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Flashcards in Tumour Deck (329)
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121

Histopathology of GCT?

Multinucleated giant cells.

 

May see bone.

 

Mononuclear stromal cells

122

Where is the most common place for sarcomas to metastasize?

1. Lungs

2. Another bone

123

What is Denosumab?

RankL inhibitor.

This is a ligand for the Rank receptor and acts as a signal for bone removal.

Denosumab is an analogue and used in GCT tumours to prevent bone turnover.

124

General treatment approach for bone sarcoma?

1. Neo adjuvant chemotherapy, multi-agent

2. Re-stage with imaging to assess for interim progression/metastases and pre-op planning

3. Wide resection

4. Chemotherapy - use response to pre-op chemo to prognosticate (% necrosis of surgical pathology) and target therapy

125

Name & decribe the possible life threatening complication of hemangioma

Kasabach-Merrit syndrome

entrapped platelets in the hemangioma leading to a possible fatal coaguloapthy

126

Phases of Paget's disease

Lytic: osteoclastic resorption

Mixed: resorption & compensatory bone formation

Sclerotic: bone formation predominates

All 3 may exist at same time so Paget's can look lytic, mixed or sclerotic (like OM its a mimicker)

127

Differential for small round blue cells on histology?

Ewing's sarcoma

Lymphoma

Osteomyelitis

Multiple myeloma

Histiocytosis

Rhabdomyosarcoma

Neuroblastoma

(LERN'M)

128

 

What tumor shows predilection for the distribution shown in this figure?

 

Osteoid Osteoma

129

What happens to NOF as the patient grown and reaches skeletal maturity

Migrate to diaphysis as patient grows AND GET LARGER

Will then usually self-resolve (become sclerotic and then go away) as the patient reaches skeletal maturity

130

Local Recurrence rate for well differentiated vs. high grade?

Well differentiated: 10%

High grade: 20%

131

Benign tumours that can metastasize to lungs (2)

GCT

Chondroblastoma

132

 

Epiphyseal Lesion with this biopsy.

 

Diagnosis?

 

Clear cell chondrosarcoma

133

7yo M severe pain after ice skating.

How do you treat?

UBC (fallen leaf sign)

Weight bearing area

Treat with bone grafting and internal fixation

134

What is the most common soft tissue sarcoma in kids?

Rhabdomyosarcoma

135

On an exam, what tumour has codman's, what has onionskinning?

Codman's: osteosarc

Onion-skinning; Ewings

136

2 risk factors for malignant transformation of osteochondroma

Cartilage cap >2cm in adults (some say >0.9cm is a risk factor)

Sessile lesions

 

 

137

What primary cancer diagnosis is associated with the shortest life expectancy after pathologic fracture?

Lung cancer

138

Medical managmeent for fibrous dysplasia?

bisphosphonate

decreases pain and bone turnover

139

How do you differentiate between ABC/GCT vs. UBC on x-ray

UBC is not as expansile

It generally doesn't go past the width of the physis

140

Which chondrosarcoma variant is typically epiphyseal?

Clear cell chondrosarcoma

141

Osteosarcoma: poor prognostic indicators:

Advanced stage of disease (most prognostic of survival)

Mets on presentation

Axial location/mets

Skip lesions

Poor response to chemotherapy (>98% necrosis is a GOOD sign)

Increased LDH and/or ALP

Tumour site & size

Expression of P-glycoprotein

Vascular involvement

Margins

Site & size of tumour

Type of sarcoma (parosteal better than intramedullar/conventional)

 

 

142

Imaging for metastasis with unknown origin?

Chest X-ray

X-ray of involved bone

Any painful extremities

Bone scan

If suspect myeloma, skeletal survey

Consider MRI of bone lesion

Ct chest/abdo/pelvis

143

What is a unique treatment option of neuroblastoma?

In young kids, nonoperatiave as they may spontaneously regress

144

4 extraosseous findings in fibrous dysplasia

cafe-au-lait spots

precocious puberty

intramuscular myxoma

Chereubism

145

Define the stages and survival for AJCC

IA

IVB

IA:

low grade

<8cm

No LN

No mets

5 year survival 98%

IVB:

Any tumour with mets to site other than lungs

5 year survival 30%

146

 

What tumor shows predilection for the distribution shown in this figure?

 

Ewings Sarcoma

147

What is the primary difference between sarcomas and carcinomas? (In terms of lineage)

Carcinomas = epithelial Sarcomas = mesemchymal

148

What is the most important factor for 5 year disease free survival in soft tissue sarcoma?

What happens if this is not achieved?

Size of operative margin

larger margin = better b/c it avoids microscopic contamination

If you have + margins, must take back for re-resection of tumour bed

149

What is the most common malignancy of bone?

What is the most common primary malignancy of bone?

 

What is the most common malignancy of bone?

Mets

What is the most common primary malignancy of bone?

myeloma

150

Describe Mirel's score