230. Neoplasia Flashcards
List the major tumors of the bone, cartilage, bone marrow
Bone: Osteoma, Osteoid Osteoma, Osteoblastoma, Osteosarcoma (only Malignant)
Cartilage: Chondroma, Osteochondroma, Chrondroblastoma, Chrondromyxoid fibroma, Chondrosarcoma (only malignant)
Bone Marrow: Myeloma, Malignant Lymphoma (both malignant)
Most common bone tumor
Most common primary tumor of bone
Most common = metastases from other site (usually osteolytic)
Primary = Multiple myeloma, then osteosarcoma
Primary usually M>F
Osteoma
(Type of tumor, age, location, imaging)
What is Gardner Syndrome?
Benign solitary tumor
Middle age
Surface of facial bone, slow growing
Dense compact bone on xray
Gardner: multiple osteomas on face
Osteoid Osteoma (type, age/sex, presentation, location, imaging, tx)
Small benign tumor of osteoblasts (<2cm) Young adults <25; M>F Nocturnal bone pain, relieved by aspirin Cortex of Long Bones (femur) Xray: zone of sclerotic lamellar bone surrounding lucent focus (nidus) tx: surgery, radiofrequency ablation
Osteoblastoma
type, location, presentation
Bigger (>2cm) benign tumor of osteoblasts
Usually affects vertebrae
Does not respond to NSAIDs
Osteochondroma
type, age/sex, location, imaging, prognosis
MOST COMMON BENIGN BONE TUMOR
Males <25 years old
tumor in bone + cartilage cap, arises from metaphysis growth plate of distal femur/proximal tibia
XR: bony stalk with cartilagenous cap continuous with bone medulla (like ice cream cone)
Prognosis: good, 1-2% recur though, but rarely progress to malignant
Chondroma
type, age/sex, location, imaging, histo
Benign intramedullary cartilagenous tumor
2-4th decade, M=F
Medulla of small bones of hands/feet
XR: well-circumscribed lucency with cartilage matrix calcification (Arc + ring = encondral bone formation at periphery of tumor)
Histo: nodules of mature cartilage in fatty bone marrow - mature collagen and low cellularity
Giant Cell Tumor of Bone
type, age/sex, location, imaging, tx, histo
Benign giant cell tumor
20-40 years, F>M
Epiphysis of long bone (distal femur/proximal tibia - KNEE)
XR: “soap-bubble” lytic lesion in epiphysis
Tx: excision, may recur
Hist: losts of giant cells (many nuclei)
Fibrous Dysplasia (type, age, location patterns, imaging, histo)
Benign tumor linked to localized developmental arrest
bone components do not differentiate to mature structures
In first 3 decades of life
Monostotic: femur most common - stabilizes at puberty
Polyostotic: may also have endocrine dysfx
XR: expansile lesion with variable internal density (ground-glass)
Histo: irregular elements of woven bone with no osteoblast rimming (immature)
Osteosarcoma (type, age/sex, location, imaging, histo, tx)
Malignant proliferation of osteoblasts
Bimodal age: 10-20yrs and >65 years
M>F
Metaphysis of long bone (Knee - DF, PT, or proximal humerus)
XR: Codman Triangle = new subperiosteal bone raises periosteum away from bone (“sunburst rxn”)
Histo: very cellular/pleiomorphic, malignant cells directly produce osteoid/woven bone
Tx: pre-op chemo, surgery excision, prosthesis/post-op chemo
Chondrosarcoma (type, age/sex, location, imaging, histo)
malignant tumor of chondrocytes
5-7th decates, M>F
Central skeleton (hip, shoulder, rib) & central part of bone (medullary cavity)
lobulated lesion with cartilage matrix calcification (arc and ring), NO periosteal reaction
Histo: hypercellular cartilage doesnt look like cartilage
Ewing Sarcoma (type, mechanism, age/sex, location, imaging, histo, tx)
Malignant neuroectodermal tumor of bone
t(11;22) chormosome translocation - fusion protein EWS-FLI1
Young age <20, M>F
Diaphysis of long bones (femur>pelvis/rib)
XR: ill defined lytic lesion, Periosteal reaction “onion skin” with soft tissue extension
Histo: focal necrosis, diffuse proliferation of small rounded neoplastic cells
Tx: chemotherapy (like osteosarcoma)
Multiple myeloma (type, age/sex, sx, location, xray, histo, tx)
clonal proliferation of plasma cells (IgG)
Most common primary malignant tumor of bone
M>F, age > 40 (peak 65-70)
sx: CRAB (hyperCa, Renal insufficiency, Anemia, lytic Bone lesion)
vertebral, ribs, skull, pelvis, femur
XR: punched out lytic lesions
Histo: proliferation of plasma cells (perinuclear hof), kappa-restricted shows clonal nature
Tx: chemo and radio therapy (poor prognosis)