Benign Tumors Flashcards
Do most benign tumors occur early or later in life?
Early (before age 20)
Are giant cell tumors benign or malignant?
80% benign but 20% malignant
What is the age range for a giant cell tumor?
20-40
What is the male to female ratio for a GCT?
1:1
What is the most common benign tumor of the sacrum?
Giant cell tumor
What is the most common location for GCT?
85% in the long bones, mostly distal femur and proximal tibia, distal radius, proximal humerus
What is unique about the male to female ratio of GCT?
Females more likely when malignant
What is the key feature about the location of bone with GCT?
SUBARTICULAR ***
What is the most common benign osseous tumor?
Solitary osteochondroma (50%)
What is the age of occurrence for an osteochondroma?
Below 20
Which tumor is a bony exostosis on the external surface of a bone and usually is lined by a hyaline cartilage cap?
Solitary osteochondroma
What are the two types of osteochondromas?
1 sessile
2 pedunculated
Where are sessile osteochondromas commonly located?
Humerus and scapula
Where are pedunculate osteochondromas commonly located?
Knee, hip, ankle
Which type of osteochondromas has a cartilage cap?
Pedunculated
What are some of the descriptive terms used for a pedunculated osteochondroma?
“Coat hanger exostosis” and “cauliflower cap”
Osteochondromas are found in what part of a long bone?
Metaphysis
Although some locations are more common than others, generally where can osteochondromas be found?
Any bone formed by endochondral ossification
Do the exostoses of the osteochondromas tend to point toward or away from the nearby joint?
AWAY
A subcondylar process pointing in which direction from the joint is considered a normal finding?
TOWARD the joint
What is another name for hereditary multiple exostosis?
Diaphyseal achalasia
What condition is an inherited autosomal dominant condition characterized by multiple osteochondromas often causing metaphyseal overgrowth?
Hereditary multiple exostosis
When is hereditary multiple exostosis usually discovered?
2-10 years of age
What is the average number of exostoses seen with hereditary multiple exostosis?
10 (can be anywhere from a few to 100 though)
How can hereditary multiple exostosis become dangerous?
5-20% become malignant, possible cord compression, possible obstructive uropathy
What radiographic feature of the hands can be seen with hereditary multiple exostosis?
Shortening of the 4th and 5th metacarpals
What radiographic feature of the fingers and toes can be seen with hereditary multiple exostosis?
Supernumerary
What radiographic feature of the radius can be seen with hereditary multiple exostosis?
Madelung (bending) or bayonet deformity
What tumor is non-neoplastic with a fluid filled cystic cavity lined with fibrous tissue?
Simple bone cyst
What is the usually age of occurrence of a simple bone cyst?
3-14 (80%)
Are solitary bone cysts painless or painful?
Painless
When can solitary bone cysts become painful?
When fractured
Where do most simple bone cysts occur?
Proximal humerus and femur (60-75%)
What is the specific location in a bone that a simple bone cysts grows?
Central in the metaphysis adjacent to growth plate
The “fallen fragment sign” is associated with what tumor?
Simple bone cyst
What does the “truncated cone appearance” mean in reference to a simple bone cyst?
Will never grow wider than its length
How can we differentiate a GCT from a simple bone cyst?
GCT = subarticular, eccentric, ages 20-40 SBC = metaphyseal, central, ages 3-14
What causes the fallen fragment sign seen with a simple bone cyst?
A piece sinks to the bottom in fluid
How are simple bone cysts treated?
Most effective = injection of steroids post drainage (but some spontaneous regress)
What is the most common bone to be involved with an osteosarcoma?
Distal femur
Which lesion is non-neoplastic and expansile containing thin-walled blood-filled cystic cavities?
Aneurysmal bone cyst
What is the age range for an ABC?
10-30 (75% occur below the age of 20)
What is the gender bias associated with an ABC?
FEMALES
What are some neurological signs that can present with an ABC?
Radiculopathy or quadriplegia with spinal involvement
What is the most common location for an ABC?
SPINE (with predilection for posterior elements like the spinous, lamina, pedicle, transverse)
What flat bones are associated with an ABC?
Pelvis
What the is the most aggressive of the non-neoplastic lesions?
Aneurysmal bone cyst
Is an aneurysmal bone cyst typically blastic or lytic?
Lytic
How does an ABC appear?
Eccentric with soap bubble expansion
Which two lesions are known to be more common in females?
Hemangioma and ABC
What is the most common benign tumor of the clavicle?
ABC
How can an MRI differentiate between a GCT and ABC?
ABC would show fluid-fluid levels due to changes of blood over time
What is the peak age for an osteoblastoma?
10-20
How would a patient present with an osteoblastoma?
Dull pain, localized swelling, decreased range of motion, painful functional scoliosis (50%)
What is the most common location for an osteoblastoma?
Spine (40%) (uniquely, the small bones of the hands and feet)
What is the age range for an osteoid osteoma?
10-25
What are the clinical features of an osteoid osteoma?
Local pain (up to 98%) that’s worse at night, decreased by activity and aspirin
Osteoid osteomas are found in what specific part of bone?
Meta and diaphyses of long bones
What tumor is associated with a nidus formation?
Osteoid osteoma
What is a nidus?
Hole with a sclerotic ring
What is the best imaging for an osteoid osteoma?
CT (shows hole/nidus in cortex)
What technique can be used to remove an osteoid osteoma?
Radiofrequency ablation
What is the term for a dark central area with a light gray around it as seen on a bone scan with an osteoid osteoma?
“Double-density sign”
What is a common location for an osteoid osteoma even though no bone is technically exempt?
SPINE (14%) specifically the posterior elements of lower thoracic and upper lumbars creating the painful scoliosis
How is the cortex affected by an osteoid osteoma which therefore differentiates it from a fibrous cortical defect?
THICKENING
Osteomas are tumors that arise in what kind of overall bone?
Membranous (think skull)
Are osteomas more commonly found in children or adults?
Adults
Osteomas are associated with what syndrome?
Gardner’s
What are common locations for osteomas?
Frontal and ethmoid sinuses, calvarium, mandible, nasal bones
Enchondromas are found in what specific part of bone?
Medullary cavity
What is the age of occurrence with enchondromas?
10-30
Are enchondromas painful?
NO
What is the most common location for enchondromas?
40% in the small bones of wrists and hands
What is the most common benign tumor of the hands and feet?
Enchondromas
Are enchondromas lytic or blastic?
Lytic
What is the treatment for enchondromas?
Usually none…(no pain)
What is the name of the condition with early childhood presentation of multiple enchondromas of the hands and feet due to nonhereditary failure of cartilage ossification?
Ollier’s (enchondromatosis)
What is the name of the condition with multiple enchondromas plus multiple soft tissue hemangiomas?
Maffucci syndrome
What lesion is a solitary vascular neoplasm which is slow growing and composed of newly formed capillary, cavernous, or venous blood vessels?
Hemangioma
At what age do hemangiomas commonly occur?
During 4-5 decades
What is the gender bias associated with hemangiomas?
FEMALE
How common are hemangiomas?
10% of overall population
What is the most common benign tumor of the spine?
Hemangioma
When do hemangiomas become symptomatic?
When the expand and cause spinal stenosis and cord compression
What is the most common location for a hemangioma?
Vertebral body of lower thoracics and upper lumbars, calvarium with special predilection for frontal bone
What are the terms used to describe the trabecular changes seen with hemangiomas?
“Accordion”, “corduroy”, “honeycomb”
If multiple vertebrae were seen to have the “corduroy” appearance that is seen with a hemangioma, what other condition should be looked at?
Osteoporosis
The “filled soda straw appearance” and “polka dot sign” seen on CT is associated with what tumor?
Hemangioma
What is the typical size of a hemangioma?
Less than 4 cm (round)
What is the age of occurrence for a chondroblastoma?
8-59 years (LOL, no joke) with peak age of 5-25 (88%)
When do chondroblastomas develop?
Before cessation of enchondral bone growth
What is the specific location in bone for a chondroblastoma?
Around apophysis or epiphysis in subarticular location
What is the most common location for a chondroblastoma?
Femur (2/3 found in lower extremities and keep in mind tarsal bones are a rare possibility
What other lesion is specific to the epiphysis along with a chondroblastoma?
Giant cell tumor (but is completely subarticular)
How can we differentiate between a giant cell tumor and chondroblastoma?
GCT = 20-40 YOA Chondroblastoma = 5-25 peak age
