45: Bone Tumors - Carnevale Flashcards
what are the 5 questions to ask?
- what is the lesion’s pattern of growth?
- are the cells of the lesion producing anything?
- what do the cells of the lesion look like?
- based on cellular features and imaging studies, is the lesion more likely benign or malignant?
- does the anatomical diagnosis correlate with the clinical picture and the radiographic appearance of the lesion? – if it doesn’t carefully reconsider all of the information for the case!
what two sites can ALL of the lesions appear in?
around the knee and at the humerus
diaphysis tumor ***
ewing sarcoma *** always in the diaphysis
metaphysis tumors
chondrosarcoma and osteosarcoma
epiphysis tumors
giant cell tumor
osteoma
- benign tumor mature bone
- asymptomatic
- 40-50 yo
- cortical bones of SKULL and FACE
- well-delimited odule
- prognosis: good, slow-growing, not invasive, no malignant
bone forming tumors
- osteoid osteoma and osteoblastoma
- benign neoplasms with identical histology
- differ in size, origin, x-ray and symptoms
x:ray - central area of tumor (nidus) usually radiolucent, surrounded by rim of sclerotic bone
bone tumor (osteoid osteoma/osteoblastoma)
painful bone tumor relieved by aspirin ***
osteoid osteoma
- if not relieved by aspirin = osteoblastoma
osteoblastoma
- teens-twenties
- vertebral column
- less than 2 cm
malignant tumor producing osteoid***
osteosarcoma
most common primary malignant tumor of bone
osteosarcoma
location osteosarcoma
metaphysis of long bones
age osteosarcoma
- under 20
- small peak in elderly with predisposing conditons (secondary osteosarcoma)
- 20% with pulmonary mets at time of diagnosis
codman triangle
elevation of periosteum to produce an angle b/w surface of involved bone - osteosarcoma
what is key for osteosarcoma diagnosis?
osteoid
osteochondroma
- young 10-30 male 3x female
- metaphysis near epiphyseal plate
- polypoid growth/ mushroom shaped
chondroma
- benign tumors of hyaline cartilage
- in medullary cavity = enchondroma
- metaphyses, hands and feet
multiple enchondromas
ollier disease
chondroma
- young 20-40
- small bones of hand and feet
chondrosarcoma is a tumor of the _______ skeleton
- 40-60 (rare in children)
- pelvic bones, axial skeleton **
small round blue tumors
ewing sarcoma
ewing sarcoma is always from the …
diaphysis
ewing sarcoma EWS vs. primitive neuroectrodermal tumor PNET
- uniform, undifferentiated small round blue cells
- cells form prominent Homer Wright rosettes with central fibrillary cores
when does a person get a fibrous cortical defect?
1st two decades of life
fibrous dysplasia
- young 10-30
- anywhere
- radiolucent, in diaphysis
immature woven bone surrounded by fibroblastic proliferation
fibrous dysplasia
giant cell tumor of bone aka
osteoclastoma
osteoclastoma
- giant cell tymor of bone
- epiphyses
- 20-55 yo (mature skeleton)
bone cell origin
bengin = osteoma, osteoid osteoma malignant = osteosarcoma
cartilage cell of origin
bengin = chondroma malignant = chondrosarcma
osteoclasts cell of origin
bengin 90% giant cell tumor, 10% malignant
malignant undifferentiatied
ewing sarcoma
metatstatic tumors to bone are at least _____________ than primary bone tumors
20 X more common
- most lesions are osteolytic
lytic metastatic bone cancer =
blastic =
majority are mixed
lytic - thyroid, lung, gi , kidney, melanoma
blastic - prostate, breast
