2.1.3 Bone and Tumor Pathology I

Question 1

What are some of the tools for evaluating a bone lesion?

Answer 1

H&P, plain films, MRI, CT, and bone scan

Question 2

Diagnose me.

Answer 2

Monostatic fibrous dysplasia

Question 3

What is the size of the nidus in osteoid osteoma?

Answer 3

under 2 cm

Question 4

Answer 4

Question 5

diagnose me.

Answer 5

Giant cell tumor

Question 6

What is the reason for pain in osteoid osteoma?

Answer 6

Prostaglandins are being made in the lesion. That is why aspirin is particularly useful in reducing the nighttime pain experienced in these patients.

Question 7

Name this condition?

Answer 7

Osteoid osteoma

Question 8

What is the name for the condition for multiple enchondromas?

Answer 8

Oillier’s dz

Question 9

What is being shown here on this bone scan of a 10-year old girl with monostatic fibrous dysplasia?

Answer 9

B/c the girl is still growing, the areas of the metaphysis are still lighting up b/c of their metabolic activity. In hip, there is assymetric activity which is indicative of an active lesion.

Question 10

What are the three clinical patterns of fibrous dysplasia?

Answer 10

Monostotic (70%) - early adolescence

Polyostotic (27%)

Polystotic dz, assoc w cafe au lait skin pigmentation and endrocrine abnormalities (McCune-Albright syndrome)

Question 11

What type of radiological study is good for viewing osteoid osteoma?

Answer 11

CT

Question 12

Benign cartilage-capped outgrowth that is attached to the skeleton by a bony stalk

Answer 12

Exostosis

Question 13

What is true about the activity of most tumors in upper extremities?

Answer 13

More active

Question 14

What is the shepard’s crook deformity?

Answer 14

The bowing of the diaphysis in relation to the head. Doing this because the bone is weak and their is an adductor moment in the hip.

Question 15

Id this specifmen

Answer 15

Osteochondroma

Question 16

Condition?

Answer 16

Giant cell tumor

Question 17

What is the saying about biopsies and cultures regarding bone?

Answer 17

Culture every biopsy

Biopsy every culture

Question 18

What is the most common benign lesion within the diaphysis region of the bone?

Answer 18

Osteoid osteoma

Question 19

What is this condition?

Answer 19

Enchondromas

Question 20

Middle-aged female with epiphyseal lesion.

(Primarly in the epiphysis that has crossed the metaphysis, distinct borders, started in medullary canal and expanded into the cortex. Edges of bone are very thin)

Answer 20

Giant cell tumor

Question 21

What are the three types of lesions found in the epiphysis and the common age group?

Answer 21

Infection - kids

Chondroblastoma - adolescents

Giant cell tumor - usually adults

Question 22

What protein is mutated in McCune-Albright syndome?

Answer 22

Guanine nucleotide-binding protein (G protein)

Question 23

condition?

Answer 23

Giant cell tumor

Nuclei in background look the same as the nuclei in the aggressive large osteoclasts. Also, the osteoclasts have an increased number of nuclei

Question 24

What are some other features seen on this path slide? What condition?

Answer 24

Cs and Js of osteoid; Background of spindle-shaped cells with elongated or truncated nuclei (depending on cut)

Monostatic fibrous dysplasia

Question 25

What temporality of pain for kids and adults is most concerning?

Answer 25

Night pain (something bad until you can prove it something else)

Question 26

Condition?

(hint: AD inheritence)

Answer 26

Hereditary, multiple osteochondromatosis

Question 27

What is covered?

Answer 27

Nidus

In center, you can see the lesion - fibrovascular structure. Around the lesion, there is a thick layer of reactive bone.

Question 28

What are these light brown macules?

Answer 28

Cafe au lait spots

Question 29

What is the current treatment for osteoid osteomas?

Answer 29

aspirin

RFA - radio-frequency ablation - cut a hole into the bone, drop a radio probe into the bone, heat it up with radio waves (can’t do this in the spine)

Question 30

When do most all of the lesions present by in patients with osteochondromas?

Answer 30

by age 12, patient typically has had enough growth spurts

Question 31

If the pain from this type of lesion (osteoid osteoma) is controlled, what are the steps in txt of this patient?

Answer 31

Continue txt w/ anti-inflammatory drugs. Studies show that some of these burn out after 3 yrs and stop hurting.

Question 32

condition?

Answer 32

Giant cell tumor

Question 33

What is the another name for multiple hereditary exostosis?

Answer 33

Multiple osteochondromas

Question 34

Txt for giant cell tumor?

Answer 34

Surgrical resection - although benign, these are are locally aggressive

Denosumab (used in osteoporosis) - targets the cells that are chewing up bones

Question 35

If you’re looking for a tumor in the cortex, is a MRI of good use?

Answer 35

No, there isn’t much fluid/soft tissue in the cortex

Question 36

Describe the appearence on this plain film.

Answer 36

Lesion is in the diaphysis (top/bottom), the cortex (inside/out), narrow zone of transition, bone reaction -making bone around it w/ a smooth external surface - meaning it isn’t make bone really fast