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NYCC MSP > Benign Bone Forming Tumors > Flashcards

Benign Bone Forming Tumors Flashcards

1
Q

Osteomas are ____-growing

A

slow

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2
Q

What are osteomas comprised of?

A

dense cortical bone

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3
Q

What is the preferential location of osteomas?

A

skull:
- calvarial & mandibular
- sinonasal & orbital bone
- sinuses: frontal, maxillary, ethmoid, sphenoid, mastoid

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4
Q

What is a potential complication of an osteoma?

A

sinusitis if formed in sinus
causes sinus pain & pressure due to obstruction

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5
Q

Having multiple osteomas is implicated in what pathology?

A

Gardner syndrome
(a variant of familial adenomatous polyposis (fAPC), associated with extra-colonic features)

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6
Q

What is the radiographic appearance of an osteoma?

A
  • densely blastic mass
  • well-defined borders
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7
Q

Enostomas are ____-growing

A

slow

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8
Q

What are enostomas comprised of?

A

dense cortical bone

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9
Q

What is the preferential location of enostomas?

A

non-skull:
- medullary cavity
- long bone surfaces

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10
Q

Enostomas are also called ____ OR ____ of bone

A
  • bone island
  • hamartoma
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11
Q

Bone islands are comprised of ____ bone, located in ____ space

A
  • dense cortical
  • trabecular
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12
Q

What does “hamartoma” mean?

A

abnormal/disorganized growth comprised of the same tissue from which it grows

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13
Q

How would you differentiate an enostoma from blastic metastasis?

A
  • ESR would be elevated if mets.
  • bone scan shows “hot” areas of blastic activity if mets.
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14
Q

How does an enostoma appear on a bone scan and why?

A

appears normal because enostoma is comprised of normal tissue, just disorganized (no increase in blastic activity)

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15
Q

Are benign tumors considered aggressive or non-aggressive?

A

non-aggressive

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16
Q

What pattern of destruction is seen in osteomas and enostomas?

A

blastic

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17
Q

What is the treatment for osteomas and enostomas?

A
  • clinical significance usually minimal
  • surgical removal if in sensitive location
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18
Q

The center of an osteoid osteoma is called a ____

A

nidus

19
Q

What is a nidus comprised of?

A

irregular trabeculae of woven bone (osteoid) within a vascular fibrous stroma containing osteoblasts & osteoclasts

20
Q

What part of a nidus may be ossified?

A

trabeculae in center (more mature)

21
Q

What age group is primarily affected by osteoid osteomas?

A

5-35 years
(most in teens)

22
Q

What bones are capable of forming an osteoid osteoma?

A

any bone that formed via endochondral ossification

23
Q

What is the preferential location of osteoid osteoma?

A
  • femur or tibia (50%)
    (10% in spine)
  • typically in cortical bone, may arise in medullary cavity
24
Q

How large is a typical nidus?

A

<1 cm

25
Q

How does an osteoid osteoma appear radiographically?

A

radiolucent lesion (nidus) surrounded by sclerotic bone

26
Q

What type of periosteal reaction is seen in an osteoid osteoma?

A

solid

27
Q

What pathology is associated with high levels of PGE2 in the area of the lesion?

A

Osteoid osteoma

28
Q

How would a patient with an osteoid osteoma present clinically?

A
  • insidious onset
  • pain at night (fewer distractions; can behave similar to fatigue Fx in adolescents)
  • pain relieved by aspirin/NSAIDs
29
Q

What pathology responds to aspirin/NSAIDs and why?

A

Osteoid Osteoma
- PGE2 released causes vasodilation of vascular components in stroma
- aspirin/NSAIDs cause vasoconstriction

30
Q

What type of periosteal reaction would occur in a fatigue fracture?

A

solid

31
Q

How might you differentiate a fatigue fracture from osteoid osteoma if unsure about an x-ray?

A

CT scan -> gives good bony definition, can see nidus clearly

32
Q

What is the natural history of an osteoid osteoma?

A
  • will go away with time (~2 yrs)
  • pain will persist (6-8/10)
33
Q

How is an osteoid osteoma treated?

A

removal of nidus via En Bloc excision

34
Q

What is an osteoblastoma comprised of?

A

(similar to osteoid osteoma)
osteoblasts lay down osteoid

35
Q

What is the preferential location of osteoblastoma?

A

spine: laminae & pedicles (post. elements)

36
Q

How large is a typical osteoblastoma?

A

> 2cm diameter (progressive enlargement)

37
Q

How does osteoblastoma appear radiographically?

A

radiolucent lesion without sclerotic reaction

38
Q

What pattern of destruction is seen in osteoblastoma?

A

geographic lytic

39
Q

What type of periosteal reaction is seen in osteoblastoma?

A

none

40
Q

Osteoblastomas release ____ causing…

A

prostaglandins causing pain (less than osteoid osteoma)

41
Q

How does osteoblastoma respond to aspirin?

A

pain unresponsive to aspirin (takes much larger dose due to ^size of lesion)

42
Q

How is an osteoblastoma treated?

A

(similar to osteoid osteoma)
- wide/en bloc excision via curette (not preferred)
- radiofrequency ablation -> electric probe inserted to liquify tumor (“microwaves” tumor)

43
Q

If an osteoma is symptomatic, what is the most likely symptom?
A) “my hat doesn’t fit anymore”
B) visual disturbance
C) sinusitis
D) headaches

A

C

NYCC MSP (28 decks)

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