B bone tumor 2 Flashcards by Erin Sinkuler

what is it

osteoma

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what is a hamartoma

histologically normal tissue in an abnormal location

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where do osteomas develope

intramembranous bones

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homogenously dense painless mass

osteoma

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common locations for osteoma

calvarium

paranasla sinuses- esp ethmoid and frontal

*not common in maxillary

sometimes in mandible (gardener syndrome)

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what is garender syndrome and what type of tumor is it assoccated with

aka familial colorectal polyposis

autosomal DOMINANT

presence of multiple polyps in colon and tumors outside the colon

extra colonic tumors: skull, thyroid cancer, epidermoid cysts, fibromas

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projects from internal table of the skull

osteoma

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usually _________radiodense and featureless

not ____________ unless blocking sinus

homoneously

symptomatic

frontal sinus osteoma

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common sites for osteoid osteoma

50% tibia/ femur

10% spine

long bones metaphyseal or diaphyseal

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_____% diagnosed before age 25

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osteoid osteoma predelection

males 2:1

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pain worse at night

relieved by asprin

long hx of pain before dx

self resolve over months/years

resection to remove

will reoccur if nidus not removed

osteoid osteoma

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possbile locations of osteoid osteoma

subperosteal

intracortical

intramedullary

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radiolucent nidus <1cm

maybe obscured by reactice sclerosis

osteiod osteoma

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osteiod osteoma

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osteiod osteoma

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osteiod osteoma

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osteiod osteoma

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osteoid osteoma

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one of 3 _____bone tumors that predilicts posterior elements of the spine

primary

osteoid osteoma

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histological twin to osteoid osteoma

osteoblastoma

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Long hx of pain; typically mos. – yrs.

´Larger, more expansile lesion

´30-50% in posterior arch of spine

´30% in long bones

´Femur and tibia most common

´Diaphyseal/metadiaphyseal location

osteoblastoma

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Expansile, geographic lesion

May be big; 2-12 cm dia. Matrix lucent, but may have stippled calcification

Often with sclerotic border and sharp transition zone

Usually lacks reactive dense reactive sclerosis of osteoid osteoma

osteoblastoma

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osteoblastoma

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young pt expansile lesion post arch

osteoblastoma

´second most common primary malignancy of bone

osteosarcoma

\_\_\_\_\_\_\_\_% of all primary malignancies of bone-osteosarcoma

osteosarcoma histology

spindle-shaped stromal cells, osteoid and intercellular collagenous material

age range of osteosarcoma

10-25 (75%)

gender pedilection for osteosarcoma

male 2:1

´Characterized by local pain, often with enlarging mass, swelling and redness ´Elevated serum alkaline phosphatase

osteosarcoma

subtypes of osteosarcoma

“Conventional” most common Parosteal Periosteal Multicentric

most common sites for osteosarcoma

knee and proximal humerus reported almost everywhere rare in spine metaphysis

basic pattern of osteosarcoma

50% are sclerotic 25% lytic 25% mixed pattern soft tissue mass with calcification and or ossification

Periosteal reaction classically what for osteosarcoma

sunburst spiculated

osteosarcoma

destuctive patterns associated with osteosarcoma

permiative/motheaten

bone to bone metastasis is common in osteosarcoma T/F

false

treatment for osteosarcoma

amputation chemo

Secondary osteosarcoma may develop from

maliganant degeneration of Pagets, HME, following radiation therapy of a benign lesion

does osteosarcoma have multiple primaries

no, rare

parosteal osteosarcoma aka

juxtacortical sarcoma

´Slower growing and less aggressive than typical osteosarcoma ´Older age group then typical o-sarc (2nd – 4th decades) ´Mild S/S; hard, local mass/swelling fixed to bone ´Variable length of symptoms but typically 2-6 months Alk. Phos and other labs often WNL

parosteal osteosarcoma

what area does parostal ostosarcoma affect

´Almost exclusively affects long bones 92% in femur, tibia and humerus ;most of remaining in fibula, radius and ulna

2 basic types of juxtacortical sarcomas based on

relative amounts of fibrous, cartilage and osteoid tissue present Parosteal osteocarcoma Periosteal osteogenic sarcoma

parosteal osteosarcoma has what kind of ossification?

cloudlike

characteristic location of parosteal osteosarcoma

posterior distal femur

most common site of enchondroma

50% occur in small bones of hands Most common benign bone tumor of hands Not common in distal phalanges or carpals Femur (14%), humerus (13%), ribs (13%)

Clinical: Little/no pain unless pathological fracture The closer to the axial skeleton, the more likely the lesion may be or become malignant

enchondroma

presence of multiple enchondromata ( usually affecting one side of the body) and is considered a dysplasia, rather than neoplastic process. A non-hereditary, non-familial condition

Enchondromatosis (Ollier’s Disease)

Geographic, radiolucent expansile lesion Sharp zone of transition Matrix may calcify “rings and broken rings” ´“flocculent” enchondroma

enchondroma

In long bones the d/dx should include med-ullary bone infarct

enchondroma

enchondromatosis \*Note the ring-like pattern of matirix calcification

Enchondromatosis-Maffucchi’s Syndrome \*Note the calcified phleboliths in soft tissues

Most common benign bone tumor

osteochondroma

most common sites for osteochondroma

predilicts long bones 50% in lower extremity; esp femur and tibia 18% in humerus Unusual, but reported in spine Location- metaphyseal lesion

´Age- develops in childhood ´Stops growing when adjacent physis closes ´Rarely (1%) become malignant; ´Late growth and/or unexplained pain _suspicious_ ´Typically asymptomatic unless ´Fractured or otherwise traumatized ´Pressure on adjacent nerve/blood vessel ´Adventitious bursa develops due to friction on overlying muscle/tendon

osteochondroma

2 types

osteochondroma ´Pedunculated = with stalk-point away from adjacent joint ´Sessile = broad-based

osteochondroma

An hereditary, autosomal dominant trait characterized by the presence of multiple osteochondromata scattered throughout the skeleton.

Hereditary Multiple Exostosis (HME) Diaphyseal Aclasis or Osteochondromatosis

* “Bayonet” deformity of hand/wrist due to short ulna * Broad femoral metaphyses

Hereditary Multiple Exostosis (HME)

•Thickened cartilagenous cap with irregular calcification may

indicate malignant change Hereditary Multiple Exostosis

Hereditary Multiple Exostosis

condition in which the part of the radius bone forming the wrist joint grows abnormally resulting in the hand to be deviated towards the little finger and the palm.

Madelung deformity

´“Codman’s tumor” rare ages 10-25 Joint pain and swelling Typically painful, but may be quiescent for extended periods

Chondroblastoma

Mild/minimal expansion Matrix shows calcification in 50% No periosteal reaction D/dx = giant cell tumor Treatment = curettage esents with insidious onset hip pain

chondroblastoma

brodies abcess

´Palpable, hard mass may be present ´Slow growing - often develops over years ´Low grade, local pain ´Metastasizes late ´Males \> Females 2:1 ´Treated with local excision or amputation ´Survival rate varies from very good in small, lower grade types to poor in large lesions with extensive local invasion

chondrosarcoma

´Prox. Femur and pelvis = 50% ´Shoulder = 13% ´Ribs = 15% ´Long tubular bones = 45% ´Expansile, geographic lesion- may be large ´Soft tissue mass common ´Calcification of matrix common ´“popcorn” or “rings and broken rings”

chondrsarcoma

chondrosarcoma

´AKA osteoclastoma ´Considered a “quasimalignant” tumor ´Histologically graded I – III ´Grade I = benign lesions ´Grade II – intermediate ´Grade III = frankly malignant ´Histology: connective tissue stromal cells with multi-nucleated giant cells ´80% are benign ´15% of all primary benign bone tumors ´5-8% of all primary malignant bone tumors

giant cell

´Typically painful (intermittently) with local swelling ´May path # ´Males = females ´Age: most in 20 – 40 yr. range (75%) ´Treatment: currette and pack ´Will reoccur commonly if not completely removed. ´Subarticular location complicates surgical resection

giant cell

common sites for giant cell tumors

´Femur (distal) \> radius (distal) \>humerus (proximal) ´ 8% sacral ´Location: subarticular ´Considered a metaphyseal lesion ´Typically eccentric ´Geographic and expansile ´Matrix purely lytic (60%) or “soapbubble” (40%)

giant cell

Giant cell tumor

Hemangioma

bone island aka

solitary enostosis

multiple bone islands =

Osteopoikilosis

histologically what is osteoid osteoma

collection of highly vascularized osteoid tissue and giant cells surrounded by reactice sclerosis of host bone