Bone Cancer & Soft Tissue Tumors Flashcards
Bone Tumors
overview (blastic v lytic)
how are they typically found
Overview
- bone tumors: majority are benign
- blastic lesion: built-up/overgrowth = appear radiodense (white) on xray
- lytic lesions: breakdown of bone = appear radioopaque (dark)
- most often determined if benign or cancerous on xray: but biopsy can be needed
Typically found
- incidental finding
- pt. symptomatic and imaging done
- bone lesions found during survellience of malignant disease
Characterisitcs of bengign v malignant lesions on bone
Benign
- pain exacerbated with activity
- no constitutional symptoms
- can have pathologic fractures
- incidentally found
Malignant
- alwasy consider malignacy in 40+
- dull, achy pain that progresses overtime
- pathologica fractures
- soft tissue masses accompanying
- constitutional symptoms (MM, lymphoma, mets of other cancers)
How will benign v malignant look on x-ray
x-ray plains are highly suggestive of diagnosing tumor
Benign
- well-defined
- nonaggressive in growth
- no cortical destruction or periosteal reaction
Malignant
- lytic lesions (darker)
- destructive
- ill-defined boarders & aggressive
- moth-eaten
- cortical destrcution: weak
- periosteal reaction
when is xray good
MRI
CT
Bone Scan
bone biopsy
for bone tumors
X-ray is usually good enough to dx.
CT: better at looking at bone detail
MRI: good for soft tissue and marrow infiltration
Bone Scan: to see trauma, tumor or infection but doesnt destinguish which is which
Bone Biopsy
- done under local anesthesia: or conscious sedation
- rarely done open in the OR
- ortho surgeon decides: its a CT guided procedure
Osteochondroma (Benign)
Etiology
Etiology
- most common benign tumor; cartilage forming
- when a piece of growth plate cartilage separates and herniates through periosteal bone at the growth plate; creates cartialge cap mushroom shape
- increased incidence with radiation/trauma
- can grow & then involute when child reaches skeletal maturity
Presentation
- asymptomatic mostly; found incidentally
- pain & swelling are MC symptoms
- visable deformity possibel
- neurovascualr impigment (common at femer: lumabr spinal nerves)
- pathologic fractures
- common in long bones around the knee
Osteochonroma
Diagnosis
Treatment
Diagnosis
- X-ray findings : cartilagous cap on tumor
- typically in the metaphysis & grow AWAY from the nearest joint space
- biopsy not needed
Lab Testing
- can do genetics if concerned for Trevor disase or have multiple osteochrondromas
Management
- serial xray monitoring
- larger/symptomatic tumors = surgery
- surgery if complications like….
- fractures at stalk
- blood vessel displacement
- compression of nerves
- bursa formation and pain
Rare but could transform to chrondrosarcoma (or osteosarcoma at base of stalk/where its bone)
rapid, painful and cap > 2cm = risk of cancer
Giant Cell Tumor (benign)
Etiology
Etiology
- females: becuase growth during pregnancy or OCP use
- typically: after skeletal maturity
- if locally aggressive: cortical thinning and remodeling bone is possible
Symptoms
- loacl pain - relieved with rest
- palpable mass
- joint stiffness/effusion if near one
- neruo sz. if spinal lesions & pathologic fractures (rarely)
Where
- Distal Femur (MC)
- proximal tibia
- distal radius
- sacrum
- proximal humerus
- MOST are near knee
Giant Cell Tumor
Diagnosis
Treatment
risk of malignancy
Diagnosis (benign)
x-ray: see well-defined lytic/cystic lesion with eccentric growth (circular)
typically in epiphysis
CT: can help assess margins of the tumor and if its effecting cortical bone
MRI: can show margins at the most detail; but not helpful for cortical bone
biopsy: not helpful: showing giant cells
Treatment
- bone curettage/scraping & filling in defect with filler or graft : wont come back if good margins (but might impact limb function)
- reduce recurrance: use polymethacrylate to fill
- argon based cryotherapy
- sclerosing (zinc, nitrogen) agents
- oral bisphosphonates (help repair?)
Malignancy Risk
- low; but does have an ability to spread to lungs (not considered mets tho?)
Osteoblastoma (Benign)
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- bone forming tumor (benign)
Symptoms
- dull, achy pain NOT relieved with NSAIDS
- affects spine and pelvic girdle
- can have neurologic or scolosis (late in life)
Diagnosis
- imaging is variable : bone biopsy is often needed
- looks malignant because it grows fast and destroys: but isnt
- MRI helpful in spine
Management
- radiofrequency ablation, cryo or laser
- surgical resection if lesion doesnt respond
- recurrance rate is high
RARE risk of malignancy
Osteoid Osteoma (benign)
Etiology
-Symptoms
Etiology
- benign, bone forming tumor
Symptoms
- pain with pain worsening at night
- relieved by NSAIDS
- in lg:femur or tibia
- in spine: scoliosis late in life
Diagnosis
- Xray: shows radiolucent: darker area in cortex; small < 1.5 cm
- mostly in shaft of long bone
Management
- percut. radiofrequency, thermal or laser
- recurrance possible if not all zapped originall
will NOt become sarcomas: rarely aggressive osteoblastoma
Aneurysmal Bone Cyst (Benging)
Etiolgy
Etiology
- blood-filled multiloculated cavities containting osteoclasts, giatn cells and reactive woven bone
- can be a result of prior trauma, prior giant cell tumors or genetic
- mostly in femer, tiibia, humerus or fibula
Symptoms
- stiffness, swelling & pain
- limited ROM if near a joint
- nero symptoms if in spine
Diagnosis
- Xray: eccentric lesions lytic with thin cortex
- soap bubble appearance
- CT: shows more detail about margins and fluid
- MRI more detail about seta and hemorrhage
- incisional biopsy is recommented to diagnose
Treatment
- curettage with or without grafting
- then sclerotherapy
Rare risk of malignancy: higher if radiation expsoure
Fiberous Dysplasia (Benign)
etiology
Symptoms
diagnosis
Treatment
Etiology
- bone forming tumor
- due to gene mutations
- monostotic ( 1bone)
- polystotic (multiple) mcCune Albright syndrome
Symptoms
- asymtompatic
- some ahve dull, achy pain
- estorgen sensitive: pregancy and menstral cycle related
- swelling, deformities or fracutres
Diagnosis
- Xray: show darker radiolucent areas with ground glass appearance overtime
- in femur, tibia, skull or facial bones (facial and ribes = monostatic)
- MRI: help deliate boarders
Treatment
- monitor with xrays
- diet and exercise for good bone health
- bisphosphates or densumab
- pregab. for pain
- can curettage
history or radition increase risk of becoming malignant
Enchondroma (benign)
Etiology
Symptoms
Etiology
- cartilage forming tumor
Symptoms
- incidental on th etubualr long bones, hands and feet
- pathologic fractures
Diagnosis
- Xrays: rings and arcs in the lesion show layering of minerals
- may need MRI
Simple bone Cyst (Benign)
Etiology
- a true bone cyst: fluid filled and surrounded by mesothial cells
Symptoms
- mostly incidental findings
- pain or pathologic fracture
- kids = proximal humerus or femur
Diangosis
- xrays are used : clean margins no bubbles
- CT/MRI for detail
Treatment
- if low risk for fracture: conservative with mointoring xrays
- injection of steroids into cyst
- cuterrage and fill
- placement with nails has 100% heal rate
very rare to malignancy
Enostosis
bone islands
- benign bone tuors forming in axial skeleton and metaphysis of long bones
dx via xray seeing small oval lesions with spiculated margins
if increasing siz or painful, reevaluate for cancer
no treatment needed
NOT risk for cancer
