Avascular Necrosis, Fractures & Infection of Bone Flashcards
1
Q
What are the five questions that should be asked with osseous lesions?
A
- Pattern of growth?
- Are the cells of the lesions producing anything?
- What do the cells look like?
- Based on cellular features, is the lesion likely benign or malignant?
- Does the anatomic dx correlate with the clinical picture
2
Q
What two areas in the body in particular, are capable of having any of the primary bone tumors?
A
Shoulder and knee
3
Q
Where can osteosarcoma occur? (3)
A
Knee
Hip
Shoulder
4
Q
Where do osteomas usually occur?
A
Skull / face
5
Q
Where do chondromas usually occur?
A
Fingers/ wrist
6
Q
Where does chondrosarcomas usually occur?
A
Axial skeleton:
- Pelvis
- Vertebrae
7
Q
Where are giant cell tumors found?
A
End of bone–epiphysis
8
Q
Where do Ewing sarcomas arise?
A
Diaphysis of long bones
9
Q
Where in the bone do osteosarcomas occur?
A
Metaphysis / physis
10
Q
Where in the bone do chondrosarcomas occur?
A
Metaphysis
11
Q
Cancer in the diaphysis = ?
A
Ewing’s sarcoma
12
Q
Cancer in the epiphysis = ?
A
Giant cell tumors
13
Q
What are osteomas, and what are the s/sx?
A
Rare, benign tumor of mature bone that is usually asymptomatic, but may cause local mechanical problems
14
Q
What is the age range that osteomas typically affect?
A
40-50
15
Q
What are the x-ray findings of osteomas?
A
Well delineated nodule
16
Q
What is the prognosis for osteomas? (3)
A
- Slow growing
- Not invasive
- Not malignant
17
Q
Which is larger: osteoid osteomas or osteoblastomas?
A
Osteomas
18
Q
True or false: osteoid osteomas and osteoblastomas have the same histological characteristics
A
True
19
Q
What are the s/sx of osteoid osteomas and osteoblastomas?
A
Painful lesions
20
Q
Which is relieved by ASA: osteoid osteomas or osteoblastomas?
A
Osteoid osteomas
21
Q
What are the x-ray findings of osteoid osteomas and osteoblastomas?
A
Central area of tumor (lucency) surrounded by a rim of sclerotic bone
22
Q
What type of bone surrounds osteoid osteomas: woven or lamellar?
A
Woven
23
Q
Who is classically affected with osteoid osteomas? Where is it classically?
A
Young adult males around the knee
24
Q
Who is classically affected with osteoblastomas? Where is it classically?
A
Teens-20s
Vertebral column
25
What is the prognosis for osteoblastomas?
Good, if totally excised
26
Osteoblastomas are usually greater than what size?
More than 2 cm
27
Bone pain not relieved by ASA = ?
Osteoblastomas
28
What are osteosarcomas?
malignant mesenchymal tumors of neoplastic cells that produce osteoid
29
What is the most common primary malignancy of bone?
Osteosarcomas
30
What is the bimodal age distribution of osteosarcomas?
less than 20 and and elderly
31
Where do osteosarcomas generally arise from?
Metaphysis of long bones of extremities
32
What MUST you see histologically to diagnose osteosarcomas?
Osteoid
33
Which gender is more affected with osteosarcomas?
Younger males
34
What are some of the conditions that predispose patients to later osteosarcomas? (5)
- Paget's disease of bone
- Chronic osteomyelitis
- Prior irradiation
- bone infarcts
- Fibrous dysplasia
35
True or false: osteosarcomas that arise later in life 2/2 past bone disease are usually more aggressive
True
36
What is the usual clinical presentation of osteosarcomas?
Bone pain, swelling, and pathological fractures
37
How aggressive is osteosarcomas?
Very--20% with lung mets by dx
38
What is the treatment for osteosarcomas?
Chemo
| Radical surgery
39
What are the x-ray findings of osteosarcomas?
Large, destructive mixed blastic and lytic mass with infiltrating margins
40
What is the usual progression of osteosarcomas?
Extends inward:
-Marrow cavity
Extends outward:
-Adjacent soft tissue
41
What is Codman's triangle?
Elevation of periosteum produces an angle between surface of the involved bone, and the fascia
42
What are the two major forms of periosteal reactions to osteosarcomas?
Lamellated ("onion skin")
| Spiculated ("sunburst")
43
True or false: the radiographic appearance of periosteal reaction does not reflect the degree of aggressiveness of the tumor
false-it does
44
Who usually gets osteochondromas?
Young (10-30 yo) males
45
Where along bones do osteochondromas usually occur?
metaphysis or near epiphyseal plate
46
What are the x-ray findings of osteochondromas?
Polypoid growth (mushroom shaped)
47
What is the prognosis for osteochondromas?
Good if solitary. If multiple, about 10% chance of developing chondrosarcoma
48
What is the treatment for osteochondromas?
Cut it out
49
What are the polypoid growths of osteochondromas usually made out of?
Cartilage, bone, and marrow
50
What is the usual presentation of osteochondromas?
Problems bending their leg or interruption of movement
Mass
51
What are chondromas?
Benign tumors of hyaline cartilage that is usually well circumscribed
52
If a chondroma is found in the medullary cavity, what are they called? What about in the subperiosteum?
- Medullary cavity = Enchondromas.
| - Subperiosteal - juxtachondroma
53
Where do chondromas usually occur?
Metaphyses of small tubular bones of hands and feet
54
What is the disease that presents with multiples enchondromas?
Ollier disease
55
What is the most common type of intraosseous cartilage tumor? Which gender is usually affected?
chondromas
| Males
56
What are the x-ray findings of chondromas?
Well defined stippled Ca
57
What are the histological characteristics of chondromas?
mature, hypocellular cartilage with bland chondrocytes
58
What is the prognosis for chondromas?
Good if solitary
| If multiple 1/3 develop chondrosarcomas
59
What is the treatment for chondromas?
Cut it out, but if not complete then may recur
60
What is the age that is usually affected with chondrosarcomas? What bone is usually affected?
- 40-60 yo
| - Pelvic bones and axial skeleton
61
What are the x-ray characteristics of chondrosarcomas?
Variably calcified, multilobular
62
What is the prognosis for chondrosarcomas?
Depends on tumor *grade* and size
63
With what disease in particular are chondrosarcomas more common?
Ollier's disease
64
What are the three characteristics that grades are based on?
- Cellularity
- Degree of nuclear atypia
- Mitotic activity
65
What is the classic description of the histology of Ewing sarcomas?
Small, round and blue cells arranged in solid nested aggregates
66
What are the cell that make up Ewing's sarcoma?
Primitive neural tumors derived from a precursor multipotent mesenchymal stem cell
67
Where in the bone do Ewing's sarcoma usually arise from?
Diaphysis
68
What is the difference between Ewing sarcomas and primitive neuroectodermal tumors (PNET)
Ewing sarcomas = undifferentiated
PNET = neural differentiation with homer wright rosettes
69
What is the translocation that often produces Ewing sarcomas? What are the genes that are mutated?
t(11;22)
EWS gene on chr 22
FLI1 gene on chr 11
(11+22 = 33 = Patrick Ewing's jersey number)
70
Who is usually affected with Ewing sarcomas?
boys under 15 yo
71
Small, round and blue cells arranged in solid nested aggregates = ?
Ewing sarcoma
72
What are the two stains that are positive with Ewing sarcomas?
- PAS+
| - CD99
73
What is the major histological difference between Ewing sarcomas and PNETs?
PNETs have Homer wright rosettes
74
What are fibrous cortical defects? how common are they? Where in the body do they usually arise?
Extremely common developmental defect that arises in the metaphysis of distal femur and proximal tibia
75
What are the usual s/sx of fibrous cortical defects?
asymptomatic--usually an incidental x-ray finding
76
What is the prognosis for fibrous cortical defects?
Resolve spontaneously
77
What are the x-ray findings of fibrous cortical defects?
scalloped appearance--"polyostotic"
78
What is the age range that is usually affected with fibrous cortical defects?
20s
79
what are the histological characteristics of fibrous cortical defects?
Spindle cells and fibroblasts with multinucleated giant cells
80
What is the age, site, x-ray characteristics, and prognosis for fibrous dysplasia?
Age: 10-30
Site: anywhere
X-ray: radiolucent, in diaphysis
Prognosis: good
81
What is the pathogenesis of fibrous dysplasia?
Somatic mutation
82
What are the histological characteristics of fibrous dysplasia?
Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation
83
Curvilinear spicules of immature woven bone (chinese characters) surrounded by fibroblastic proliferation on histology = ?
Fibrous dysplasia
84
What are giant cell tumors of bone, and where do they occur?
- Tumors that contain numerous osteoclast-like multinucleated giant cells
- epiphyses of long bones, generally around the knee
85
What is the age range in which giant cell tumors usually occur?Gender?
20-55 yo
| Females
86
What are the usual s/sx of giant cell tumors?
Arthritic symptoms
87
How aggressive are giant cell tumors?
malignant
88
True or false: most tumors in the bone are mets
True--20x more common
89
Most metastatic tumors to the bone are osteolytic or osteoblastic?
Osteolytic
90
What are the two osteoblastic mets?
Prostate and breast
91
What are the 5 osteolytic bone mets?
```
Thyroid
Lung
GI tract
Kidney
Melanoma
```
92
The majority of mets to bone are osteoblastic, osteolytic, or mixed
Mixed
