10-Bone tumors Flashcards
What are the different patterns of bone destruction?
name it increasing malignancy.
geographic (benign)
moth-eaten
permeative (most malignant)
Describe the geographic pattern of bone destruction.
- least destructive, slowly developing, usually benign or low-grade malignancy
- *well-defined zone of transition that separates the lesion from normal appearing bone
What is the most common benign primary bone tumor?
osteochondroma
what is the most common malignant primary bone tumor?
multiple myeloma
describe the permeative pattern of bone destruction.
- most aggressive and rapidly progressive malignant process
- *zone of transition is poorly defined and is very wide
name the malignant bone tumors of the foot.
- chondrosarcoma
- osteosarcoma
- periosteal sarcoma
- ewings sarcoma
- fibrosarcoma
- multiple myeloma
describe the moth-eaten pattern of bone destruction.
- is a more rapidly destructive process than geographic;
- has an intermediate zone of transition that is wide and less well-defined
name the benign bone tumors of the foot.
*mnemonic: FOG MACHINES
- fibrous dysplasia
- osteochondroma
- giant cell tumor
- myeloma
- aneurysmal bone cyst
- chondroblastoma, chondromyxoid fibroma, clear cell
- hemangioma
- infection
- non-ossifying fibroma
- eosinophilic granuloma, enchondroma, epidermal
- inclusion cyst
- solitary bone cyst
what are the different patterns of periosteal reactions
- single layer- benign but sometimes malignant
- onion skin- malignant, multiple layers of periosteum
- sunburst- spiculated rays
- hair on end- parallel rays
- codman triangle- triangular elevation of periosteum
what are the most common cancers that metastasize to the foot?
- breast
- prostate
- lung
- kidney
what bone tumors do not form matrix?
“BEG” to see the Matrix (but can’t form it)
- bone cysts
- ewings sarcoma
- giant cell tumor
what primary bone tumors are more frequent in females?
“GAP” tumors are more common in females
- giant cell tumor
- ABC (aneurysmal bone cyst)
- parosteal osteosarcoma
Name some bone tumors that are located in the epiphysis.
“ECG”
- chondroblastoma
- giant cell tumor (forms in metaphysis though)
name some bone tumors found in the metaphysis.
“FACE UP GMO”
- non-ossifying fibroma
- aneurysmal bone cyst
- chondrosarcoma
- enchondroma (also diaphyseal)
- unicameral bone cyst
- parosteal osteosarcoma
- osteochodnroma
- giant cell tumor (extends into epiphysis)
- medullary osteosarcoma
- parosteal osteosarcoma
name some bone tumors found in the diaphysis.
“EE, POO”
- osteoid osteoma
- osteoblastoma
- enchondroma (also metaphyseal)
- ewings sarcoma (also meta-diaphysis)
- periosteal osteosarcoma
name some bone tumors that are centrally located.
“Central in the EU”
- enchondroma
- unicameral bone cyst
name some bone tumors found in the cortex of bone.
“OF cortex”
- osteoid osteoma
- non-ossifying fibroma
name some bone tumors that are found eccentrically located in the medullary canal.
“Eccentric giant old con”
- giant cell tumor
- chondrosarcoma
- osteosarcoma
name some bone tumors that are found in the periosteum.
- osteochondroma
- periosteal osteosarcoma
what are characteristics of an osteoid osteoma?
- benign, osteolytic lesion with central nidus (<1 cm) that may have calcifications
- 1st to 2nd decades of life
- Dull pain, worse at night, relieved with ASA
what are characteristics of osteoblastoma?
- “giant osteoid osteoma”
- benign tumor that may become malignant
- osteolytic lesion with well-circumscribed nidus (>1.5cm) that may have multiple calcifications
- occurs in 2nd to 3rd decades of life
- less symptomatic than osteoid osteoma, pain not relieved by ASA
what are the characteristics of an enchondroma?
- benign, well-defined intramedullary cartilaginous lesion
- painless swelling unless pathologic fracture
- geographic lesions w/ punctate calcified matrix
- occurs in 3rd to 4th decades of life
what is Ollier disease?
- multiple enchondromatosis
- may become malignant
- occurs in 1st decade of life
what is maffuccis disease?
- multiple enchondromas with soft tissue hemangiomas
- most become malignant
- 1st decade of life
what are characteristics of a chondroblastoma?
- benign, geographic , osteolytic lesion w/ sclerotic margins
- occurs in 2nd to 3rd decade of life
- pain and joint effusion
what are characterisitcs of an osteochondroma?
- most common benign primary bone tumor
- cartilage-capped, hyperpalstic bone pointing away from the joint
- occurs in 2nd to 4th decades of life
- suspect malignant transformation with growth after skeletal maturity, pain, or cap >2cm
what are the characteristics of a non-ossifying fibroma?
- benign CT lesion with fibrous replacement of bone
- expansive, radiolucent, medullary lesions
- 1st to 2nd decades of life
- lesions typically resolve with age
- do not biopsy
what are characteristics of a fibrous dysplasia?
- benign, geographic, fibro-osseous lesion with ground glass matrix
- presents with deformity
- sometimes painful secondary to fracture
what are characteristics of a unicameral bone cyst (UBC)?
- benign, geographic, medullary lesion that is fluid-filled
- commonly found in calcaneus
- occurs in 1st to 2nd decades of life
- asymptomatic until fx
- fallen fragment sign- pathologic fx in which cortex lies within lesion
what are characteristics of an aneurysmal bone cyst (ABC)?
- benign, expansile, lytic lesion with blood-filleld cavities
- may extend into soft tissue
- fluid-fluid levels seen on MRI
- occurs in 1st to 3rd decades of life
- more common in females
- painful, especially with pathologic fractures
what are the characteristics of giant cell (GC) tumor?
- benign but locally aggressive
- lytic lesion with ground glass, “soap-bubble appearance”
- may destroy cortex and have soft tissue mass
- more common in females
- 3rd to 4th decades of life
- painful
what are characteristics of a multiple myeloma?
- most common primary malignant bone tumor
- punched out lesions or diffusely osteopenic with hair-on
- end radiating spicules
- affect 45-80 y/o
- painful w/ weakness or neurologic sx
- bence-jones protein found within urine
what are characteristics of an osteosarcoma?
- *most common primary malignant bone tumor
- sunburst periosteal reaction with codman triangle and cloud-like, dense bone formation
- occurs in 2nd to 3rd decades of life
- dull aching pain
- if in the medullary canal–> poor prognosis
what is the most common bone tumor associated with paget’s disease?
osteosarcoma
what are characteristics of ewing sarcoma?
- aggressive, permeative, lytic lesion with onion skin appearance
- may have large soft tissue mass
- usually under 20 y/o
- poor prognosis
what are characteristics of a chondrosarcoma?
- malignant, moth-eaten lesion with medullary and soft tissue calcifications
- occurs in 5th to 6th decades of life
- painful
what study is most useful in searching for metatstatic bone disease?
- total skeletal bone scan
- malignant lesions will show increased uptake
differences in prognosis for osteosarcomas found in:
medullary, parosteal, and periosteal
- Medullary
- poor prognosis
- Periosteal
- Slightly better prognosis than medullary
- Parosteal
- more common in females
- better prognosis than medullary
