Bone and Soft Tissue Tumors

Question 1

What are the 18 and 2* ossification centers?

Answer 1

metaphysis and epiphysis

Question 2

What are the 4 adult soft tissue sarcomas?

Answer 2

UPS/MFH
liposarcoma
leiomyosarcoma
angiosarcoma

Question 3

What are the 3 soft tissue tumors of children? How do they metastasize?

Answer 3

rhabdomyosarcoma
synovial sarcoma
epithelioid sarcoma

Question 4

How are benign soft tissue tumors characterized?

Answer 4

small, slow growing, well-circumscribed and homogenous surface

Question 5

How are malignant soft tissue tumors classified?

Answer 5

large, hemorrhagic, necrotic, rapid growing, poorly cirumscribed, heterogenous surface

Question 6

What are the prognostic factors for soft tissue tumors?

Answer 6

stage- most important
grade
size
location- superficial and peripheral are better than deep and central

Question 7

What does the prognostic factor of grade indicate?

Answer 7

degree of differentiation

low-> high determined by amt of mitosis, cellularity, pleomorphism, necrosis

Question 8

What is the histological appearance of low grade vs high grade fibrosarcoma?

Answer 8

low: elongated spindle cells, fat, pink collagen, limited mitosis and no necrosis
high: hypercellularity, mitotic figures, unorganized

Question 9

What are the common routes of metastasis for soft tissue sarcoma?

Answer 9

lung via blood

lymphatics

Question 10

What are the treatments for soft tissue sarcomas?

Answer 10

radiation
surgery
chemotherapy- only for some pediatric cases usually

Question 11

What are the 3 most common soft tissue tumors?

Answer 11

MFH
liposarcoma
synovial sarcoma

Question 12

What are some differential diagnoses for small round blue cell tumors in bone?

Answer 12

Ewings, osteosarcoma, lymphoma/leukemia, neuroblastoma, chondrosarcoma

Question 13

What are some of the differential diagnosis for small round blue cell tumors of soft tissue?

Answer 13

Ewings, rhabdomyosarcoma, round cell liposarcoma, mesenchymal chondrosarcoma, synovial sarcoma

Question 14

If you suspect a bone tumor in an adult, what is the generalization until proven otherwise?

Answer 14

MM or metastatic disease

Question 15

What is the treatment for osteosarcoma?

Answer 15

pre-op chemo, surgery resection, post-op chemo

Question 16

what is the treatment for Ewings?

Answer 16

chemo, possibly: surgery resection, radiation

Question 17

What are the primary sites for skeletal metastases?
Osteoblastic? *
Osteolytic?

Answer 17

PTBLK- adults
prostate*, thyroid, breast, lung, kidney
children- neuroblastoma and wilms tumor

Question 18

Which bones are commonly metastasized too first?

Answer 18

skull, vertebrae, pelvis

tubular bones are more rarely met to.

Question 19

What are the clinical manifestations of bone mets?

Answer 19

pain, pathological fractures and marrow dysfunction

Question 20

Giant cell tumors most commonly occur where, what ages and gender?

Answer 20

males/females, 30s, knee/wrist

Question 21

Osteosarcoma is characterized by what?

Answer 21

malignant tumor of direct bone/osteiod formation by proliferating tumor cells

Question 22

What is the radiographic presentation of osteosarcoma?

Answer 22

fluffy osteoid, codman’s triangle, and cortical destruction mass

Question 23

How is chondrosarcoma characterised? Radiographic presentation?

Answer 23

men, 50s, knee/hip
popcorn/smoke ring appearance on xray
Bx: see cartilage on bone bx of adult (not nl)

Question 24

What is the epidemiology of ewings sarcoma?

Answer 24

boys, 10-12 yrs, white, femur/hip, chromosomal abl of t(11;22)

Question 25

What is the clinical differential diagnosis of bone tumor with potential Ewings?

Answer 25

Osteomyelitis v tumor-Ewings Sarcoma

Question 26

What is the radiographical appearance of Ewing’s Sarcoma?

Answer 26

onion-skinning periosteal reaction, permeative destruction, diphyseal

soft tissue mass on CT and MRI