Bone, Cartilage and Soft tissue tumors: Clinical Correlations Flashcards
Examples of common bone lesions.
Metstatic carcinoma
Multiple myeloma
Lymphoma of bone
Osteosarcoma
Ewing sarcoma
Unicameral bone cyst (UBC)
Aneurysmal bone cyst (ABC)
Enchondroma
Osteochondroma
Chondrosarcoma
Examples of soft tissue lesions.
Lipoma
Desmoid
Soft tissue sarcoma
Lymphoma
What are some tests/imaging that are helpful for staging a bone lesion?
- X-ray of entire affected bone
- Whole body bone scan (or skeletal survey – multiple myeloma)
- CT scan of chest, abdomen and pelvis OR PET/CT
- Serum protein electrophoresis/Urine Protein Electrophoresis/Serum free light chains–multiple myeloma or plasmacytoma [don’t forget about labs!!]
- Prostatic specific antigen (for prostate adenocarcinoma)
What is multiple myeloma?
A common lymphoid malignancy – sheets of plasma cells with atypical cell features
When does multiple myeloma present in individuals?
Median age is 70 yo
What part of the bone does multiple myeloma affect?
Principally invovles bone marrow and causes lytic lesions throughout the skeleton (most commonly vertebrae, ribs, skull, pelvis, femur, clavicle, and scapula)
Results in “pathological fractures”
Why does multiple myeloma do what it does?
Cells produce a monoclonal immunoglobulin, most often IgG.
What marker identifies B cells?
CD20
Neoplasms composed of lymphocytes resembling a normal stage of differentiation
Lymphomas
Most common type of lymphoma in adults, derived from clonal B cells
B-cell lymphomas
What happens if a soft tissue biopsy results shows glands?
Probably a metastatic (ie lung) cancer – primary soft tissue cancers do not show this
Most common type of lung cancer in woman and nonsmokers
Metastases early (to bone, brain, and liver)
Lung adenocarcinomas
What is the biological marker that is positive in adenocarcinomas arising in the lungs?
TTF1
What is a potential cause of unicameral bone cysts?
Increased intraosseous pressure
Are unicameral bone cysts benign or malignant?
Benign
What ages do unicameral bone cysts affect? And where do they present in bone?
Children and young adults
Metaphyseal region of long bones
Usually proximal femur or humerus
Present as pathological fracture
How do unicameral bone cysts occur? What do they look like pathologically?
Bone cortex is eroded by the cyst and elicits secondary periosteal new bone formation
Pathology: cyst filled wtih clear fluid and lined with thin fibrous membrane; because of frequent fractures old blood (hemosiderin) and granulation tissue may be present
How do they treat UBC?
Aspirate inject into them, suck out and put in steriods or Ca/PO4 matrix
What are aneurysmal bone cysts (ABC)?
Eccentric solitary expansile lesion
Benign neoplasm with characteristic translocation
How do ABC’s present? Where do they commonly occur?
Swelling, pain and tenderness
Occur in metaphyseal region of long bones – but any bone may be involved
What do ABC’s look like pathologically?
Cystic spaces filled with blood but no endothelial cell lining
Between the blood filled speaces are fibrous septa, giant cells and immature bone or osteoid
How are aneurysmal bone cysts treated?
Embolization/sclerotherapy
When should you NOT try to remove “lipomas” in clinic?
Bigger than 3 cm or deep mass – get an MRI
Lipoma
A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure. It’s doughy to touch and usually not tender. You may have more than one lipoma. Lipomas can occur at any age, but they’re most often detected during middle age.
(Thanks Mayo Clinic)
Desmoid Fibromatosis
Cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body.
Desmoid tumors often appear as infiltrative, usually well-differentiated, firm overgrowths of fibrous tissue, and they are locally aggressive.
(Thanks MedScape)
Soft Tissue Sarcoma
Cancerous (malignant) tumors that originate in the soft tissues of your body. The soft tissues include muscle, fat, blood vessels, nerves, tendons and the lining of your joints (synovial tissues).
(Thanks Mayo Clinic)
How are chondrosarcoma’s graded?
Grades 1 - 3
What are some take home points about biopsy?
- Location determined by person doing definitive surgery
- Avoid contaminating compartments
- Assume a sarcoma if isolated disease
- Communicate with pathologist
