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MM Test 3 > B6.067 Bone Tumors > Flashcards

B6.067 Bone Tumors Flashcards

1
Q

benign lesions in 0-5

A

eosinophilic granuloma (EG) (osteomyelitis)

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2
Q

malignant lesions in 0-5

A

leukemia (ALL)
mets (neuroblastoma)
limited but significant ddx

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3
Q

benign lesions in 5-10

A

unicameral bone cyst
non-ossifying fibroma (NOF)
osteochondroma

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4
Q

malignant lesions in 5-10

A

Ewing sarcoma

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5
Q

what is an NOF

A

non ossifying fibroma

developmental abnormality where scar tissue is present in place of bone

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6
Q

benign lesions 10-20

A

osteoid osteoma
bone cysts
chondroblastoma

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7
Q

malignant lesions 10-20

A

osteosarcoma

Ewing sarcoma

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8
Q

benign lesions in adults

A

enchondroma

giant cell tumor

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9
Q

malignant lesions in adults

A

chondrosarcoma
metastasis
lymphoma
myeloma

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10
Q

most common symptom of bone tumors

A

pain

nerve endings in the periosteum respond to compression of tumor

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11
Q

do soft tissue tumors present with pain?

A

not unless they run into the bone

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12
Q

characteristics of pain to examine

A 
duration
-weeks/months : tumor
-days/ weeks: inflamm
mechanical vs resting
recent trauma or injury
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13
Q

what are 2 different etiologies of soft tissue mass

A

bone tumor extending into soft tissue
OR
tumor of the soft tissue

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14
Q

2nd most common symptoms of bone tumor

A

soft tissue mass

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15
Q

characteristics of soft tissue masses to examine / ddx

A

days/weeks after injury: myositis ossificans
painful mass over days: infection
enlarging painless mass: soft tissue tumor
enlarging painful mass: bone tumor
progressive hematoma after trauma : tumor

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16
Q

why is a progressive hematoma after trauma worrisome

A

should NOT continue to grow under normal circumstances
likely caused by tumor angiogenesis factor producing friable blood vessels around the tumor
these more likely to continue to bleed than normal BVs without tumor growth

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17
Q

evaluation of possible bone tumor

A 
size of mass
neuro status (involving nerve?)
tenderness
range of motion of adjacent joints
local/distant nodes
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18
Q

would you see node involvement in osteosarcoma?

A

NO
spread via blood, not to nodes
see lung involvement most commonly

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19
Q

most common location of bone tumors

A

metaphysis

intramedullary

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20
Q

vertebral body is similar to the ______ of long bones

A

metaphysis

more likely tumor location

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21
Q

posterior spinal elements are similar to _______ of long bones

A

diaphysis
more cortical bone
less common tumor location

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22
Q

types of tumor margins

A

geographic
moth-eaten
permeative

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23
Q

concerning tumor margin patterns

A

moth eaten
permeative
cannot demarcate the transition between normal and abnormal bone
both are present, but no clear line

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24
Q

geographic tumor margin

A

sharp transition between abnormal and normal bone

benign

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25
Q

what to look for on radiographs of bone tumors

A

what is tumor doing to bone?
what is bone doing to tumor?
what is in the matrix or the lesion?

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26
Q

options for what could be the matrix composition inside a tumor of the bone

A

no matrix = fluid, blood, fibrous tissue
dense = bone, osteonecrosis
“popcorn” = cartilage
“ground glass” = osteoid

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27
Q

when do you use MRI

A

assess soft tissues and bone marrow extent

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28
Q

when do you use CT

A

bone integrity
mineralization pattern
systemic involvement assessment (metastasis)

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29
Q

when do you use a bone scan

A

determine degree of activity of known bone involvement or to look for other areas of bone involvement (assessing for mets in bone sarcomas or other sites of disease in polyostotic benign lesions)

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30
Q

do sarcomas typically have multiple bone lesions?

A

no

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31
Q

what are some diseases that can present with multiple bone lesions

A 
osteochondroma
metastases
leukemia
enchondroma
fibrous dysplasia
Langerhans cell histiocytosis
non-ossifying fibromas/ fibrous cortical defects
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32
Q

xray findings in osteosarcoma

A

permeative margin
dense area of bone growth
soft tissue expansion possible (fuzzy white outline)

33
Q

Tc99 bone scan findings on osteosarcoma

A

increased uptake in location of tumor

34
Q

how do you excise a osteosarcoma?

A

WIDE margins

tumor + normal tissue around it

35
Q

histo features of osteosarcoma

A

mitotic figures in tumor cells surrounded by pink osteoid substance

36
Q

common locations for osteosarcoma

A 
areas around growth plates 
knee (50%)
hip (15%)
shoulder (10%)
jaw (8%)
37
Q

most common primary malignant bone tumor

A

osteosarcoma

38
Q

age distribution of osteosarcoma

A

bimodal distribution
75% in pts < 20, most commonly when kids have rapid growth period
other peak between 60s-80s, usually a result of a preexisting lesion

39
Q

genetic predisposition to osteosarcoma

A

mutations in p53 and RB
hereditary RB are 1000x more likely to develop osteosarcoma
MOST PEOPLE DONT HAVE AN IDENTIFIABLE MUTATION THO

40
Q

associations with osteosarcoma in adults

A 
bone infarcts
chronic osteomyelitis
Paget
radiation
bone neoplasia
WORSE in adults...many die
41
Q

progressive knee pain in kiddos

A

osteosarcoma until proven otherwise

even if there was trauma

42
Q

treatment for osteosarcoma

A

start on systemic chemo immediately, even if lung and bone scans do not show mets
could be micromets that aren’t visible
DOES NOT respond to radiation
surgical excision of primary tumor

43
Q

what determines reconstructive potential of a limb after tumor excision?

A

amount of soft tissue structures intact
nerve and muscles need to be able to power the extremity
amputation f this stuff isn’t left

44
Q

what is true of ambulating with a prosthesis?

A

work well but require more energy than walking with a reconstructed extremity
important if patient has compromised cardiac or pulm status

45
Q

options for reconstruction

A

allograft - frozen from bone bank
megaprosthesis - joint replacement where segments can be added to grow w patient
rotationplasty

46
Q

what is the general rule of thumb about using a megaprosthesis

A

don’t use in patients < 7-8
you lose growth plates
cant grow enough to keep up with patient, will lead to large limb length discrepancy

47
Q

who is a good candidate for a rotationplasty?

A

younger kids > older kids

younger kids will have less psychiatric concern with having to completely learn how to use a new limb

48
Q

what happens in a rotationplasty

A

connect tibia to proximal femur with heel on anterior of patient
ankle functions as a knee joint

49
Q

advantages of rotationplasty

A 
better psych outcomes in young patients
limited phantom pain
standing/walking on weight bearing surfaces (soles of feet used to pressure, don't get torn up in prosthetic)
control for limb length discrepancy
good activity level
more durable in kids than endoprosthesis
50
Q

xray findings in chrondrosarcoma

A

expansile lesion

characteristic punctate calcifications (popcorn)

51
Q

what is a 4 corner amputations

A

arm
clavicle
scapula
usually try really hard to save upper extremities but you gotta do what you gotta do ya know

52
Q

normal cartilage histo

A

group of 2-3 cells per lacuna

lots of pink matrix between cell groups

53
Q

enchonroma

A

benign cartilage tumor

54
Q

enchondroma histo

A

increased cellularity from regular cartilage
matrix still present tho
normal nuclei

55
Q

chondrosarcoma histo

A

decreased matrix
increased cellularity
abnormal nuclei with multiple mitotic figures

56
Q

most common primary bone tumor in adults

A

chondrosarcoma

57
Q

common locations for chondrosarcoma

A

shoulder girdle

hip/pelvis

58
Q

treatment of chrondrosarcoma

A

surgical excision

chemo for rare variant, but in general doesn’t respond to chemo

59
Q

additional imaging needed in chondrosarcoma

A

CT chest to check for lung mets

needed in all sarcomas

60
Q

imaging findings in Ewings sarcoma

A

permeative lesion
MRI shows extensive marrow involvement
subperiosteal edema

61
Q

treatment options for Ewings

A

surgical resection or radiation

radiation can damage growth plate in kids

62
Q

histo of Ewings

A

small/round blue cell tumor

sheets of small cells with inconspicuous cytoplasm

63
Q

epidemiology of Ewings

A

most patients are < 20
second most common bone tumor in kids (after osteosarcoma)
more common in Caucasians
slightly more common in boys

64
Q

symptoms of Ewings

A

pain, fever, leukocytosis
SUPER important to distinguish from osteomyelitis
can appear identically until biopsied

65
Q

where does Ewings occur

A

diaphysis/metaphysis of long bones

66
Q

Ddx of Ewings based on histo

A

metastatic neuroblastoma
metastatic rhabdomyosarcoma
lymphoma

67
Q

genetics associated with Ewings

A

85% t(11;22)
5-10% t(21;22)
1% t(7;22)
in ALL cases: fusion of EWS gene on chromosome 22 to a member of the ETS family of transcription factors (most commonly FLI1)

68
Q

EWs-FLI1 fusion gene

A

acts as a dominant oncogene constitutively active transcription factor that stimulates cell proliferation

69
Q

prognosis of Ewings

A

75% 5 year survival

50% long term cure

70
Q

hardest location of Ewings to cure

A

pelvis

hard to excise

71
Q

epidemiology of soft tissue tumors

A

much more common than bone tumors
most are benign
lipoma most common

72
Q

how to determine origin of soft tissue tumor

A

evaluate initially with plain films to determine if mass is coming from bone or soft tissue and to evaluate for any mineralization within the lesion

73
Q

epidemiology of soft tissue vs bone malignancies

A

malignant primary bone tumors occur in younger patients

malignant soft tissue tumors are more common among adults

74
Q

most common location of synovial sarcoma

A

buttock

if u said synovium you truly SUCKKKKK

75
Q

epidemiology of synovial sarcoma

A

3rd most common type of soft tissue sarcoma (most common among teenagers)

76
Q

appearance of synovial sarcoma on MRI

A

mass that is made of something between fat and fluid

77
Q

histo of synovial sarcoma

A

typically biphasic tumor
-spindle cells
-glandular epithelial cells
can have monophasic, spindle cell variant (in men) that is only detected by translocation

78
Q

genetics associated with synovial sarcoma

A

t(X;18)

79
Q

treatment of synovial sarcoma

A

radiation therapy

wide resection

MM Test 3 (31 decks)

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