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Tumor > Boards Study > Flashcards

Boards Study Flashcards

1
Q

Endothelin 1 has a role in:

A

osteoblastic tumor mets

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2
Q

genetic mutation in McCune Albright

A

G alpha subunit

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3
Q

Occult lytic bone mets with no known primary are typically:

A

lung

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4
Q

do radiation and chemo work for chondrosarcomas?

A

no

- EXCEPT for Dedifferentiated Chondrosarcoma

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5
Q

most likely site of mets?

A

spine

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6
Q

most like site of pathologic fracture

A

proximal femur

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7
Q

when you nail a pathologic fracture of the hip, which zones get radiation

A

the entire femur, because you spread the metastatic disease through the entire canal

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8
Q

depth-related resection guidelines for acral lentiginous melanoma

A

> 4mm depth is full ray amputation

<0.76mm is disarticulation

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9
Q

treatment of enchondromas of the digits?

A

can be treated with curettage and bone grafting

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10
Q

E-cadherin and Integrins in tumor cells:

A

E-cadherin decreases and allow migration from tumor of origin

Integrins increase and establish foci of metastasis

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11
Q

Maffucci syndrome

A

multiple enchondromas and hemangiomas

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12
Q

surgery for lymphomas typically involves:

A

intramedullary stabilization. that’s basically all.

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13
Q

chondroblastoma metastatic potential

A

can met to lungs in 2%

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14
Q

Survival rates of localized osteosarcoma

A

65-70%

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15
Q

most common axial site of a giant cell tumor

A

sacrum

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16
Q

most common sites of metastatic osteosarcoma

A
  • lung (get CT chest)

- bone

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17
Q

Treatment of osteosarcoma

A

chemotherapy and wide resection

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18
Q

Treatment of chondrosarcoma

A

wide resection alone

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19
Q

All soft tissue sarcomas show this on MRI:

A

low T1 signal

high T2 signal

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20
Q

CD99+ immunohistochemistry means:

A

tumor is Ewing’s sarcoma

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21
Q

Enneking / MSK Tumor Society Classification

A 
I = low grade
II = high grade
III = metastatic
A = intra-compartmental
B = extra-compartmental
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22
Q

Low grade sarcomas: (all stage I tumors)

A
  • parosteal osteosarcoma
  • well differentiated intramedullary osteosarcoma
  • intramedullary chondrosarcoma
  • chordoma
  • adamantinoma
  • secondary chondrosarcomas (MHE, Ollier’s)

Treat with wide resection alone

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23
Q

High grade sarcomas (all stage II tumors)

A
  • conventional osteosarcoma
  • Ewing’s
  • Dedifferentiated chondrosarcoma
  • Malignant fibrous histiocytoma
  • Secondary sarcomas (Paget’s, Irradiation, Bone infarc)

Treat with chemo and wide resection

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24
Q

Lesions in the tibia

A

adamantinoma
osteofibrous dysplasia
fibrous dysplasia
osteomyelitis

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25
Q

S100, CD1A immunostains

A

Langerhans cell histiocytosis (eosinophilic gran)

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26
Q

Keratin immunostain

A

Metastatic cancer

Adamantinoma

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27
Q

CD20 (b cell) immunostain

A

lymphoma

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28
Q

CD99 immunostain

A

Ewing’s

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29
Q

Keratin, S100 immunostain

A

Chordoma

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30
Q

CD138 immunostain

A

Myeloma

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31
Q

Only tumors you aspirate and inject cortisone

A

EOG

UBC

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32
Q

Tumors you curettage

A
  • giant cell tumor
  • ABC
  • NOF
  • chondroblastoma
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33
Q

Tumors that get Chemo

A
  • high grade osteosarcoma
  • Ewing’s tumor
  • Mets

any high grade tumor

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34
Q

Mechanisms of Radiation therapy

A

production of free radicals

direct genetic damage

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35
Q

Tumors treated with Bisphosphonates

A
  • Metastatic bone disease
  • Myeloma
  • Paget’s disease
  • Polyostotic fibrous dysplasia
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36
Q

When do you give a bisphosphonate holiday?

A

after 5-8 years

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37
Q

If mets distal to elbow or distal to knee we should think:

A

lung carcinoma

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38
Q

Everything malignant in bone is (MRI findings):

A

Low T1 signal

HIgh T2 signal

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39
Q

IF Hgb low and ESR high, think:

A

myeloma

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40
Q

Criteria for internal fixation of an osseous lesion

A 
>50% cortical destruction
high stress site
purely lytic pattern
weight bearing pain
pain following irradiation
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41
Q

after you prophylactically fix a metastatic lesion, you must:

A

GIVE RADIATION
- every single patient

also give denosumab or bisphosphonate

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42
Q

Bence jones proteins

A

light chains (kappa or lambda) release into the urine in multiple myeloma

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43
Q

systemic complications of myeloma:

A
  • hypercalcemia
  • nephropathy
  • anemia
44
Q

If Hgb <12 and ESR >50, think:

A

multiple myeloma

45
Q

Characteristic xray findings of lymphoma:

A

long lesions

- can involve over 50% of bone length in the appendicular skeleton

46
Q

when there is hyaline cartilage in the medullary cavity, ti is either:

A

enchondroma (not growing)

chondrosarcoma (growing)

47
Q

Common secondary sarcomas:

A
  • paget’s
  • post irradiation
  • sarcoma in a bone infarct
48
Q

Geographic pattern of Paget’s disease:

A

caucasians of Anglo-saxon descent

  • europe
  • north america
  • australia
  • new zealand
49
Q

bone disease caused by Paramyxovirus infection:

A

Paget’s disease

  • long subclinical course
  • disease localized to single organ system
  • intranuclear virus capsid-like structures

Nuclear inclusion within the osteoclasts

50
Q

Viruses implicated in Paget’s

A
  • RSV
  • Paramyxovirus
  • Canine virus (?)
51
Q

Lab findings in Paget’s

A
  • elevated serum alk phos
  • elevated urine collagen breakdown products
  • – N-telopeptide
  • – Hydroxyproline
52
Q

most common types of post-radiation sarcomas:

A
  • MFH

- osteosarcomas

53
Q

Enchondroma on MRI

A

Low T1

High T2

54
Q

Bone islands on MRI

A

Low T1

Low T2

55
Q

Osteopoikilosis

A

multiple areas of bone islands

56
Q

Most frequently presenting stage of osteosarcoma:

A

Enneking II B

57
Q

poor prognostic factors for treatment of osteosarcoma:

A
  • mets at presentation
  • skip lesions in single bone
  • post-treatment necrosis of <90%
58
Q

IF you see a young person with malignant appearing tumor with chondroid appearance on histo, think:

A

osteosarcoma
- periosteal
- parosteal
standard subtype

59
Q

Ewing’s Treatment:

A

chemo sandwich

60
Q

poor prognostic factor for Ewing’s?

A

post chemo necrosis of <95%

61
Q

Where will you see UBC?

A

proximal humerus
proximal femur

nowhere else

62
Q

Treatment of UBC in proximal humerus

A

injection of methylprednisolone

63
Q

Treatment of UBC in proximal femur

A

curettage, bone graft, internal fixation

64
Q

Histology of Osteoblastoma:

A

loose fibrovascular connective tissue with OSTEOBLASTIC RIMMING

65
Q

Most common benign tumor to go to the lungs

A

Giant cell tumor (2%)

66
Q

Recurrence rates of curettage of a UBC:

A

High - around 70% in some series

67
Q

What is responsible for low T1 and T2 signal in PVNS?

A

Hemosiderin

68
Q

When you see periarticular erosions on both sides of a jont, you should think:

A

primary synovial process

  • PVNS
  • RA
  • infection
69
Q

Rheumatoid nodules show up on:

A

extensor surfaces

70
Q

Gout crystals:

A

negatively birefringent

needle shaped

71
Q

Lymph nodes soft tissue mets:

A

CARES

  • clear cell
  • angiosarc
  • rhabdomyosarc
  • epithelioid sarc
  • synovial sarc
72
Q

Epithelioid sarcoma stains with:

A

Keratin!!!! Strongly Keratin +

73
Q

Denosumab

A
  • RANK-L monocloncal Ab

- give for myeloma or metastatic disease or osteoporosis

74
Q

Osteoblast markers

A 
Vitamin D
Osteocalcin
RANKL
Alkaline phosphatase
TGF-b
BMPs
75
Q

Osteoclast Markers

A 
RANK receptor
Acid phosophatase
Cathepsin K
Calcitonin
A/B integrin receptor
76
Q

Istotropic nature of woven bone

A

mechanical characteristics are independent of direction of loading

77
Q

In children, woven bone allows for:

A

resistance to fracture

78
Q

What kind of bone is seen in fibrous dysplasia

A

GNAS mutation

  • inability to form mature bone
  • ALL Woven Bone
79
Q

By age 2, most bone is:

A

Lamellar bone

80
Q

Anisotropic nature of lamellar bone

A

mechanical properties of bone are dependent upon directionality of loading

81
Q

Gene mutation for Melorrheostosis

82
Q

Role of TGFb and BMPS in bone formation

A

osteoclasts eliminate bone and releases TGFb and BMP

  • TGFb recruits mesenchymal stem cells
  • BMPs turn these into osteoblasts
83
Q

What are the coupling factors for bone resroption and bone creation:

A

TGF-b and BMP

84
Q

Fibro-osseous Dysplasia

A

ACVR1
shoulder contractures
shortened first rays
Mineralization of the soft tissues

DO NOT OPERATE - they turn to stone

85
Q

Overactivity of TGFb is:

A

Camarati Engelman Disease

- thicknening of the diaphyses (diaphyseal dysplasia)

86
Q

RUNX2

A

Master regulator of the osteoblast

- mutation here = Cleidocranial Dysplasi

87
Q

SOX9

A

transcription factor for cartilage

88
Q

PPAR gamma

A

transcription factor for fat

89
Q

Transcription factors for bone:

A

RUNX2

Osterix

90
Q

Sclerostin

A

secreted by osteocytes

inhibits bone formation

91
Q

high mechanical stresses will do waht to sclerostin levels?

A

will DROP sclerostin levels

- will increase if you cast someone, or otherwise unload the bones

92
Q

TRAP does what:

A

helps acidify the matrix to resorb it

93
Q

These chemical signals tell a bone to resorb:

A
  • PTH
  • Vitamin D
  • Prostaglandin E
94
Q

Bone chemical composition:

A

Ca10 P4 (6) - OH2

95
Q

What is the only collagen which mineralizes?

96
Q

What osteoblast secretion factor controls insulin secretionin the pancreas?

A

Osteocalcin

97
Q

Recommmndation of daily calcium/D supplements

A
  • 1200 mg caclcium

- 800mg D

98
Q

Female athlete triad:

A

Decreased available energy
Disturbed Menses
Decreased bone mineral density

Treatment is: make the girls eat

99
Q

3 Gene defects for osteoporisis

A
  • Vitamin D receptor
  • LDRP5
  • COL1 gene
100
Q

Inflammatory phase of fx healing: Growth Factors

A
  • PDGF
  • TGFB
  • IL1, 6
  • PGE2
101
Q

Soft Callus Phase of Fx healing: Growth Factors

A

SOX9 –> COL2

Indian Hedgehog

102
Q

Hard Callus Phase of Fx Healing: Growth Factors

A

Type X Collagen
RUNX2 –> Osteocalcin (osteoblasts)
Osteopontin

103
Q

Characteristics of secondary chondrosarcoma following an osteochondroma:

A

low grade
curable with resection alone
<1% of the time

104
Q

Workup of a bone sarcoma should include:

A

chest CT

- rarely need Abdomen or Pelvis due to extremely rare mets to viscera

105
Q

A marginal resection is defined as

A

Through the margin and reactive zone of the tumor. Or through the pseudo capsule. Microscopic disease may be found here.

Tumor (3 decks)

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