8: Bone, cartiledge, soft tissue tumors

Question 1

Staging of Bone Lesion

Answer 1

• X-ray of entire affected bone
• Whole body bone scan (or skeletal
survey)
• CT scan of chest, abdomen, and
pelvis OR or PET/CT
• Serum Protein Electrophoresis /Urine
Protein Electrophoresis /serum free
light chains
(for multiple myeloma or
plasmacytoma)
• Prostatic specific antigen (for prostate carcinoma

Question 2

A common lymphoid malignancy
(Sheets of plasma cells with atypical
cell features)
Median age is 70 years
Principally involves bone marrow
and causes lytic lesions throughout
skeleton (most commonly vertebrae, ribs,
skull, pelvis, femur, clavicle, & scapula)

Answer 2

Multiple Myeloma

Question 3

Principally involves bone marrow
and causes lytic lesions throughout
skeleton (most commonly vertebrae, ribs,
skull, pelvis, femur, clavicle, & scapula)

Answer 3

Multiple myeloma

Question 4

Cells produce monoclonal immunoglobulin IgG and results in pathologic fx

Answer 4

Multiple Myeloma

Question 5

neoplasms composed
of lymphocytes resembling a normal
stage of differentiation

Answer 5

Lymphomas:
B-cell lymphomas: most common
type of lymphoma in adults, derived
from clonal B cells

Question 6

most common
type of lymphoma in adults, derived
from clonal B cells

Answer 6

B-cell lymphomas:

Question 7

Histlolgically, how can we idenfity B cell lymphomas

Answer 7

CD20 marker

Question 8

Most common cancer in nonsmoking women

Answer 8

Lung adenocarcinomas:
Metastases early (to bone, brain,
and liver)

Question 9

Lung adenocarcinomas met early to:

Answer 9

Lung adenocarcinomas:
Metastases early (to bone, brain,
and liver)

Question 10

Performed biopsy from cancer in stomach. Stains TTF1 +… What does this mean

Answer 10

Means it is lung adenocarcinma origin… this is not the primary tumor- its inthe lung

Question 11

Location of Unicameral Bone cyst

Who it affects

Answer 11

Bone Cyst

• Benign
• Children & young adults
• Metaphyseal region of long bones
• Usually proximal femur or humerus

Question 12

10 yo male comes in with lesion in his humerus. Has periosteal rxn and soft tissue invovlment with abnormal bone marrow. DDx?

Answer 12

Osteosarcoma

Ewing Sarcoma

Question 14

Presentaiton of Unicarmeral Bone Cyst

Answer 14

-Presentation: pathologic fracture
-Bone cortex is eroded by cyst & elicits
secondary periosteal new bone
formation

Question 15

Pathology: cyst filled with clear fluid &
lined with thin fibrous membrane
-Because of frequent fractures: old blood
(hemosiderin) and granulation tissue
maybe present

Answer 15

Unicameral Bone Cyst

Question 16

You are doing a pathology rotation and the attending shows you a A spongy, honeycombed, blood-filled mass with cystic
spaces of various sizes, some containing osseous
tissue within the septated walls.

Answer 16

Aneurysmal Bone Cyst

Question 17

Histology of ABC tumor

Answer 17

Giant cell, immature bone, &
blood filled cysts without lining
cells

Question 18

Descibe the lesion in ABC and who is likely to get it and why they would come to clinic

Answer 18

Eccentric solitary expansile lesion

• Mostly < 20 years
• Swelling, pain, or tenderness

Question 19

MOst common invovlement (part of bone and location) of ABC

Answer 19

• Metaphyseal region of long bones: common
• -But any bone may be involved

Question 20

Pathology of ABC

Answer 20

bening neoplasm with characteristic translocation

Question 21

TX for ABC

Answer 21

Curettate, embolaization and scleropahty

Question 22

See a lytic lesion with no mineral in it, going up into epiphysis. May have soft tissue invovlment

Answer 22

Giant Cell TUmor

Question 23

Adult Soft Tissue Masses:

Answer 23

Lipomas
• Soft tissue sarcomas
• Desmoid fibromatosis

Question 24

What kind of tumor is this… What are the key characteristics?

Answer 24

LIpoma

see bening looking lipoblasts

Question 25

When removing this tumor it is well encased and comes right out

Answer 25

Lipomas

Question 26

Desmoid Fibromatosis histology

What special staining can we use

Answer 26

bland spindle cells, densely packed, no pleomorphism.

Stain with Beta Catenin