090814 bone cartilage soft tissue tumors clinical

Question 1

unicameral bone cyst vs aneurysmal bone cyst

Answer 1

both benign

aneurysmal is lytic; it has fluid/fluid levels (when blood is separated into plasma and RBCs); it is more aggressive

Question 2

desmoid

Answer 2

locally aggressive fibrous tissue lesion with no malignant potential

pain to treat

Question 3

when looking at diagnosing these tumors, what should you consider?

Answer 3

PMH
age
location
aggressive? bone has had time to respond with sclerotic rim?

matrix production? very few things do (cartilage lesions-enchondromas, osteochondromas, chondrosarcomas; osteosarcomas)

Question 4

when you stage a bone lesion, what do you do?

Answer 4

XR entire affected bone

whole body bone scan (or skeletal survey for multple myeloma)

CT scan of chest, abd, and pelvis (to look at common sites like breast kidney lung whose cancers can metastasize) OR PET/CT, which is more expensive

serum protein electrophoresis/urine proein electrophoresis/serum free light chains (for multiple myeloma or plasmacytoma)

PSA (for prostate)

Question 5

TTF1 positive means

Answer 5

TTF1 is positive in adenocarcinomas coming from the lungs

Question 6

cytokeratin is positive in

Answer 6

carcinomas

Question 7

osteochondromas

Answer 7

extensions of growth plate

Question 8

giant cell tumors tend to be where

Answer 8

epiphyseal

Question 9

bone cysts can cause

Answer 9

fractures

on radiography, looks a little exapnded

Question 10

unicameral bone cysts occur in whom and where?

Answer 10

children and young adults

metaphyseal region of long bones

Question 11

what happens to bone cortex when you have unicameral bone cyst?

Answer 11

it is eroded by the cyst and elicits a secondary periosteal new bone formation

Question 12

why would you see hemosidern and granulation tissue with a unicameral bone cyst

Answer 12

b/c of frequent fractures–you get old blood (hemosiderin) and granulation tissue

Question 13

what exactly is a unicameral bone cyst

Answer 13

cyst filled with clear fluid and lined with thin fibrous membrane; most people grow out of them

Question 14

aneurysmal bone cyst

Answer 14

benign neoplasm

giant cells in them
immature bone
filled with blood
honeycomb, blood filled mass

btwn blood filled spaces you can see fibrous septa, giant cells and immature bone or osteoid

Question 15

aneurysmal bone cysts occur in whom and where?

Answer 15

usually less than 20 yrs old
metaphyseal region of long bones common

get PAIN, swelling, tenderness

Question 16

how to treat anuerysmal bone cyst

Answer 16

curettage (scraping)
or
embolization/scleropathy

Question 17

no mineral in it on radiography means

Answer 17

purely lytic lesion

Question 18

if you can’t tell where the lesion starts or stops

Answer 18

it’s aggressive

Question 19

soft tissue sarcomas usually don’t hurt until they are so big that they press on nerves: true or false?

Answer 19

true

Question 20

lipomas are the most common soft tissue tumor, but if they are bigger than 3 cm, or deep, what should you do?

Answer 20

just get an MRI to rule out the possibility of it being another type of tumor. just to be safe

Question 21

desmoid fribromatosis

Answer 21

firm, hard, thick , fibrous tissue

very difficult to treat

Question 22

soft tissue tumors more likely in what age group

Answer 22

older pts

Question 23

what confirms desmoid fibromatosis

Answer 23

beta catenin

Question 24

what if you see pleomorphic cells and stuff you can’t even recognize

Answer 24

could be high grade undifferentiated pleomorphic sarcoma

Question 25

if there’s breach of cortex for cartilage tumor, most likely?

Answer 25

chondrosarcoma

Question 26

can endonchondromas be mineralized?

Answer 26

yes, or can be radiolucent

Question 27

only part of osteochondroma that is abnormal

Answer 27

cartilage cap

Question 28

anything producing malignant osteoid

Answer 28

has mineralization, aggressive appearance = osteosarcoma