45: Bone Tumors - Carnevale

Question 1

what are the 5 questions to ask?

Answer 1

1. what is the lesion’s pattern of growth?
2. are the cells of the lesion producing anything?
3. what do the cells of the lesion look like?
4. based on cellular features and imaging studies, is the lesion more likely benign or malignant?
5. 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!

Question 2

what two sites can ALL of the lesions appear in?

Answer 2

around the knee and at the humerus

Question 3

diaphysis tumor ***

Answer 3

ewing sarcoma *** always in the diaphysis

Question 4

metaphysis tumors

Answer 4

chondrosarcoma and osteosarcoma

Question 5

epiphysis tumors

Answer 5

giant cell tumor

Question 6

osteoma

Answer 6

• 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

Question 7

bone forming tumors

Answer 7

• osteoid osteoma and osteoblastoma
• benign neoplasms with identical histology
• differ in size, origin, x-ray and symptoms

Question 8

x:ray - central area of tumor (nidus) usually radiolucent, surrounded by rim of sclerotic bone

Answer 8

bone tumor (osteoid osteoma/osteoblastoma)

Question 9

painful bone tumor relieved by aspirin ***

Answer 9

osteoid osteoma

- if not relieved by aspirin = osteoblastoma

Question 10

osteoblastoma

Answer 10

• teens-twenties
• vertebral column
• less than 2 cm

Question 11

malignant tumor producing osteoid***

Answer 11

osteosarcoma

Question 12

most common primary malignant tumor of bone

Answer 12

osteosarcoma

Question 13

location osteosarcoma

Answer 13

metaphysis of long bones

Question 14

age osteosarcoma

Answer 14

• under 20
• small peak in elderly with predisposing conditons (secondary osteosarcoma)
• 20% with pulmonary mets at time of diagnosis

Question 15

codman triangle

Answer 15

elevation of periosteum to produce an angle b/w surface of involved bone - osteosarcoma

Question 16

what is key for osteosarcoma diagnosis?

Answer 16

osteoid

Question 17

osteochondroma

Answer 17

• young 10-30 male 3x female
• metaphysis near epiphyseal plate
• polypoid growth/ mushroom shaped

Question 18

chondroma

Answer 18

• benign tumors of hyaline cartilage
• in medullary cavity = enchondroma
• metaphyses, hands and feet

Question 19

multiple enchondromas

Answer 19

ollier disease

Question 20

chondroma

Answer 20

• young 20-40

- small bones of hand and feet

Question 21

chondrosarcoma is a tumor of the _______ skeleton

Answer 21

• 40-60 (rare in children)

- pelvic bones, axial skeleton **

Question 22

small round blue tumors

Answer 22

ewing sarcoma

Question 23

ewing sarcoma is always from the …

Answer 23

diaphysis

Question 24

ewing sarcoma EWS vs. primitive neuroectrodermal tumor PNET

Answer 24

• uniform, undifferentiated small round blue cells

- cells form prominent Homer Wright rosettes with central fibrillary cores

Question 25

when does a person get a fibrous cortical defect?

Answer 25

1st two decades of life

Question 26

fibrous dysplasia

Answer 26

• young 10-30
• anywhere
• radiolucent, in diaphysis

Question 27

immature woven bone surrounded by fibroblastic proliferation

Answer 27

fibrous dysplasia

Question 28

giant cell tumor of bone aka

Answer 28

osteoclastoma

Question 29

osteoclastoma

Answer 29

• giant cell tymor of bone
• epiphyses
• 20-55 yo (mature skeleton)

Question 30

bone cell origin

Answer 30

bengin = osteoma, osteoid osteoma
malignant = osteosarcoma

Question 31

cartilage cell of origin

Answer 31

bengin = chondroma
malignant = chondrosarcma

Question 32

osteoclasts cell of origin

Answer 32

bengin 90% giant cell tumor, 10% malignant

Question 33

malignant undifferentiatied

Answer 33

ewing sarcoma

Question 34

metatstatic tumors to bone are at least _____________ than primary bone tumors

Answer 34

20 X more common

- most lesions are osteolytic

Question 35

lytic metastatic bone cancer =
blastic =
majority are mixed

Answer 35

lytic - thyroid, lung, gi , kidney, melanoma

blastic - prostate, breast