Approach to Pediatric Bone Tumours

Question 1

which sarcomas are most common in children

Answer 1

osteosarcoma and ewing.

Question 2

note: procedures of controling a pediatric tumour

Question 3

pre-requisites for limb salvage.

Answer 3

you really gotta consier your odds if you think about saving the limb. ther’es lots of complications– infection, fracture, delayed wound healing, nerve injuries, revision surgeries, revision to amputation.

Question 4

general equation to see about future bone growth and limb discrepancy if you do a tuor resection.

Answer 4

skeletal maturity for boys in 16 years, girls for 14 years.

• when younger, you multiply their age difference y 1.5 cm.

ex/ tumor resection at a 9 year old male = 7x1.5cm/year= 10.5 cm limb length inequality.

Question 5

what is an allograft

Answer 5

a processed bone from bone bank. has a higher 30% complication rate but it’s less that expandable prosthesis.

Question 6

what is a rotational plasty

Answer 6

Form of limb salvage

• Residual bone/limbs are rotated and reconfigured to
preserve limb function

• Lower extremity = Van Ness rotationplasty • Upper extremity = Hefti Calvicular rotationplasty

Question 7

in a hefti rotation plasty of the proximal humerus, you remove the -__ __

Answer 7

remove the roator cuff and distal humerus.

Question 8

an ____ is a bony outgrowth with a cartilage cap that is considered benign but can undergo a malignant transformation. it originates from the ___.

Answer 8

an OSTEOCHONDROMA is a bony outgrowth with a cartilage cap that is considered benign but can undergo a malignant transformation. it originates from the PHYSIS.

Question 9

Answer 9

osteochondroma

Question 10

what are some indications that the osteochondroma might be progressing to malignancy?

Answer 10

Question 11

an ____ is a benign intramedullary cartilage tumor, looking like a nest of cartilage cells. it originates from the ___ and has low malignant transformation.

Answer 11

an ENCHONDROMA is a benign intramedullary cartilage tumor, looking like a nest of cartilage cells. it originates from the PHYSIS and has low malignant transformation.

Question 12

treatments for endochondroma

Answer 12

DONT BIOPSY. usually it might actually resolve on it’s own, re only remove if the’re symptomatic.

Question 13

Answer 13

endochondroma

Question 14

what type of tissue does an osteoid osteoma produce?

Answer 14

benign BONE forming tumor.

Question 15

which demographic affected by osteoid osteoma

Answer 15

pends– young adults. corically based and paindul. pain relief with NSAIDS. presents with. A LOT OF PAIN

Question 16

treatment of osteoid osteoma

Answer 16

radiofrequency ablation

Question 17

Answer 17

osteoid osteoma– forming cortical bone

Question 18

difference between normal bone cyst and aneurysmal bone cyst

Answer 18

UBC (aka simple bone cyst) •Simple cystic cavities in bone •Proximal femur and proximal humerus •Filled with plasma filtrate (~ synovial fluid) •Begin in peds … can persist into early adulthood •Weaken bone •Associated pathologic fracture •Often heal after fracture

ABC (aka aneurysmal bone cyst) •Septated cystic cavities in bone •Virtually any bone •Blood filled •Begin in peds … can persist into early adulthood •Weaken bone •Associated pathologic fracture •More aggressive bone changes than UBC •Can recur after surgical treatment

Question 19

Answer 19

aneusymal bone cyst. note the septated cystic cavitiy

Question 20

Answer 20

UBC bone cyst. it’s on the humerus which is the classic position of UBC

Question 21

giant cell tumor of bone is a benign tumor of the ___. occurs in ___ ___ populations. it involves a proliferation of ___ cells which recruit ____-like multinucleated giant cells.

Although it’s not cancer and thus benign, it can destroy bone and be limb threatening. it can recur locally.

Answer 21

giant cell tumor of bone is a benign tumor of the METAPHYSIS. occurs in YOUNG ADULT populations. it involves a proliferation of STROMAL cells which recruit OSTEOCLAST-like multinucleated giant cells.

Although it’s not cancer and thus benign, it can destroy bone and be limb threatening. it can recur locally.

Question 22

Answer 22

giant cell tumor. lots of osteoclast recruitment in clumsp

Question 23

Answer 23

clouding at the distal end of the femur (metaphysis), more bone formation. lesioning apparent. giant cell tumor.

Question 24

treatment of giant cell tumor

Answer 24

Question 25

note

Question 26

main organ cancers that cause metastatic bone disesase

Answer 26

paird axial organs– breast, prostate, thyroid, kidney ,lung, GI, melanoma.

Question 27

myeloma is considered the most common bone malignancy. it isn’t a sarcoma, and it has ___ origin

Answer 27

haematopoietic origin

Question 28

note: metastatic lesions often occur in spine, ribs and pelvis most commonly, but if it spreads to distal limbs knee/elbow, think lung cancer or melanoma or breast cancer.

Question 29

workups when working with metastatic bone disease

Answer 29

Question 30

specific systemic issue caused by myeloma

Answer 30

renal insufficiency.

Question 31

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