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)
Describe Mazabraud syndrome
Polyostotic fibrous dysplasia