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Flashcards in Tumour Deck (329)
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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