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Surg Dz > Benign Bone Tumors > Flashcards

Benign Bone Tumors Flashcards

1
Q

What is an Osteoid Osteoma ?

A

A Benign bone forming tumor that occurs mainly in the long bones and accounts for about 12% of the benign tumors.

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2
Q

What is osteoid osteoma characterized by?

A

Characterized by small radiolucent nidus, which produces high levels of prostaglandins

“Radiographs show dense sclerotic zone of cortical thickening laterally, which contains the small oval lucent nidus”

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3
Q

What are sx of osteoid osteoma?

A

Nocturnal pain that is *relieved within 20-25 minutes of starting NSAIDs

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4
Q

What is the preferred imaging modality for an osteoid osteoma?

A

CT is preferred

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5
Q

What is the treatment of choice for Osteoid osteoma?

A

Interstitial laser photocoagulation is TOC.

If left untreated, typically resolves spontaneously . Removal of the nidus generally results in pain resolution. Recurrence if Nidus is not completely removed

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6
Q

What is an Osteoblastoma ?

A

Benign bone forming tumor that makes up 14% of the benign tumors.

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7
Q

Where does Osteoblastoma most commonly occur?

A

Posterior column of the spine

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8
Q

What are the sx of Osteoblastoma?

A

Chronic pain, pain is less responsive to NSAIDs and neurological sx

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9
Q

What imaging do you use for Osteoblastoma?

A

Often requires CT or MRI for identification (it can mimic malignant neoplasms and radiographs are variable)

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10
Q

What is treatment for Osteoblastoma

A

Curettage and excision.

If untreated, continues to enlarge and may damage adjacent structures and may cause progressive neurologic sx

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11
Q

What is Osteochondroma ? (Cartilage forming)

A

A cartilage capped bony spur arising on the external surface of a bone that typically occurs spontaneously

Most commonly seen around the knee (distal femur) and proximal humerus

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12
Q

What age groups do you see osteochondromas in?

A

10-20 yo

M>F

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13
Q

Osteochondromas make up ______% of benign bone tumors?

A

30%

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14
Q

What are sx of osteochondroma?

A

+/- painful mass palpable near the ends of long bones

Can be trauma associated

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15
Q

What is treatment for osteochondroma?

A

Observation and possible surgery

Risk of malignant transformation to chondrosarcoma; Hereditary multiple osteochondromas (HMO)

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16
Q

Does osteochondroma have malignant potential?

A

Yes; risk of malignant transformation into hereditary multiple osteochondromas HMO

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17
Q

What do Osteochondroma radiographs look like

A

CAULIFLOWER looking exostosis

Areas of increased density scattered throughout the osteochondroma, representing calcified islands of cartilage

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18
Q

What is Hereditary Multiple Osteochondromas?

A

HMO are 2 or more exostoses in the appendicular and axial skeleton.

Most cases are caused by autosomal dominant inheritance of a gremlin mutation in the tumor suppressor genes EXT1 or EXT2

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19
Q

What is the prevalence of HMO?

A

1:50,000

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20
Q

What are features of HMO?

A

Short stature and angular deformities

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21
Q

When do you get an MRI for HMO?

A

MRI warranted if there’s concern for adjacent soft tissue impingement, new focal pain, or concern for chondrosarcomatous transformation

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22
Q

Treatment for HMO?

A

Hemiepiphysiodesis= Guided growth surgical technique to correct angular deformities in skeletally immature patients

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23
Q

What is an Enchondroma?

A

A cartilage forming tumor that develops in the medulla (marrow cavity) of long bones and causes widening of the bone

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24
Q

Enchondroma makes up ____% of benign bone tumors

A

3%

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25
Q

Do enchondromas occur more in males or females?

A

M=F

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26
Q

What is the prevalence of Enchondroma?

A

1/100,000

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27
Q

Where do Enchondromas form?

A

Long bones

Mostly hands, then humerus, then femur

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28
Q

What are multiple enchondromas called and what are their sx?

A

Enchondromatosis/Ollier Disease/Maffucci Syndrome

—HA, cranial nerve deficit if intracranial
—Risk of malignant transformation to chondrosarcoma

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29
Q

What is treatment for enchondroma?

A

Observation or curettage/bone grafting

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30
Q

What do radiographs of Multiple Enchondromatosis show?

A

Expansile, soap bubble lesions. The expansion of the bone has widened the diaphysis of most of the affected bones

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31
Q

What is Chondroblastoma?

A

Benign bone tumor most common at the epiphysis or apophyses of long bones (the proximal humerus and around the knee)

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32
Q

What do radiographs of chondroblastoma show?

A

Small, well defined epiphyseal lesions with a sclerotic border that may cross the physis (growth plate)

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33
Q

What population do you see Chondroblastoma in?

A

10-20 yo

M>F

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34
Q

What are sx of chondroblastoma?

A

Constant, low grade pain and swelling

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35
Q

What is treatment for chondroblastoma?

A

Observation, possible surgery
—Likely to continue growing if left untreated
—Risk for lung metastases

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36
Q

What is a chondromyxoid fibroma?

A

A rare tumor of the tubular long bones

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37
Q

What population does chondromyxoid fibroma occur in?

A

20-30s

M>F

38
Q

What are sx of chondromyxoid fibroma

A

longstanding pain

39
Q

What do radiographs of chondromyxoid fibroma show?

A

Intramedullary, lobulated or bubbly lesion in the metaphysis

40
Q

Treatment for Chondromyxoid fibroma?

A

Curettage and bone grafting

41
Q

What is the prognosis for chondromyxoid fibroma like?

A

Generally good, 20% recurrence rate

42
Q

What is Fibrous Dysplasia

A

Lesion in which portions of the bone are replaced by fibrous connective tissue and poorly formed trabecular bone.

They Originate in the medullary cavity, caused by mutation in GNAS1 gene

43
Q

Fibrous dysplasia makes up ______% of benign bone tumors

A

5-7%

44
Q

What population do you see fibrous dysplasia in?

A

Teens/20s and M>F

45
Q

Where does fibrous dysplasia most commonly occur

A

Most common in the proximal femur, can occur in single and multiple bones

46
Q

What do radiographs of Fibrous Dysplasia look like?

A

“Ground glass” matrix, Cafe au lait macules

Shepherds crook deformity caused by fractures sustained over the years. Irregular, marginated, ground glass lucencies are surrounded by reactive bone. The shaft has an appearance that has been likened to a soap bubble

47
Q

What is treatment for fibrous dysplasia?

A

Curettage, bone graft, stabilization, and biphosphonate

48
Q

What is an ossifying fibroma

A

“Not a tumor per se, more a deformity inducing lesion” A fibrous ossifying neoplasm characterized by the substitution of normal bone by fibrous tissues and newly calcified products.

49
Q

What does radiographs of ossifying fibroma show?

A

Thinning of cortices and sclerosis

50
Q

What are complications of ossifying fibroma?

A

Limb bowing and pathologic fractures

51
Q

What is treatment for ossifying fibroma?

A

Observation, large lesions monitor more closely

If symptomatic— excision, curettage, bone graft

52
Q

What is the prognosis for ossifying fibroma?

A

May recur if excised before maturity

Usually good if after maturity

53
Q

What is a non ossifying fibroma?

A

A common fibrous lesion, usually developmental defect in which areas that normally ossify are filled with fibrous connective tissue

54
Q

What percentage of benign tumors do non ossifying fibromas make up?

A

35%

55
Q

What age groups and people are non ossifying fibromas commonly seen in?

A

5-15 year olds

M>F 2:1

56
Q

What areas are non ossifying fibromas commonly located?

A

Distal femur> proximal tibia>distal tibia

57
Q

What are the symptoms of nonossifying fibromas?

A

Asymptomatic and usually incidental. Seen typically after trauma (pathologic fracture)

58
Q

What do radiographs of nonossifying fibromas look like?

A

Metaphyseal, eccentric “bubbly” lytic lesion, lesions enlarge

59
Q

Are CTs helpful in treating non ossifying fibromas?

A

Yes, CT is helpful to predict pathologic fracture potential

60
Q

What is treatment for nonossifying fibroma

A

Observation (may resolve spontaneously/reossify)

Casting for fractures

Curettage

61
Q

What is the prognosis for non ossifying fibromas?

A

Usually spontaneously resolves and no malignant potential

62
Q

Is there malignant potential for non ossifying fibromas?

A

No

63
Q

What is a simple bone cyst?

A

Fluid filled lesion with a fibrous lining

64
Q

What age/M or F are simple bone cysts seen in?

A

Typically occurs before 20years of age and

F=M

65
Q

Where are simple bone cysts most commonly located?

A

Most common in proximal humerus and femur

66
Q

What do radiographs of simple bone cysts look like

A

FALLEN FRAGMENT SIGN— the presence of a fractured piece of bone resting dependently in a cystic bone lesion

Also, well marginated lytic lesions of the metaphysic or metasdiaphysis with or without reactive sclerosis

“Scalloped endosteal margin”

67
Q

What is the treatment for simple bone cysts?

A

Observation, aspiration, methylprednisone

68
Q

What is an aneurysmal bone cyst?

A

A non malignant expansile vascular lesion that consists of blood filled channels

Makes up 9% of benign bone tumors

69
Q

What age group gets aneurysmal bone cysts?

A

Generally in adolescents and F>M

70
Q

Where are aneurysmal bone cysts most commonly located?

A

Most common in posterior spine, femur, and tibia

71
Q

What are the sx of aneurysmal bone cysts?

A

Fractures, limps, swelling, neurological sx, and growth arrest

72
Q

What are the radiologic characteristics of aneurysmal bone cysts?

A

Expanded lesions of the diametphyseal area. The lesion is trabeculated and does not cross the physis. These lesions are radiologically characteristic enough to allow a confident diagnosis

73
Q

What is a Giant Cell Osteoclastoma?

A

A tumor characterized by the presence of multinucleated giant cells (osteoclast like cells)

74
Q

What age groups get Giant Cell Osteoclastomas?

A

Young adults have the peak incidence (20s and 30s) but can range up to 50

F>M

Incidence of 1.7 per million people

75
Q

What are the sx of Giant Cell Osteoclastomas?

A

Pain, swelling, limitation of joint movement, and pathologic fractures

76
Q

Where are Giant Cell Osteoclastomas usually located?

A

Long bone metaphysis and epiphysis, about 50% are around the knee

77
Q

How do you diagnose Giant Cell Osteoclastomas?

A

You need to biopsy and look at histology to see the cell type

78
Q

Do Giant Cell Osteoclastomas have malignant potential?

A

Yes but its rare. 2-5% and will usually metastasize to lungs

79
Q

What is the prognosis for Giant Cell Osteoclastomas?

A

5 year 76% disease free survival rate

17% mortality rate

80
Q

What is the treatment for Giant cell Osteoclastoma?

A

Curettage, bone graft, and reconstructive surgery.

If non operative: denosumab and radiation

81
Q

What’s the general treatment for benign tumors?

A

The treatment of benign tumors depends upon the presence of symptoms
—Lesions with symptoms that are tolerable or can be controlled may be served with serial examinations and radiographs every 4-6 months

Treatment options for symptomatic lesions include
—Surgical resection, which may be aided by CT guided needle localization
—Radio frequency ablation
—Cryotherapy
—MRI guided high intensity focused ultrasound
—Most commonly curettage and bone grafting

**Surgical options may be limited by proximity to vital structures

82
Q

What are the general poor prognostic indicators of bone tumors?

A 
—Metastases at presentation
—Tumors arising from the axial skeleton
—Large tumor volume (>10cm)
—Increased alkaline phosphatase or lactate dehydrogenase
—Lymph node involvement
83
Q

What’s the mortality rate of Ewing’s Sarcoma ?

A

40-50% mortality rate in spite of chemotherapy, irradiation, and surgery

84
Q

How has the 5 year survival rate of Osteosarcoma changed from 1965 to now?

A

15% in 1965 to 60% currently

85
Q

What age groups get Enchondromas?

A

Usually occurs in 10-20 year olds

Children <10 you can see Enchondromatosis

86
Q

What’s the most common location for an Osteoid Osteoma to be?

A

The femur

87
Q

What ages of people are affected by Osteoblastomas?

A

Can affect any age, but is usually seen in 10-20 year olds and M>F

88
Q

Where are Osteochondromas commonly located?

A

Most commonly seen around the knee (distal femur) and the proximal humerus

89
Q

What age groups get ossifying fibromas?

A

Occurs in children 10yo and younger

90
Q

Where are Ossifying fibromas commonly located?

A

Common in the diaphysis of the tibia or fibula, maxilla and mandible, or sinonasal

Surg Dz (9 decks)

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