4 posterior element tumours
What systemic pathology (ie non ortho) do people with Paget's disease get?
high output cardiac failure
due to increased turnover of bone
What percentage of vertebral body tumours are malignanet?
What bone metasteses are not redio sensitive?
Which is the most readio-sensitive?
1) GI and Renal
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)
Which side of the spine in an osteoid osteoma normally found in?
Concavity of the spine
Histology of ewings sarcoma?
Small round blue cells
How do you classify UBC?
Active - in continuity with physis
Latent - bony bridge between UBC and physis
Most common location of mets in soft tissue sarcoma
They can mets to LNs, but lungs are still most common
Survival rate of chondrosarcoma
Directly correlates with histological grade:
Grade 1: 90%
Grade 2: 60-70%
Grade 3: 30-50%
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
Wide resection is standard of care
± radiation if:
What is the most common cause of painful scoliosis in the adolescent population?
5 complications with treatment of UBC
embolizatio of injected material
local reaction to injected material
What kind of tumour results from malignant transformation of a chronic OM?
what is the treatment?
Treat with wide excision/amputation + adjuvant chemo/rads
Prognosis is poor with late diagnosis, good with early
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!
4 predisposing genetic factors for intramedullary osteosarcoma
Rothmund thomson syndrome
60 yo F with constitutional symptoms, pain palpable mass. (see picture)
Dx & treatment
Treatment is surgical stabilization, chemo, radiation
*Lymphoma can have a soft tissue mass!
*lymphoma: small round blue cell
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
Age range for GCT?
indications for excisional bx
superficial to fascia
Not overlying NV structure
excise AND LEAVE BEHIND FASCIA
"Pop corn densities" are useful in differentiating what secondary malignancy from its benign precursor?
Secondary chondrosarcoma from enchondroma.
What is the histo of periosteal osteosarcoma
osteoid + chondroblastic matrix
If no osteoid, will be classified as chondrosarcoma
What tumor shows predilection for the distribution shown in this figure?
Giant Cell Tumor
Desribe AJCC classification system
Soft soft tissue tumours:
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)
Night symptoms/constitutional symptoms
Soft tissue extension
Lysis of prior chondroid mineralization
Ddx for multiple giant cell containing lesions?
Management of hypercalcemia
Fluids (200-300mL/hr initially, then maintaining u/o 100-150mL/hr)
Can use denosumab if refractory to bisphosphonates
LOOP DIURETICS ARE NOW NOT RECOMMENDED
dDx for Benign Latent Lesion (3)
Treatment for suspected low-grade chondrosarcoma (instead of enchondroma)