18.2 Bone Tumors

Question 1

What are osteomas? Where, anatomically, are they most likely to be found?

Answer 1

Benign tumors of the bone that most commonly arise on the surface of facial bones

Question 2

What GI disease is associated with the development of osteomas?

Answer 2

Gardner’s syndrome

Question 3

What is osteoid osteoma? What are the cells that form this? Where, anatomically, are these usually found, and where in the bone are they?

Answer 3

• Benign tumor of osteoblasts surrounded by a rim of reactive bone
• Arises in the cortex of long bones, usually near the diaphysis

Question 4

What is the age range that osteoid osteomas usually occur in?

Answer 4

Less than 25 years old

Question 5

What are the radiological findings of osteoid osteomas?

Answer 5

Bony mass, with a radiolucent core

reflects the osteoid in the center, and the reactive bone around it

Question 6

What is the usualy presentation of osteoid osteomas? What can be used to treat it?

Answer 6

Bone pain relieved by ASA

Question 7

Which is relieved by ASA: osteoid osteomas, or osteoblastomas?

Answer 7

Osteoid osteomas

Question 8

What are the cells that comprise an osteoblastoma? Where, anatomically, does it usually arise? How big are they, usually?

Answer 8

• Proliferation of osteoblasts
• Larger than 2 cm
• Vertebrae

Question 9

What is the size difference between osteoid osteomas and osteoblastomas?

Answer 9

Osteoblastomas are greater than 2 cm, while osteoid osteomas are usually smaller

Question 10

What are the usual s/sx of osteoblastomas?

Answer 10

Bone pain unrelieved by ASA

Question 11

What is the most common benign tumor of bone?

Answer 11

Osteochondroma

Question 12

What is an osteochondroma?

Answer 12

Tumor of bone with an overlying cartilage cap, that usually arises as a lateral projection of a growth plate

Question 13

True or false: an osteochondroma is contiguous with the underlying growth plate

Answer 13

True

Question 14

What is a major consequence of untreated osteochondroma

Answer 14

Overlying cartilage can transform into a chondrosarcoma

Question 15

What are the cells that comprise osteosarcomas? What is the age that is usually affected? Where in the bony / bone do they develop?

Answer 15

• Malignant proliferation of osteoblasts
• Teenagers and the elderly
• Metaphysis of long bones (femur or proximal tibia)

Question 16

What are three major risk factors for the development of osteosarcomas?

Answer 16

• Rb
• Paget’s disease of bone
• Radiation exposure

Question 17

What is the usual cause of osteosarcomas in the elderly? What is different about the prognosis of these, relative to younger onset disease?

Answer 17

Usually d/t PDB or other disease processes, and carries a worse prognosis

Question 18

What are the usual presenting s/sx of osteosarcomas?

Answer 18

Pathologic fracture or bone pain

Question 19

What are the two classic x-ray findings of osteosarcoma?

Answer 19

• Codman’s triangle–raising of the periosteum of the bone, with underlying separation of the cortex
• Star burst appearance of bone d/t spicules of bone being produced

Question 20

What are the histological findings of osteosarcomas?

Answer 20

Malignant cells surrounded by osteoid

Question 21

What are the cells that comprise giant cell tumors? In whom does this usually occur?

Answer 21

• Comprised of multinucleated giant cells

- Occurs in young women

Question 22

What is the one primary bone lesion that arises in the epiphysis of long bones?

Answer 22

Giant cell tumors

Question 23

What is the classic appearance of giant cell tumors on x-ray?

Answer 23

Soap-bubble appearance

Question 24

What is the prognosis for giant cell tumors?

Answer 24

Locally aggressive, and may recur

Question 25

Where do giant cell tumors usually arise, anatomically speaking?

Answer 25

Epiphysis of long bones

Question 26

What are Ewing Sarcomas? Where in the body / bone do they usually arise?

Answer 26

• Malignant proliferation of poorly differentiated cells from neuroectoderm
• Diaphysis of long bones inside the medullary cavity

Question 27

What is the age range and gender of the usual Ewing sarcoma pt?

Answer 27

Young male

Question 28

What is the classic x-ray appearance of Ewing Sarcoma? What causes this?

Answer 28

• Onion skin appearance

- Reaction of the periosteum d/t pressure from internal Ewing

Question 29

What are the stains that are positive for Ewing sarcoma?

Answer 29

CD99 and S100

Question 30

What are the histological findings of Ewing’s sarcoma?

Answer 30

Lots of small round blue cells

Question 31

What is the translocation that produces Ewing’s sarcoma?

Answer 31

11:22

11 + 22 = 33, Ewing’s jersey number”

Question 32

What is the prognosis of Ewing’s sarcoma?

Answer 32

Often presents with mets, but is responsive to chemo

Question 33

Where do chondromas usually occur in the body?

Answer 33

Fingers / hands

Question 34

What are chondromas, generally? Where do they arise relative to bone?

Answer 34

Benign tumor of cartilage that arise in the medulla of bone

Question 35

What is a chondrosarcomas, and where in the body / bone do these usually arise?

Answer 35

• Malignant cartilage forming tumor

- Arises in the medulla of the pelvis of central skeleton

Question 36

What are the two metastatic tumors of bone that are osteoblastic?

Answer 36

Prostate

Breast

Question 37

Which are most common, primary or mets to bone?

Answer 37

Mets

Question 38

Are most mets to bone osteolytic or osteoblastic?

Answer 38

Osteolytic

Question 39

What is the difference between osteolytic and osteoblastic lesions?

Answer 39

Osteolytic produces punched out appearance, while osteoblastic causes sclerosis of the bone