50/51: Bone Tumors - Mahoney

Question 1

best radiologic test to help diagnose bone lesions, including tumors

Answer 1

x-ray

Question 2

when do you do a biopsy?

Answer 2

last step

- do not do if you will not be treating the malignancy or the center of biopsy performance will not be performing biopsy

Question 3

latent

Answer 3

thin sclerotic or radiolucent narrow margin (0.1-1.0 mm), no periosteal reaction, absent soft tissue mass

Question 4

active

Answer 4

wide (2-10 mm) margin, none or mild periosteal reaction, absent soft tissue mass

Question 5

aggressive

Answer 5

wide or poorly defined margin, mild or major periosteal reaction, soft tissue mass present

Question 6

several ill-defined areas of lucency

Answer 6

moth eaten - aggressive

Question 7

ill-defined pattern of lucency caused by many small irregular holes in the bone

Answer 7

permeative - aggressive infection or malignancy

Question 8

geographic lesions

Answer 8

lesion grows slowly, bone has time to retreat and lay down new bone around the lesion

Question 9

lesion grows in fits or starts, periosteum has time to lay down thin shell of new bone before the leion starts another growht sput

Answer 9

lamellate/ onion skin

Question 10

sun burst/ hair on end

Answer 10

periosteum has no time to lay down bone, but sharpey’s fibers bevome stretched out perpendicular to bone and then ossify

Question 11

codman’s triangle

Answer 11

only the edges of the raised periosteum will ossify - this little bit of ossification forms a small angle with the surface of bone, but not a complete triangle

Question 12

non-metastatic diseases the produce periosteal reactions

Answer 12

HEATHV

hypertrophic pulmonary osteoarthropathy
endosteal hyperostosis
acromegaly
thyroid acropachy
hypervitaminosis A
*** venous stasis

Question 13

what is bone matrix?

Answer 13

substance in bone produced by osteoblasts AND chondroblasts

Question 14

speckled

Answer 14

chondroid matrix

Question 15

cloudy

Answer 15

osseous matrix

Question 16

ground glass

Answer 16

fibrous, cystic lesion producing little or no calcification

Question 17

4 cartilage forming tumors

Answer 17

osteochondroma
solitary enchondroma
chondroblastoma
chondrosarcoma

Question 18

2 bone forming tumors

Answer 18

osteoid osteoma and osteoblastoma

osteogenic sarcoma

Question 19

benign tumors

Answer 19

enchondroma
osteochondroma
osteoid osteoma
osteoblastoma
giant cell tumore (10% malignant)
chondroblastoma

Question 20

malignant tumors

Answer 20

osteogenic sarcoma
chondrosarcoma
fibrosarcoma
ewing's sarcoma
metastatic carcinoma

Question 21

FOG MACHINES

Answer 21

solitary lytic lesions of bone

Fibrous dysplasia
Osteoid osteoma/osteoblastoma
Giant cell tumor

Metastasis, myeloma
Aneurysmal bone cyst
Chondroblastoma, chondromyxoid fibroma
Hyperparathyroidism, hemangioma
Infection
Non-ossifying fibroma
Eosinophilic granuloma, enchondroma
Solitary boe cyst, sarcoidosis

Question 22

long lesion in a long bone

Answer 22

fibrous dysplasia or non-ossifying fibroma (moves into marrow space)

Question 23

hurts like a b and tough to see

Answer 23

osteoid osteoma

• night pain relieved by ASA or NSAIDS
• produces high amounts of prostaglandins

Question 24

at the end of a long fast, teens have a blast

Answer 24

osteoblastoma

- most common tumor in teens at the ends of the long bones

Question 25

osteoid osteoma v osteoblastoma

Answer 25

no surrounding reactive bone sclerosis in osteoblastoma

Question 26

massive in metaphysis

Answer 26

giant cell tumor

Question 27

most common primary bone malignancy in body

Answer 27

metastasis/myeloma

Question 28

metastasis to bone

Answer 28

adult male - lung adult female - breast also kidney and thyroid

Question 29

#1 primary metastasis to foot and ankle bone

Answer 29

colorectal CA

Question 30

most common primary malignatnt tumor of bone in body

Answer 30

myeloma

Question 31

mosaic glass on MRI

Answer 31

aneurysmal bone cyst

Question 32

multiple punched out lesions

Answer 32

multiple myeloma

Question 33

chicken wire matrix

Answer 33

chondroblastoma (also consider osteoblastoma if young age group)

Question 34

brown tumors

Answer 34

hyperparathyroidism (hemosiderin deposition)

Question 35

bubbly lesions of bone - NFC GAMES

Answer 35

``` Non-ossifying fibroma Fibrous dysplasia Chondrosarcoma Giant cell tumor Aneurysmal bone cyst Metastatic CA Enchondroma/Ewing's sarcoma Solitary bone cyst ```

Question 36

end of bone, with speckled tone

Answer 36

enchondroma

Question 37

endosteal scalloping

Answer 37

eosinophilic granuloma

Question 38

where does solitary bone cyst love to be?

Answer 38

under middle facet in calcaneus | "best bet is middle facet"

Question 39

fallen fragment sign

Answer 39

solitary bone cyst

Question 40

multiple lucent bone lesions

Answer 40

HIFEM ``` Hyperparathyroidism/hemangioma Infection Fibrous dysplasia Enchondroma/eosinophilic granuloma Metastasis/ myeloma ```

Question 41

lytic lesions in metaphysis

Answer 41

CAGE ON MUD Chondroblastoma Aneurysmal bone cyst Giant cell tumor Enchondroma/ewing's sarcoma Osteoblastoma/sarcoma/myelitis Non-ossifying fibroma Malignant fibrous histiocytoma(fibrosarcoma) Unicameral bone cyst Desmoid tumor

Question 42

``` malignant lucent bone lesion by age *** less than 1 yo 1-10 yo 10-30 yo 30-40 yo 40+ ```

Answer 42

``` neuroblastoma ewing's sarcoma osteosarcoma/ ewing's fibrosarcoma, lymphoma metastasis, myeloma, chondrosarcoma ```

Question 43

most common primary bone malignancy in foot and ankle

Answer 43

chondrosarcoma

Question 44

moth-eaten or onion-skin with a soft tissue mss

Answer 44

ewing's sarcoma

Question 45

best place to get ewing's sarcoma

Answer 45

70% survival forefoot | 30% survival rearfoot

Question 46

solitary of multifocal sclerotic lesions of bone

Answer 46

COP BOBS HIP Chronic osteomyelitis Osteochondroma Paget's disease Breast metastasis Osteogenic sarcoma Bone island Stress fracture Hemangioma Infarct Prostate metastasis

Question 47

most common bone tumor in foot and ankle

Answer 47

osteochondroma

Question 48

develops from epiphysis and ceases growth growing away from the epiphysis

Answer 48

osteochondroma

Question 49

how is a subungual exostosis different than an osteochondroma?

Answer 49

- more common in females - has fibrocartilage cap - does not arise from epiphysis - from capillary hemangioma

Question 50

flame-shaped or blades of grass sclerotic lesions of bone

Answer 50

pagets disease

Question 51

globular bone sclerosis

Answer 51

MOM POO ``` Melorrheostosis "candle wax dz" Osteopathia striata-linear striations Metastasis Pyknodysostosis- dense and brittle Osteopoikilosis - spotted bones Osteomyelitis ```

Question 52

candle wax disease

Answer 52

melorrheostosis