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Flashcards in Tumour Deck (329)
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211

Patient with RTC symptoms and solitary enchondroma found on imaging.  Plan?

Treat mechanical symptoms of RTCT. 

No need to treat incidentally found enchondromas as they normally have nothing to do with adjacent joint mechnical symptoms

If enchondroma is truly symptomatic, then intralesional curettage

212

Distal radius lytic lesion DDH? (4)

GCT

Abc

Chondrosarcoma

Telientatic osteosarcoma

213

Poor prognostic indicators in osteosarcoma (11)

advanced stage of disease (most predictive of survival)

response to chemotherapy (as judged by percent tumor necrosis of resected specimen)

  • >98% is a good prognostic indicator, but doesn't say what's bad

tumor site and size

expression of P-glycoprotein

tumor cells can pump chemotherapy out of cell with MDR expression

present in 25% of primary lesions and 50% of metastatic lesions

high serum alkaline phosphatase

high lactic dehydrogenase

vascular involvement

surgical margins

type of chemotherapy regimen

214

Genetic translocation association with osteosarcoma?

None

no translocation

However it has associted mutations: p53, Rb

215

dDx for path with giant cells

GCT

ABC

telangiectatic osteosarcoma

conventional osteosarcoma

216

Metastatic Tumor that is blastic?

Prostate

217

A translocation of chromosome 11 and 22 resulting in a chimeric protein is characteristic of what Tumor?

Ewing's sarcoma

 

Translocation results in EWS gene

218

You are working up a malignant looking tumor. It is bright on T2 with liquid, purulent looking gross pathology and no osteointegration matrix. what is it?

Ewing's sarcoma

219

Synovial sarcoma treatment

Same as any other soft tissue sarcoma:

wide resection + radiation

Radiation can be pre or post op (controversial)

UNLIKE other ST sarcomas, chemo may help in synovial sarcoma in both local control and overall survival

 

220

What colour is chondroid matrix on staining?

Blue

221

You're suspicious of multiple myeloma.  How do you stage it?

Skeletal survey

NOT bone scan, b/c they will be cold in 30% (b/c it lacks osteoblastic activity)

222

 

What is the diagnostic criteria for MM?

 

requires one major and one minor (or three minor) criteria for diagnosis

major criteria

biopsy confirmation of plasmacytoma

>10% plasma cells on bone marrow biopsy

serum IgG > 3.5g/dL, IgA > 2g/dL 

urine IgA > 1g/24hr or presence of Bence Jones proteins

minor criteria

10-30% plasma cells on bone marrow biopsy

serum or urine protein levels below those listed for major criteria

presence of multiple lytic bone lesions ("punched out" lesions without evidence of surrounding sclerosis)

decreased serum IgG levels

223

Recurrence rate of UBC

depends on treatment modality but generally up to 25-30% is reasonable

With steroids, some have reported recurrence up to 88%

(JAAOS 2014)

224

What benign tumour is characterized by fatty infiltration of sub synovial connective tissue?

Lipoma aborecens

225

What primaries metastasize to bone?

Lymphoma

Melanoma

 

Visceral carcinomas: Breast Prostate Lung Kidney Thyroid

226

Driving cell behind Paget's?

ostoclasts

227

What primaries are most likely to present as metastasis with unknown origin?

Lung and kidney (because they are more likely to be occult)

228

How do you differentiate between ABC and telangiectatic osteosarcoma on MRI?

It's hard - you can't really

orthobullets says you need bx to truly differentiate

top: TO

Bottom: ABC

229

What part of bone does ewings usually occur?

Diaphysis

230

Most common tumour of hand?

enchondroma

231

What on histo is pathognomonic for Schwannoma?

Verocay bodies

Composed of 2 rows of aligned nuclei in a palisading formation

232

Preferred treatment of EG.  Name 5 modalities

Salvage procedures

Nonop with treatment of mechanical symptoms preferred

  • Obervation alone
  • bracing (if amenable)
  • Low dose radiation (for spinal lesions that cause neuro symptoms)
  • Chemo (diffuse HSC)
  • Corticosteroid injections
  • Bisphosphonates

Operative if fails:

  • Curettage and bone grafting for lesions endangering articular surface
  • Spinal deformity correction

 

233

Dose for adjuvant radiation in soft-tissue sarcoma?

What are complications of 45 Gy vs 60Gy?

45-65Gy

45Gy: woudn has delayed healing

60Gy: wound not expected to heal

234

CD99

Ewing's sarcoma

235

8 lesiosn that can be found in vertebral body

multiple myeloma (most common primary tumor of spine)
           - chordoma
           - osteosarcoma
           - hemangioma
           - giant cell tumor of bone: sacrum;
           - eosinophilic granuloma
                                        - osteosarcoma of the spine
           - osteoid-osteoma and osteoblastoma of the spine

236

dDx for Benign aggressive lesion

Osteoblastoma

GCT

ABC

CMF

Chondroblastoma

±UBC

237

Long term survival of parosteal osteosarcoma when local contrl has been achieved

95%

238

 

What subtype of lipoma is painful?

 

AngioLipoma

239

Poor prognostic indicators in Ewing's

male age >14

fever

anemia

high LDH

axial location

use of radiotherapy without surgery

poor histologic response to chemo

Transcription Type II (Survival benefit with transcription type I EWS/FLI1 mutation)

Poor response to chemo

No effect of pathologic fracture

Local recurrence not as poor prognostic factor as in osteosarcoma ("death sentence" if local recurrence in osteosarcoma)

240

Most common site of mets of osteosarcoma

Lung: most common

Another bone: second most common