Bone and soft tissue tumors Flashcards
_ is the most common benign bone tumor; it classically presents in patients aged 10-30
Osteochondroma is the most common benign bone tumor; it classically presents in patients aged 10-30
The most common tumor of the hand is a _ ; it typically presents in 20-50 year old
The most common tumor of the hand is an enchondroma ; it typically presents in 20-50 year old
Osteochondroma typically occurs in [bone region]
Osteochondroma typically occurs in metaphysis of long bone
* Most commonly is asymptomatic but can be painful to palpation
Enchondroma is most common in the [region] of the hand, feet, or distal femur
Enchondroma is most common in the medulla of the hand, feet, or distal femur
* Often asymptomatic but can cause pathologic fractures
X-ray showing a sessile, pedunculated lesion near the metaphysis is classic for _
X-ray showing a sessile, pedunculated lesion near the metaphysis is classic for osteochondroma
Enchondroma of the hand arises from _ and will present as a well-defined lucent medullary lesion
Enchondroma of the hand arises from hyaline cartilage and will present as a well-defined lucent medullary lesion
* Only removed if symptomatic
Osteochondroma may be removed if symptomatic; otherwise risk is very low for transformation into _
Osteochondroma may be removed if symptomatic; otherwise risk is very low for transformation into chondrosarcoma
_ is a benign bone tumor of the surface of facial and cranial bones
Osteoma is a benign bone tumor of the surface of facial and cranial bones
* It is typically asymptomatic, surgery done if the lesion is extensive
Osteoma is most closely associated with [genetic syndrome]
Osteoma is most closely associated with gardner syndrome (variant of FAP with bone and soft tissue tumors)
Diagnosis?
Osteoma
Osteoma will most typically occur in [ages] while osteoid osteoma is most common in [ages]
Osteoma will most typically occur in middle age while osteoid osteoma is most common in 5-25 yo
Bone pain that is worse at night and is relieved by NSAIDs may be suggestive of [bone tumor]
Bone pain that is worse at night and is relieved by NSAIDs may be suggestive of osteoid osteoma
Osteoid osteoma is classically found in [bone region]
Osteoid osteoma is classically found in metaphysis and diaphysis of long bones
Osteoid osteoma is [benign/malignant]
Osteoid osteoma is benign
* NSAIDs control pain, surgical removal if needed
Diagnosis?
Osteoid osteoma: radiolucent osteoid core with surrounding perifocal sclerosis
Osteoblastoma is [benign/malignant]
Osteoblastoma is benign
How will osteoblastoma present?
Localized pain with or without swelling, typically in 10-20 year-old male
* Most commonly occur in the vertebrae and can cause neurological symptoms if nerve compression occurs
Osteoblastoma is most commonly in _ but may also be found in _
Osteoblastoma is most commonly in vertebrae but may also be found in long bone diaphysis
Osteoblastoma is typically [larger/smaller] than osteoid osteoma and [will/will not] respond to NSAIDs
Osteoblastoma is typically larger than osteoid osteoma and will not respond to NSAIDs
* Surgical removal may be necessary, remember they often involve the vertebrae and cause neurological sx
Diagnosis?
Osteoblastoma
Another name for osteoclastoma is _
Another name for osteoclastoma is giant cell tumor
Giant cell tumors will typically affect [region of bone]
Giant cell tumors will typically affect epiphysis or metaphysis of long bones
* Most common in the knee or distal femur
Giant cell tumors are most common in ages _ , as age increases the chance of the tumor being malignant increases
Giant cell tumors are most common in ages 20-40 , as age increases the chance of the tumor being malignant increases
* Most of the time they are benign
How does giant cell tumor typically present?
Localized bone pain (sometimes with swelling)
* Pathologic fractures
* Decreased range of motion
* Common in knee/ distal femur
The buzzword for giant cell tumor on X-ray is _
The buzzword for giant cell tumor on X-ray is “soap-bubble” appearance
* Will show an osteolytic multicystic lesion
Giant cell tumors are treated with _
Giant cell tumors are treated with surgical intervention
Histology of giant cell tumors will reveal increased (3 cell types):
Histology of giant cell tumors will reveal increased..
1. Multinucleated giant cells
2. Macrophages
3. Stromal cells
Giant cell tumors have increased stromal cell activity releasing _
Giant cell tumors have increased stromal cell activity releasing RANK-L –> activates osteoclasts –> osteolytic lesion
Osteosarcoma age distribution is _
Osteosarcoma age distribution is bimodal (10-30 and > 60)
Osteosarcoma is a malignant bone tumor most commonly found in the [bone region]
Osteosarcoma is a malignant bone tumor most commonly found in the metaphysis of long bones
* Common to find it near the knee
Osteosarcoma will present with [sx]
Osteosarcoma will present with localized pain that is worse at night, swelling, reduced ROM, pathologic fractures, sometimes B sx
Name some causes of secondary osteosarcoma:
Name some causes of secondary osteosarcoma:
* Paget disease
* Radiation
* Bony infarcts
* Retinoblastoma
* Li-Fraumeni syndrome
* Increased age
On histology, osteosarcoma will present with [findings]
On histology, osteosarcoma will present with pleomorphic osteoid producing cells
* Aka malignant osteoblasts
What would you expect on serum labs with osteosarcoma?
High ESR
High LDH
High ALP
[Primary/Secondary] cases of osteosarcoma have the worse prognosis
Secondary cases of osteosarcoma have the worse prognosis
* Primary cases respond to surgery and chemotherapy
Osteosarcoma should be treated with surgery and [chemotherapy/radiation]
Osteosarcoma should be treated with surgery and chemotherapy
* Often resistant to radiation therapy
(3) Classical signs of osteosarcoma on X-ray:
(3) Classical signs of osteosarcoma on X-ray:
1. Sunburst pattern
2. Codman triangle
3. Osteolysis (moth-eaten appearance)
Codman triangle is a sign of [phenomenon] associated with osteosarcoma
Codman triangle is a sign of periosteal elevation associated with osteosarcoma
Chondrosarcoma is a type of _
Chondrosarcoma is a type of malignant bone tumor
* Made up of malignant chondrocytes (cells that make cartilage)
Chondrosarcoma typically affects [demographic]
Chondrosarcoma typically affects men > 50 years old
Chondrosarcoma is most commonly found in [bone region] of [bones]
Chondrosarcoma is most commonly found in medullary portion of femur, humerus, pelvis, ribs
Chondrosarcoma will present with [sx]
Chondrosarcoma will present with localized pain and swelling, worse at night, pathologic fractures
On histology, a chondrosarcoma will appear as peripheral calcification with hyaline cartilage nodules, which is [type collagen] as well as malignant chondrocytes
On histology, a chondrosarcoma will appear as peripheral calcification with hyaline cartilage nodules, which is type II collagen as well as malignant chondrocytes
Chondrosarcomas are said to have a “moth-eaten” appearance due to _ and a “popcorn appearance” due to _
Chondrosarcomas are said to have a “moth-eaten” appearance due to osteolysis and a “popcorn appearance” due to intralesional calcification
Chondrosarcoma has [prognosis] with [management]
Chondrosarcoma has low metastatic potential with surgical excision, chemo and or radiation
Ewing sarcoma is [benign/malignant]
Ewing sarcoma is malignant bone tumor
Ewing sarcoma typically affects [demographic]
Ewing sarcoma typically affects young white males (10-20)
Ewing sarcome tends to affect [bones] or [bones]
Ewing sarcome tends to affect diaphysis of long bones or flat bones
* Ex: femur or pelvis
If the patient has localized bone pain and swelling along with B-symptoms it should raise concern for _ or _
If the patient has localized bone pain and swelling along with B-symptoms it should raise concern for osteosarcoma or Ewing
* B symptoms will not always be present
_ on X-ray is buzzy for Ewing sarcoma
“Onion skin” appearance on X-ray is buzzy for Ewing sarcoma
* Also lytic bone lesions (moth-eaten appearance)
Ewing sarcoma on histology will present with anaplastic cells of _ origin
Ewing sarcoma on histology will present with anaplastic cells of neuroectodermal (mesenchymal) origin
* Will see lots of small blue cells so must differentiate from lymphocytes seen in lymphoma or osteomyelitis
Ewing sarcoma is associated with a chromosomal translocation, _ which leads to uncontrolled cellular proliferation
Ewing sarcoma is associated with a chromosomal translocation, t(11;22) which leads to uncontrolled cellular proliferation
* EWS-FLI1 fusion protein
Serum labs for ewing sarcoma will show…
High ESR
High LDH
High WBC
Osteosarcoma is associated with mutations in _
Osteosarcoma is associated with mutations in retinoblastoma (Rb)
Diagnosis?
Osteochondroma
New bone pain in a patient > 60 years old is most likely _
New bone pain in a patient > 60 years old is most likely metastatic disease
* In this population, primary bone tumors are less likely to occur
Name the common metastatic tumors to bone
Name the common metastatic tumors to bone: PBKTL (“lead kettle”)
* Prostate
* Breast
* Kidney
* Thyroid
* Lung
The most common soft tissue mass in adults is _ ; the most common mass in kids is _
The most common soft tissue mass in adults is lipoma ; the most common mass in kids is hemangioma
_ is defective mineralization of otherwise normal osteoid
Osteomalacia/rickets is defective mineralization of otherwise normal osteoid
* It is a qualitative issue
Diagnosis?
Rickets- Deficient mineralization of chondroid scaffolding leads to accumulation of hypertrophic cartilage
Osteoporosis is a [qualitative/quantitative] issue of bone
Osteoporosis is a quantitative issue of bone
* There is normal bone mineralization but less quantity
* Decrease in the organic material of the bone (osteoid)
