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OITE > Benign bone lesions > Flashcards

Benign bone lesions Flashcards

1
Q

Small discrete, painful benign bone lesions

A

osteoid osteoma

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2
Q

Typical age of osteoid osteoma

A

5-25

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3
Q

Most common location for osteoid osteoma

A

Lower extremity: proximal femur>proximal tibia

Spine: thoracic and lumbar regions, posterior elements, side of concavity in scoliosis (painful in adolescents)

Hand: proximal phalanx

Foot: talar neck

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4
Q

What is attributed to pain of OO

A

PGE2 and Cox expression

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5
Q

Prognosis of OO

A

pain resolves and lesions spontaneously resolves after 5-7 years

in spine early resection leads to resolutions of scoliosis in <11yos

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6
Q

Presentation of OO

A

constant and progressive, worse at night and with ETOH, relieved by NSAIDS

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7
Q

Appearance on imaging

A

intensly reactive bone (thickened bone and fibrovascular tissue) around radiolucent nidus (central nodule of woven bone and osteoid with osteoblastic rimming)

<2 cm (if larger think osteoblastoma)

Bone scan: hot area of uptake in nidus, low uptake in reactive zone “double density sign”

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8
Q

long bone osteomas need to be differentiated from what

A

stress fracture, osteomyleitis, Ewings sarcoma

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9
Q

Posterior spinal elements of lesion concerning for OO need to be diff from what

A

ABC, osteoblastoma

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10
Q

Treatment of osteoid osteoma

A

1st line: observation, NSAIDS (also spine w/o scoliosis)

Percutaneous radiofrequency ablation, MR guided high intensity US - failure of medical management

Surgical resection with currettage - not amendable to above (close to skin or nerve), spine lesions with painful scoliosis

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11
Q

What is most common benign bone tumor in hand

A

enchondroma

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12
Q

What is an enchondroma

A

2nd most common benign cartilage lesion

chondroblasts escape physis

benign hyaline cartilage

asymptomatic (if symptomatic think sarcoma), sometimes pathologic fracture in hand

observation vs curettage and grafting

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13
Q

What is a periosteal chondroma

A

painful lesion in cortex of proximal humerus (small lytic area)
10-20yo
Painful due to irritation of tendons
Marginal excision including underlying cortex

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14
Q

Ollier’s Disease

A

multiple enchondromatosis, skeletal dysplasia (short, bowing)

10-15% of malignant transformation

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15
Q

Mafucci’s Disease

A

Multiple enchondromatosis and soft tissue hemangiomas

highest rate of malignant transformation (50+)

high rate of visceral malignancy

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16
Q

What is an osteochondroma

A

most common benign bone tumor

young patients 10-30

arises from cartilage of perichondral ring

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17
Q

Typical size of cartilage cap of osteochondroma

A

<1cm, if bigger then suggestive of malignant lesion

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18
Q

Treatment of osteochondroma

A

observation, but may remove if issue

Should not grow after skeletal maturity (if does think chondrosarcoma)

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19
Q

Multiple Hereditary Osteochondral Exostosis

A

AD

Multiple osteochondroma (sessile or pedunculated)

skeletal abnormalities (coxa valga, tethering of radius with bowing or tethering of fibula)

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20
Q

Genes for Multiple hereditary exostosis

A

EXT1,2,3 tumor suppressor genes (affects prehypertrophic chondrocytes causing decreased heparin sulfate production)

Loss of Indian Hedgehog Protein

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21
Q

What is a chondroblastoma

A

lytic lesion in epiphyseal or apophyseal area of bone in early teenager

treatment curettage and bone grafting

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22
Q

What do you see on XR and histo for chondroblastoma

A

Flecks of calcification on XR, abuts articular surface

chondroblasts with “chicken wire calcification” and cobblestone appears

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23
Q

What do chondroblastomas stain postive for

A

S100

24
Q

What do chondroblastomas and GCT have in common

A

can present with mets to lung

Also lesion may present with areas of secondary ABC

25
Q

“Popcorn stippling” bone lesion

A

enchondroma

26
Q

Similiar to osteoid osteoma but >2cm and painful, lytic in spine, blastic in extremities

A

Osteoblastoma

lacks peripheral bony reaction (diff. from OO)

Curettage and grafting, radiation if unresectable

27
Q

middle aged, eccentric lytic lesion in metaphysis of in distal femur, distal tibia, distal radius; extends to subchondral surface, metaphyseal side of physis in kids, Cmyc or P53

A

Giant cell tumor

multinucleated giant cells

28
Q

Treatment of giant cell tumor of bone

A

curettage and local adjuvent treatment (PMMA/freeze/phenol/argon)

could try bisphosphonates (N containing, inhibit farnesyl pyrophospate synthase on osteoclast)

Denosumab (prolia) antibody against RANKL, decreases size of lesion

29
Q

How should teriperatide be given

A

Forteo, synthetic PTH

daily to prevent resorption of bone, receptor on osteoblast

if continuous will cause resorption of bone

30
Q

What must be ordered with Giant Cell Tumor

A

CT chest: mets to lung

31
Q

Teenage with expansive, eccentric lytic lesion with bony septae, seen in calcaneous or metatarsals*

A

ABC, can be in posterior elements of spine

Curettage and grafting

32
Q

What is differntial for ABC lesions

A

telangiectatic osteosarcoma

33
Q

Gene translocations of ABC lesion

A

t(16;17) upregulation of USP6

34
Q

Young kid with fallen fragment sign in proximal femur or humerus

A

Unicameral bone cyst

observation but may aspirate and inject with steroid

if risk of fracture, curettage and bone graft

“active if adjacent with physis” latent if not

35
Q

How to treat UBC with fracture

A

treat fracture conservatively then deal with UBC

36
Q

Intrameduallary smoke up chimney sign

A

Bone infarct

same risk factors as osteonecrosis

observation

37
Q

young kid lytic lesion with periosteal reaction, skull, ribs, long bones, spine, kidney bean shape nuclei with eosinophils

A

Eosinophilic granuloma (langerhand histiocytosis), racquet shaped organelle in EM

Treatment curettge and grafting, radiation if very symptomatic

38
Q

Staining for Eosinophilic granuloma

A

CD1a

39
Q

older person, lytic and blastic lesions, usually show skull radiograph, stages, elevated alk phos, hydroxyproline, urinary N telopeptide

A

Pagets disease

lytic lytic and blastic, blastic, burnt out

40
Q

What else can be associated with Pagets

A

High output cardiac failure

tibia/femur bowing, hip/knee osteoarthritis

41
Q

Hallmark of pagets disease on histo

A

mosaic pattern of bone

42
Q

Genetics of Pagets disease

A

AD, SQSTM1 - codes for RANK

43
Q

Treatment of Pagets

A

Fosamax (bisphosphonates)

2nd line calcitonin (if total joint, cement and pretreat with calcitonin)

44
Q

infant with unilateral tibial varus, lucency medial cortex of metphysis

A

focal fibrocartilagenous dysplasia

histo: layers of collagenic fibrous tissue

resolves on own

45
Q

Old person with long standing Pagets, no longer responsive to treatment, destruction of bone

A

high grade osteosarcoma or fibrosarcoma

chemo, surgery chemo

46
Q

Patient with cystic or lytic lesion usually around hip, may be expansile, Ground glass appearance, histo “C and Os

A

Fibrous dysplasia

Tx observation, if symptomatic curettage and internal fixation

47
Q

Fibrous dysplasia has high expression of what and with what mutation

A

FGF-23

GS alpha protein (GNAS) on 20q13, affects cAMP pathway, unable to produce normal lamellar bone

48
Q

Findings of McCune-Albrights syndrome

A

polystotic fibrous dysplasia, cause of Maine cafe-au-lait spots and endocrinopathy

Bisphosphonates can help with pain

49
Q

kid with lytic lesion of tibia causing anterolateral bowing, histo rimming osteo blasts and fibrous tissue

A

osteofibrous dysplasia, tx observation

*dont confuse with fibrous dysplasia or adamantinoma (nests of epitheliod cells and needs resection)

50
Q

bubbly eccentric lesion on xray, usually in metaphysis, histo swirling fibrous tissue with giant cells

A

non-ossifying fibroma

tx: observation, may leave Giant Bone Island

May be seen with Jaffe-Campancci sydrome (visual problems, MR, cafe-au-lait lesions

51
Q

lesions with bubbly appearance on xray

A

NOF, ABC, UBC - NOF may have hemosiderin pigmentation

52
Q
A

Osteoid osteoma

53
Q
A

Osteoid osteoma

distinct demarcation between nidus and reactive bone

Nidus: immature osteoid trabeculae (woven bone) with sharp boarder of osteoblastic rimming

Reactive zone: surrounding sclerotic border

54
Q

Pathophysiology of enchondroma

A

chondroblasts and fragments of epiphyseal cartilage escape from physis, displace into metaphysis and proliferate

55
Q

Associated conditions with enchondroma

A

Olliers disease (multiple enchondromatosis), enchondromas throughout long bones

Maffucci’s syndrome - multiple enchondromas and soft-tissue angiomas, enchondromas markedly expand the bone, angio are round calcified phelboliths, high rate of malignant transformatin

56
Q

Workup of enchondroma

A

xray - popcorn stippling, arcs, whorls, rings, minimal erosion, may have cortical expasion in hands and feet or lytic appearance

skeletal survay and bone scan in polystotic disease suspected

core needle biopsy if bone scalloping or lysis

OITE (6 decks)

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