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Flashcards in Tumour Deck (329)
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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