Bone and soft tissue tumors

Question 1

_ is the most common benign bone tumor; it classically presents in patients aged 10-30

Answer 1

Osteochondroma is the most common benign bone tumor; it classically presents in patients aged 10-30

Question 2

The most common tumor of the hand is a _ ; it typically presents in 20-50 year old

Answer 2

The most common tumor of the hand is an enchondroma ; it typically presents in 20-50 year old

Question 3

Osteochondroma typically occurs in [bone region]

Answer 3

Osteochondroma typically occurs in metaphysis of long bone
* Most commonly is asymptomatic but can be painful to palpation

Question 4

Enchondroma is most common in the [region] of the hand, feet, or distal femur

Answer 4

Enchondroma is most common in the medulla of the hand, feet, or distal femur
* Often asymptomatic but can cause pathologic fractures

Question 5

X-ray showing a sessile, pedunculated lesion near the metaphysis is classic for _

Answer 5

X-ray showing a sessile, pedunculated lesion near the metaphysis is classic for osteochondroma

Question 6

Enchondroma of the hand arises from _ and will present as a well-defined lucent medullary lesion

Answer 6

Enchondroma of the hand arises from hyaline cartilage and will present as a well-defined lucent medullary lesion
* Only removed if symptomatic

Question 7

Osteochondroma may be removed if symptomatic; otherwise risk is very low for transformation into _

Answer 7

Osteochondroma may be removed if symptomatic; otherwise risk is very low for transformation into chondrosarcoma

Question 8

_ is a benign bone tumor of the surface of facial and cranial bones

Answer 8

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

Question 9

Osteoma is most closely associated with [genetic syndrome]

Answer 9

Osteoma is most closely associated with gardner syndrome (variant of FAP with bone and soft tissue tumors)

Question 10

Diagnosis?

Answer 10

Osteoma

Question 11

Osteoma will most typically occur in [ages] while osteoid osteoma is most common in [ages]

Answer 11

Osteoma will most typically occur in middle age while osteoid osteoma is most common in 5-25 yo

Question 12

Bone pain that is worse at night and is relieved by NSAIDs may be suggestive of [bone tumor]

Answer 12

Bone pain that is worse at night and is relieved by NSAIDs may be suggestive of osteoid osteoma

Question 13

Osteoid osteoma is classically found in [bone region]

Answer 13

Osteoid osteoma is classically found in metaphysis and diaphysis of long bones

Question 14

Osteoid osteoma is [benign/malignant]

Answer 14

Osteoid osteoma is benign
* NSAIDs control pain, surgical removal if needed

Question 15

Diagnosis?

Answer 15

Osteoid osteoma: radiolucent osteoid core with surrounding perifocal sclerosis

Question 16

Osteoblastoma is [benign/malignant]

Answer 16

Osteoblastoma is benign

Question 17

How will osteoblastoma present?

Answer 17

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

Question 18

Osteoblastoma is most commonly in _ but may also be found in _

Answer 18

Osteoblastoma is most commonly in vertebrae but may also be found in long bone diaphysis

Question 19

Osteoblastoma is typically [larger/smaller] than osteoid osteoma and [will/will not] respond to NSAIDs

Answer 19

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

Question 20

Diagnosis?

Answer 20

Osteoblastoma

Question 21

Another name for osteoclastoma is _

Answer 21

Another name for osteoclastoma is giant cell tumor

Question 22

Giant cell tumors will typically affect [region of bone]

Answer 22

Giant cell tumors will typically affect epiphysis or metaphysis of long bones
* Most common in the knee or distal femur

Question 23

Giant cell tumors are most common in ages _ , as age increases the chance of the tumor being malignant increases

Answer 23

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

Question 24

How does giant cell tumor typically present?

Answer 24

Localized bone pain (sometimes with swelling)
* Pathologic fractures
* Decreased range of motion
* Common in knee/ distal femur

Question 25

The buzzword for giant cell tumor on X-ray is _

Answer 25

The buzzword for giant cell tumor on X-ray is **"soap-bubble" appearance** * *Will show an osteolytic multicystic lesion*

Question 26

Giant cell tumors are treated with _

Answer 26

Giant cell tumors are treated with **surgical intervention**

Question 27

Histology of giant cell tumors will reveal increased (3 cell types):

Answer 27

Histology of giant cell tumors will reveal increased.. 1. **Multinucleated giant cells** 2. **Macrophages** 3. **Stromal cells**

Question 28

Giant cell tumors have increased stromal cell activity releasing _

Answer 28

Giant cell tumors have increased stromal cell activity releasing **RANK-L** --> activates osteoclasts --> osteolytic lesion

Question 29

Osteosarcoma age distribution is _

Answer 29

Osteosarcoma age distribution is **bimodal (10-30 and > 60)**

Question 30

Osteosarcoma is a malignant bone tumor most commonly found in the [bone region]

Answer 30

Osteosarcoma is a malignant bone tumor most commonly found in the **metaphysis of long bones** * *Common to find it near the knee*

Question 31

Osteosarcoma will present with [sx]

Answer 31

Osteosarcoma will present with **localized pain that is worse at night, swelling, reduced ROM, pathologic fractures, sometimes B sx**

Question 32

Name some causes of secondary osteosarcoma:

Answer 32

Name some causes of secondary osteosarcoma: * **Paget disease** * **Radiation** * **Bony infarcts** * **Retinoblastoma** * **Li-Fraumeni syndrome** * **Increased age**

Question 33

On histology, osteosarcoma will present with [findings]

Answer 33

On histology, osteosarcoma will present with **pleomorphic osteoid producing cells** * *Aka malignant osteoblasts*

Question 34

What would you expect on serum labs with osteosarcoma?

Answer 34

High **ESR** High **LDH** High **ALP**

Question 35

[Primary/Secondary] cases of osteosarcoma have the worse prognosis

Answer 35

**Secondary** cases of osteosarcoma have the worse prognosis * *Primary cases respond to surgery and chemotherapy*

Question 36

Osteosarcoma should be treated with surgery and [chemotherapy/radiation]

Answer 36

Osteosarcoma should be treated with surgery and **chemotherapy** * *Often resistant to radiation therapy*

Question 37

(3) Classical signs of osteosarcoma on X-ray:

Answer 37

(3) Classical signs of osteosarcoma on X-ray: 1. **Sunburst pattern** 2. **Codman triangle** 3. **Osteolysis (moth-eaten appearance)**

Question 38

Codman triangle is a sign of [phenomenon] associated with osteosarcoma

Answer 38

Codman triangle is a sign of **periosteal elevation** associated with osteosarcoma

Question 39

Chondrosarcoma is a type of _

Answer 39

Chondrosarcoma is a type of **malignant bone tumor** * Made up of malignant chondrocytes (cells that make cartilage)

Question 40

Chondrosarcoma typically affects [demographic]

Answer 40

Chondrosarcoma typically affects **men > 50 years old**

Question 41

Chondrosarcoma is most commonly found in [bone region] of [bones]

Answer 41

Chondrosarcoma is most commonly found in **medullary portion** of **femur, humerus, pelvis, ribs**

Question 42

Chondrosarcoma will present with [sx]

Answer 42

Chondrosarcoma will present with **localized pain and swelling, worse at night, pathologic fractures**

Question 43

On histology, a chondrosarcoma will appear as peripheral calcification with hyaline cartilage nodules, which is [type collagen] as well as malignant chondrocytes

Answer 43

On histology, a chondrosarcoma will appear as **peripheral calcification with hyaline cartilage nodules**, which is **type II collagen** as well as **malignant chondrocytes**

Question 44

Chondrosarcomas are said to have a "moth-eaten" appearance due to _ and a "popcorn appearance" due to _

Answer 44

Chondrosarcomas are said to have a "moth-eaten" appearance due to **osteolysis** and a "popcorn appearance" due to **intralesional calcification**

Question 45

Chondrosarcoma has [prognosis] with [management]

Answer 45

Chondrosarcoma has **low metastatic potential** with **surgical excision, chemo and or radiation**

Question 46

Ewing sarcoma is [benign/malignant]

Answer 46

Ewing sarcoma is **malignant bone tumor**

Question 47

Ewing sarcoma typically affects [demographic]

Answer 47

Ewing sarcoma typically affects **young white males (10-20)**

Question 48

Ewing sarcome tends to affect [bones] or [bones]

Answer 48

Ewing sarcome tends to affect **diaphysis of long bones** or **flat bones** * *Ex: femur or pelvis*

Question 49

If the patient has localized bone pain and swelling along with B-symptoms it should raise concern for _ or _

Answer 49

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

Question 50

_ on X-ray is buzzy for Ewing sarcoma

Answer 50

**"Onion skin" appearance** on X-ray is buzzy for Ewing sarcoma * Also lytic bone lesions (moth-eaten appearance)

Question 51

Ewing sarcoma on histology will present with anaplastic cells of _ origin

Answer 51

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*

Question 52

Ewing sarcoma is associated with a chromosomal translocation, _ which leads to uncontrolled cellular proliferation

Answer 52

Ewing sarcoma is associated with a chromosomal translocation, **t(11;22)** which leads to uncontrolled cellular proliferation * **EWS-FLI1** fusion protein

Question 53

Serum labs for ewing sarcoma will show...

Answer 53

High **ESR** High **LDH** High **WBC**

Question 54

Osteosarcoma is associated with mutations in _

Answer 54

Osteosarcoma is associated with mutations in **retinoblastoma (Rb)**

Question 55

Diagnosis?

Answer 55

**Osteochondroma**

Question 56

New bone pain in a patient > 60 years old is most likely _

Answer 56

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*

Question 57

Name the common metastatic tumors to bone

Answer 57

Name the common metastatic tumors to bone: **PBKTL ("lead kettle")** * Prostate * Breast * Kidney * Thyroid * Lung

Question 58

The most common soft tissue mass in adults is _ ; the most common mass in kids is _

Answer 58

The most common soft tissue mass in adults is **lipoma** ; the most common mass in kids is **hemangioma**

Question 59

_ is defective mineralization of otherwise normal osteoid

Answer 59

**Osteomalacia/rickets** is defective mineralization of otherwise normal osteoid * *It is a qualitative issue*

Question 60

Diagnosis?

Answer 60

**Rickets**- Deficient mineralization of chondroid scaffolding leads to accumulation of hypertrophic cartilage

Question 61

Osteoporosis is a [qualitative/quantitative] issue of bone

Answer 61

Osteoporosis is a **quantitative** issue of bone * *There is normal bone mineralization but less quantity* * Decrease in the organic material of the bone (osteoid)