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Tumors > bone/cartilage tumors > Flashcards

bone/cartilage tumors Flashcards

1
Q

location of OB

A

flat bones/vertebra (posterior elements)

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2
Q

bone location of OB

A

75% D, then M

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3
Q

description of OB

A

bubbly lytic lesion with reactive sclerosis, round/oval, w/ or w/o expansions, cortical thinning, possible ca++ and ST mass

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4
Q

bone scan for OB

A

increased uptake

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5
Q

bone scan OO

A

double density sign

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6
Q

describe OF

A

well circumscribed, lobulated/bubbly expansile, osteolytic/ground glass
ca++ is curvilinear/spheroidal

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7
Q

location of OF

A

90% tibia

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8
Q

bone location OF

A

mid-D

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9
Q

MRI of OF

A

low T1; iso-high T2

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10
Q

2nd OS from…

A

Paget’s, extensive bone infarcts, post radiation, OC, and OB

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11
Q

Osteoma location

A

skull 9paranasal sinus, vault)

mid clavicle, mandible, maxilla

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12
Q

age osteoma

A

40-60 yo

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13
Q

MC sinus osteoma

A

frontal 80%

sphenoid very rare

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14
Q

rad features osteoma

A

well defined single or multiple dense foci, smooth - no lobulations

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15
Q

MR osteoma

A

low T1-T2

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16
Q

CT osteoma

A

variable density/ground glass app

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17
Q

bone scan osteoma

A

no uptake

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18
Q

Gardners syndrome triad

A

colonic polyposis, osteomatosis, and ST tumors

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19
Q

enostoma rad features

A

accumulation of dense bone in medullary cavity
single or multiple - uniform sclerotic foci w/ discreet margins
thorny/radiating spicules = brush border app

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20
Q

typical size of enostoma

A

<1 cm but can grow slowly

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21
Q

MRI enostoma

A

low on all

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22
Q

bone scan enostoma

A

usually no uptake, occasionally can be some

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23
Q

when to biopsy enostoma

A

if size increase 50% in one year or 25% in size years

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24
Q

DDX enostoma

A

blastic mets, osteoma, OO, enchondroma, bone infarct, FD, osteopoikilosis

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25
Q

does osteopoikilosis have malignant degeneration

A

NO

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26
Q

osteopathia straita AKA

A

Voorhoeve’s disease

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27
Q

osteopathia striata description

A 
benign dysplasia of bone 
E/M of tubular bones
bilateral
celery stalk metaphysis 
DDX: congenital infections (rubella/syphillis/cytomegalovirus)
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28
Q

OO description

A

blastic tumor w/ central core of vascular osteoid surrounded by reactive sclerosis

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29
Q

age of OO

A

7-25 yo = adolescents

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30
Q

size of OO

A

<1 cm; no more than 2 cm

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31
Q

location of OO

A

femur then tibia = 50-60% = LE
diaphysis; E rare
posterior elements/pedicle of l/s; concave side of scoliosis

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32
Q

pathophysiology of OO

A

nidus contains prostaglandins

similar to OB

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33
Q

periosteal rxn w/ OO

A

solid

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34
Q

small bones of hand/ft w/ OO

A

can have prominent ST swelling

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35
Q

bone scan OO

A

double density sign

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36
Q

choice of advanced imaging w/ OO

A

CT

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37
Q

average time of resolution w/ OO

A

33 months; may heal spontaneously

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38
Q

DDX OO

A

OB, Brodie’s abscess, stress fx

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39
Q

malignant transformation OO

A

NO

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40
Q

age conventional OB

A

<30 yo

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41
Q

MR for OB

A 
may simulate malignancy
can have fluid levels
hypointense T1/2 w/ decreased intensity = calcific foci
FLARE phenomenon
enhances w/ contrast
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42
Q

OB recurrence

A

10% if incomplete excision

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43
Q

aggressive OB hallmark

A

eosinophilic granuloma = epithelia OB w/ atypical nuclei

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44
Q

recurrent tumors w/ aggressive OB

A

more aggressive

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45
Q

DDX of aggressive OB

A

conventional OB

OS

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46
Q

AKA of OF in tubular bones

A

osteofibrous dysplasia

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47
Q

AKA of OF in facial bones

A

cement ossifying fibroma or psammamatous OF or juvenile active OF

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48
Q

OF location

A

most in facial bones

mandible > maxilla

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49
Q

OF age

A

2-4th

FEMALES

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50
Q

OF MC…

A

painless expansile lesion of tooth bearing region of mandible

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51
Q

OF in tubular bones location

A

tib/fib
middle 1/3 diaphysis
tibia = 90%

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52
Q

osteofibrous dysplasia leads too..

A

painless enlargement and bowing of bone

ANT/ANT-LAT portion

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53
Q

OF dysplasia/OF of long bone assoc….

A

maybe adamantinoma

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54
Q

pathology for OF dysplasia

A

cytokeratin-positive cells

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55
Q

pathology for OF of jaw

A

psammomatous calcification

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56
Q

OF vs FD

A

FD not as amenable to excision - OF well demarcated and easily removed

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57
Q

OF rad appearance

A

well circumscribed, slow growing uni/multilocular osteolytic lesions
expansile
calcifications - curvilinear, spheroidal
sclerosis/ground glass

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58
Q

OF long bone location

A

mid-diaphysis esp anteriorly

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59
Q

OF MRI

A

low T1, iso high T2; enhancement w/ T1 contrast

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60
Q

OF MRI mandible

A

intermediate to high signal T1/T2 - no ST or cortical destruction

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61
Q

prognosis of OF

A

tends to regress if >10 yo

surgery if large/aggressive

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62
Q

malignancy with OF

A

none

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63
Q

recurrence of OF

A

high w/ curettage and bone grafting > 60%

can appear aggressive; may have components of adamantinoma

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64
Q

DDX OF

A

FD - no osteoblastic rimming
adamantinoma - usually larger, older age
well diff intraosseous OS
EG, infection, gnathic OS, denticious cyst

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65
Q

primary OS age

A

10-20 yo; males

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66
Q

secondary OS age

A

elderly - 2nd to malignant degeneration of pagers, bone infarcts, post-radiotherapy, osteochondroma, or OB

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67
Q

OS makes up what % of primary bone tumors

A

20

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68
Q

age for OS

A

10-25

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69
Q

OS is MC…

A

bone tumor in children/adolescents

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70
Q

symptoms of OS

A

pain, swelling, decreased ROM, warmth, pyrexia

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71
Q

location of OS

A

80% in tubular bones
femur - 40%; tibia 16%, humerus 15%
50-75% around knee

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72
Q

bone location of OS

A

metaphyseal; 2-11% diaphyseal
abut open physeal plate in children
if epiphyseal (rare) = femoral condyles

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73
Q

path OS

A

mostly osteoblastic, chondroblastic, and fibroblastic

hemorrhage - cyst like spaces similar to ABC

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74
Q

skip mets occurs in % of OS

A

25

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75
Q

rad appearance OS

A 
Mixed MC (resnick); variable appearance 
ill defined cumulous cloud; medullary plastic
bone distraction w/ ST mass
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76
Q

periosteal rxn OS

A

codman’s triangle and sunburst; lamellated less often

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77
Q

bone scan OS

A

helpful to find mets

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78
Q

MR OS

A

low T1, high T2 - enhances w/ gad

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79
Q

tx OS

A

surgery, chemo, radiotherapy

amputation

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80
Q

mets of OS

A

lung (cannonball mets) - can calcify

then bone and regional LN

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81
Q

GOS location

A

mandible > maxilla (entire/partial pacification of maxillary sinus is common)
-alveolar ridge and antrum

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82
Q

GOS age

A

30yo (older than conventional); M

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83
Q

mets w/ GOS

A

decreased tendency

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84
Q

GOS rad appearance

A 
variable; may have matrix ca++
intramedullary extension (diff from osteoma) 
ST/cortical involvement
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85
Q

TOS features

A

large cystic cavities w/ fresh/clotted blood; uncommon - 11% of OS

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86
Q

TOS location

A

tubular bones - F>T>H

MC around knee

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87
Q

histologically TOS

A

resembles ABC

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88
Q

rate of path fx w/ TOS

A

25-30% = high

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89
Q

TOS rad app

A

lytic expansile - large multilocular/pseudocystic lacking periosteal rxn
can be well defined

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90
Q

bone location TOS

A

metaphyseal w/ ext to D or E

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91
Q

bone scan TOS

A

DOUGHNUT SIGN - central photopenia w/ peripheral increased uptake

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92
Q

lesions w/ doughnut sign

A

TOS, ABC, GCT, and SBC

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93
Q

MRI TOS

A

fluid fluid levels
hemorrhage shows increased T1 and variable T2
(high signal d/t methemoglobin)

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94
Q

CT TOS

A

low attenuating fluid-fluid levels

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95
Q

DDX of TOS

A

ABC
GCT
angiosarcoma

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96
Q

SCOS features

A

resembles Ewing’s
lace-like osteoid pattern
may have periodic acid-Schiff rxn

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97
Q

age SCOS

A

2-4th (may have small children or elderly)

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98
Q

location SCOS

A

F>T>H>ilium

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99
Q

SCOS rad app

A

large mostly lytic lesion - medullary and cortical bone

50% have periostitis/ST mass

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100
Q

bone location SCOS

A

E and M

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101
Q

prognosis of SCOS

A

worse than conventional - most die w/in 1 yr

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102
Q

intraosseous low grade/well diff OS age

A

higher age group - ave 33 yrs; FEMALE

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103
Q

intraosseous low grade/well diff OS location

A

distal femur 50%, prox tibia = KNEE

can occur in cloves = DDX chordoma

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104
Q

histologically intraosseous low grade/well diff OS

A

resembles parosteal OS and FD

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105
Q

intraosseous low grade/well diff OS rad appearance

A

large lesion can be purely sclerotic or mixed

  • can lack aggressive features
  • altered trabeculations
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106
Q

bone location intraosseous low grade/well diff OS

A

metaphysis

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107
Q

DDX intraosseous low grade/well diff OS

A

FD, NOF, CMF

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108
Q

prognosis intraosseous low grade/well diff OS

A

better than conventional = 90-100% survival

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109
Q

recurrence intraosseous low grade/well diff OS

A

occurs w/ inadequate removal at higher grade

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110
Q

intracortical OS features

A

rarest!!

can be early manifestation of conventional/periosteal OS

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111
Q

age intracortical OS

A

found adults

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112
Q

bone location intracortical OS

A

diaphysis

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113
Q

location intracortical OS

A

tibia or femur

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114
Q

rad appearance intracortical OS

A

w/in cortex as lytic lesion w/ surrounding sclerosis but without radiating osseous spicules
eccentric
can have multiple calcific foci

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115
Q

ST involvement intracortical OS

A

rare at initial time of diagnosis

**no medullary or ST involvement (possibly later stages)

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116
Q

DDX intracortical OS

A

OO
FD
OB
intracortical abscess

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117
Q

surface high grade (conv) OS age

A

2-3rd; F=M

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118
Q

surface high grade (conv) OS location

A

tubular boes

MC femur

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119
Q

bone location surface high grade (conv) OS

A

diaphyseal

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120
Q

histologically surface high grade (conv) OS

A

same as conventional - only diff is localization to surface of bone

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121
Q

rad appearance surface high grade (conv) OS

A

may resemble periosteal OS
broad based partially/completely ossified lesion from external surface of bone
cortical bone destruction

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122
Q

surface high grade (conv) OS prognosis

A

equal to conventional high grade

worse than per/parosteal

123
Q

periosteal OS features

A

from deep layer of periosteum

2ND MC juxtacortical OS

124
Q

age periosteal OS

A

2-3rd

125
Q

location periosteal OS

A

long tubular bones

126
Q

bone location periosteal OS

A

diaphysis

127
Q

femur location periosteal OS

A

anterior lat/med

128
Q

femur location parosteal OS

A

posterior

129
Q

rad appearance periosteal OS

A

thick/irregular cortex, radiating spicules into ST

non-homogenous spiculated matrix

130
Q

medullary cavity w/ periosteal OS

A

UNINVOLVED (rare exception)

131
Q

periosteal rx periosteal OS

A

codman’s or sunburst

132
Q

MRI periosteal OS

A

hypointense T1 and T2

can see bony spicules radiating from surface

133
Q

DDX on MRI periosteal OS and conventional

A

conventional typically involves entire circumference of cortex and intramedullary expansion

134
Q

prognosis periosteal OS

A

better than conventional

poorer than parosteal

135
Q

features of parosteal OS

A

arises from outer fibrous layers of periosteum

MC form originating from surface of a bone

136
Q

recurrence/mets of periosteal OS

A

occur if inadequate resection

137
Q

age parosteal OS

A

2-5th

**higher age group

138
Q

location parosteal OS

A

long bones - femur 65, humerus 15, tibia 10

around knee = 70%

139
Q

rad appearance parosteal OS

A

large radio dense, oval/spheroid mass w/ smooth lobulated/irregular margins
sessile, can have cleavage plane

140
Q

bone location parosteal OS

A

metaphyseal, less common E

D is distinctly uncommon

141
Q

String sign

A

seen in 30% of parosteal OS

thin radiolucent line separating tumor from cortex

142
Q

ossification of parosteal OS

A

from base to periphery

MO is opposite*

143
Q

periostitis w/ parosteal OS

A

often absent

144
Q

DDX parosteal OS

A 
HO
sessile OC
periosteal OS
high grade OS
CS
145
Q

prognosis parosteal OS

A

dedifferentiated parosteal OS can develop from low grade –> high grade mesenchymal component 20-25%

146
Q

multi centric OS features

A

more than one skeletal site

147
Q

simultaneous multi centric OS

A

rare, mostly children, poor prognosis

148
Q

metachronous multi centric OS

A

adolescents/young adults
asymmetric
one or more tumors develop after initial tx of primary OS (could be late mets)

149
Q

unicentric w/ met multi centric OS

A

skip/transarticular bony mets w or w/ pulmonary mets

spine and pelvic bones

150
Q

enchondroma def

A

benign; dev in medullary cavity and composed of lobules of hyaline cartilage

151
Q

age enchondroma

A

20-40 yo

M=F

152
Q

enchondroma asymptomatic unless…

A

path fx or malignant degeneration

153
Q

enchondroma MC…

A

benign tumor of hands/feet

154
Q

MC phalange for enchondroma

A

5th finger

155
Q

location enchondroma

A

proximal phalanges, metacarpal, middle phalanx, terminal phalanx

156
Q

% enchondroma tubular bones

A

25%, UE

humerus, femur, tib

157
Q

bone location enchondroma

A

M of LB; D of hands/ft

158
Q

malignant degeneration of enchondroma

A

<1%

159
Q

rad appearance enchondroma

A

well defined lucent lesion (bubbly/lobulated)
endosteal scalloping
50% matrix ca++ (punctate, stippled, rings/arcs, flocculent)

160
Q

enchondroma protuberans

A

expansile - exophytic growth through cortex

rare

161
Q

enchondroma MR

A

low T1; high T2

calcific foci are low signal

162
Q

DDX enchondroma

A

ICE

163
Q

difference of enchondroma from low grade chondrosarc

A 
endosteal scalloping >2/3 of cortical thickness in >2/3 of the lesion
epiphyseal 
>5 cm
older age
painful in absence of fx
164
Q

ollier’s ds bilateral or unilateral?

A

often unilateral

165
Q

age ollier’s ds

A

1st decade

166
Q

ollier’s ds deformity of wrist

A

madelung’s

167
Q

location ollier’s ds

A

tibia, femur, fib

168
Q

MC location for path fx of ollier’s ds in children

A

femur

169
Q

adult risk of malignant degeneration w/ ollier’s ds

A

5-30%

mostly to CS (could also be dedeff CS, OS, or chondroid chordoma)

170
Q

lesions do or do not grow after skeletally mature w/ ollier’s ds…

A

NO

171
Q

type of dysplasia of Maffucci’s syndrome

A

mesodermal

172
Q

describe Maffucci’s syndrome

A

enchondromatosis+ ST vascular tumors (hemangioma) - look like phleboliths on film

173
Q

malignant degeneration w/ Maffucci’s syndrome

A

25-50%

-mostly to CS, usually after 40 yo

174
Q

age Maffucci’s syndrome

A

1st decade

175
Q

type of hemangiomas w/ Maffucci’s syndrome

A

cavernous/capillary

176
Q

location HME

A

almost all cases have exostoses around the knee

-more likely to involve scapula too

177
Q

subungual exostosis location

A

distal phalanx beneath or adjacent to nail bed
great toe in 70-80% - pt usually has hx of trauma/infection
thumb/index finger

178
Q

what portion of phalanx typically involved w/ subungual exostosis

A

dorsal or dorsomedial aspect of distal portion of phalanx

179
Q

size of subungual exostosis

A

approx 1 cm

180
Q

features of subungual exostosis

A

fibrocartilage cap

lack clear contiguity w/ medullary cavity and cortex (different than OC)

181
Q

Nora’s lesion AKA

A

bizarre parosteal osteochondromatous proliferation = BPOP

182
Q

Turret exostosis AKA

A

acquired OC

183
Q

location Turret exostosis

A

dorsal surface of proximal or middle phalanx

  • palmer thumb
  • not common in metatarsals or phalanges of foot
184
Q

history w/ Turret exostosis

A

trauma or puncture wound

185
Q

Turret exostosis is likely…

A

ossifying subperiosteal hematoma

–> arising from reactive periosteum following trauma

186
Q

clinical findings Turret exostosis

A

loss of flexion of digit

pain, ST swelling, cosmetic deformity

187
Q

Trevor’s Disease AKA

A

dysplasia epiphysealis hemimelica

188
Q

age Trevor’s Disease

A

children and young adults

189
Q

clinical features Trevor’s Disease

A

swelling - less likely pain and deformity
one side of body
LE

190
Q

location Trevor’s Disease

A

talus, distal femur, tibia

191
Q

Trevor’s Disease distribution

A

commonly multiple bones in single extremity in 60-70%

192
Q

bone location Trevor’s Disease

A

one side of epiphysis

Medial 2:1

193
Q

forms of Trevor’s Disease

A

monostotic
classic = multiple bones in single extremity
generalized/severe = entire extremity

194
Q

rad appearance Trevor’s Disease

A

irregular ossifications
adjacent metaphysis may be wide
joint may be widened

195
Q

location Maffucci’s Syndrome

A

50% unilateral

metacarpals and phalanges of hand

196
Q

complications Maffucci’s Syndrome

A

deformities, malignant transformation

197
Q

malignant transformation Maffucci’s Syndrome

A

20-50 % to CS usually after 40 yo

-or hemangiosarc, lymphangiosarc, and fibrosarc

198
Q

development of periosteal (juxtacortical) chondroma

A

develops adjacent to cortical surface; beneath periosteal membrane

199
Q

age periosteal chondroma

A

<30yo

most 2nd decade

200
Q

location periosteal chondroma

A

long tubular bones 70%, hands, feet

-humerus/femur

201
Q

symptoms periosteal chondroma

A

initial swelling w/ mild-mod pain

202
Q

periosteal chondroma frequently found at…

A

insert sites of tendons or ligaments

203
Q

bone location periosteal chondroma

A

metaphysis

204
Q

rad appearance periosteal chondroma

A

ST mass w/ erosion or saucerization
medullary sclerosis/periostitis
buttressing or thickened cortex**
ca++ 50%

205
Q

DDX periosteal chondroma

A

periosteal/juxtacortical CS

206
Q

Chondroblastoma AKA

A

Codman’s tumor

207
Q

age Chondroblastoma

A

5-25 yo

208
Q

symptoms Chondroblastoma

A

pain, swelling, tenderness, joint manifestations

209
Q

joint effusions w/ Chondroblastoma

A

30%

210
Q

bone location Chondroblastoma

A

epiphysis or apophysis

can extend into metaphysis 25-50%

211
Q

location Chondroblastoma

A

femur, humerus, tibia, hands/ft
H/T = proximal
feet = calcanus/talus

212
Q

location in feet of Chondroblastoma

A

talus and calcaneus

213
Q

pathophysiology of CB

A

multinucleate giant cells that simulate those in ABC

214
Q

rad app Chondroblastoma

A

well defined, ovoid, bubbly lytic lesion w/ thin sclerotic rim
ca++ 30-50%

215
Q

size Chondroblastoma

A

< 5-6 cm

216
Q

ca++ Chondroblastoma

A

30-50%

217
Q

periostitis Chondroblastoma

A

30-50%

218
Q

bone scan Chondroblastoma

A

hypervascularity w/ avid accumulation

219
Q

CT Chondroblastoma

A

solid periosteal rxn, internal ca++, cortical breach

220
Q

MR Chondroblastoma

A

low t1; variable (low/intermed) T2

T2 shows adjacent marrow edema

221
Q

MR sign Chondroblastoma

A

fluid fluid levels like ABC

222
Q

what commonly occurs w/ Chondroblastoma

A

secondary ABC

223
Q

management Chondroblastoma

A

surgical resection (curettage)

224
Q

mets w/ Chondroblastoma

A

lungs after removal of primary tumor

225
Q

main DDX factor w/ Chondroblastoma

A

FOGMACHINES

-most don’t have bone marrow edema like CB

226
Q

chondromyxoid fibroma is least common…

A

benign tumor of cartilage

227
Q

age chondromyxoid fibroma

A

10-30 yo

228
Q

symptoms chondromyxoid fibroma

A

slow progressive pain, tenderness, swelling and decreased ROM

229
Q

path fx w/ chondromyxoid fibroma

A

yes

230
Q

location chondromyxoid fibroma

A

LTB

tibia + femur = 55%

231
Q

% of chondromyxoid fibroma in LE

A

70%

232
Q

bone location chondromyxoid fibroma

A

metaphysis w/ ext to E; or D

233
Q

rad appearance chondromyxoid fibroma

A

eccentric geographic bubbly lucent lesion

cortical expansion, sclerosis, coarse trabeculation

234
Q

ca++ chondromyxoid fibroma

A

<13%

235
Q

separations chondromyxoid fibroma

A

pseudotrabeculation = 60%

236
Q

larger lesions w/ chondromyxoid fibroma

A

cause complete penetration of cortex causing osseous defect = bite (if w/ periostitis)
*highly characteristic w/ chondromyxoid fibroma

237
Q

MR chondromyxoid fibroma

A

multilobulated - low T1; high T2

238
Q

bone scan chondromyxoid fibroma

A

doughnut sign

239
Q

management chondromyxoid fibroma

A

wide block excision/curettage

240
Q

recurrence chondromyxoid fibroma

A

25%

241
Q

malignant transformation chondromyxoid fibroma

A

rare

242
Q

some consider osteochondromas MC….

A

developmental physeal growth defect

243
Q

osteochondroma are MC benign tumor….

A

of the appendicular skeleton

244
Q

osteochondroma more common in lower or upper extremity?

A

LE 2:1

245
Q

age osteochondroma

A

children/adolescents

246
Q

location osteochondroma

A

femur, humerus, tibia

247
Q

bone location osteochondroma

A

metaphysis

if in epiphysis = Trevor’s disease

248
Q

in adults w/ osteochondroma what size cap is concerning? what size is considered malignant?

A

> 1 cm

3 cm

249
Q

in children w/ osteochondroma the cap may be as thick as…

A

3 cm

250
Q

osteochondroma point towards or away from joint?

A

away

251
Q

osteochondroma MR

A

high T2, low/intermediate T1

252
Q

bone scan osteochondroma

A

uptake if metabolically active but can’t determine benign vs malignant

normal bone scan virtually eliminates malignant degeneration

253
Q

malignant transformation % osteochondroma

A

1% to chondrosarc

254
Q

HME AKA

A

diaphyseal aclasis

255
Q

malignant transformation HME

A

5-25%

256
Q

age HME

A

1-2nd decades

257
Q

family history HME

A

yes, autosomal dominant

chromosomes 8, 11, 19

258
Q

deformities of HME

A

bilateral coxa valga, Brahman bull appearance of proximal femoral metaphysis
bayonet deformity
madeline’s deformity

259
Q

conventional CS age

A

30-60 yo

260
Q

symptoms conventional CS

A

pain of 1-2 yrs; warmth w/ ST mass

261
Q

conventional CS location

A

tubular bones, innominate, ribs, femur

-proximal F/T/H/Fib

262
Q

conventional CS is MC…

A

malignant neoplasm of scapula, ribs, sternum, and small bones of hands

263
Q

conventional CS in ribs/sternum arise at what junction

A

costochondral

264
Q

conventional CS in jaw…

A

maxilla > mandible

265
Q

bone location conventional CS

A

metaphysis, can extend into epiphysis

266
Q

high grade conventional CS frequently assoc w/..

A

non-calcified matrix

267
Q

bone scan conventional CS

A

increased central accumulation

268
Q

MR conventional CS

A

high T2; enhances w/ gad

269
Q

mets conventional CS

A

lung - skeleton- liver- kidney

270
Q

if no ca++ conventional CS may resemble….

A

plasmacytoma, lymphoma, mets

271
Q

location central CS

A

tubular bones - femur/humerus

flat - pelvis

272
Q

rad appearance central CS

A

elongated slightly expansile, multilobulated lytic lesions, ca++, ST mass

273
Q

peripheral CS features

A

MC from pre-existing OC or as juxtacortical CS

274
Q

periosteal CS histologically similar to …

A

conventional CS

275
Q

age periosteal CS

A

young/middle aged men

276
Q

MC aspect of femur periosteal CS

A

posterior metadiaphyseal

277
Q

periostitis periosteal CS

A

not common, tend to have Codman’s triangle

278
Q

clear cell CS age

A

3-5 decade; rare <15 yo

279
Q

location clear cell CS

A

LTB, 90% are proximal ends; femur, humerus

unusual in flat bones

280
Q

bone location clear cell CS

A

epiphyseal is RULE

281
Q

multiple sites w/ clear cell CS

A

uncommon

but could be multifocal tumors or mets

282
Q

rad appearance clear cell CS

A

lytic and slightly expansile; ca++ in 35%

20% have peripheral rind of sclerosis

283
Q

DDX clear cell CS

A

conventional - pattern of distribution and bone location
CB - older age, metaphyseal extension, lack of periostitis

others: ABC, OB, FD, GCT, mets….

284
Q

prognosis clear cell CS

A

low grade - much better than conventional

285
Q

recurrence and mets clear cell CS

A

seen if surgery is conservative

yes, lungs, brains, and bones

286
Q

Mesenchymal CS % in ST

A

30-75%

287
Q

age Mesenchymal CS

A

2-4th decade

ave 25 yo

288
Q

symptoms Mesenchymal CS

A

pain, swelling, ST mass, stiffness

289
Q

location Mesenchymal CS

A

femur, ribs, spine

20% in craniofacial bones

290
Q

rad appearance Mesenchymal CS

A

similar to conventional

lytic, sclerosis, periostitis, usually stippled ca++

291
Q

size Mesenchymal CS

A

2-18 cm

smaller than conventional

292
Q

DDX Mesenchymal CS

A

aggressive lesions

-ewing’s, small cell OS, dediff CS, hemangiopericytoma

293
Q

prognosis Mesenchymal CS

A

aggressive variant = poor prognosis

294
Q

met w/ Mesenchymal CS

A

yes, regional and distant LN (unlike conventional)

295
Q

features dedifferentiated CS

A

variant of conventional that has high grade sarcoma in approx w/ low grade cartilage tumor

296
Q

% of dedifferentiated CS

A

10% of CS

297
Q

age dedifferentiated CS

A

5-7th decades

ave 60 yo (most older than 50)

298
Q

histologically dedifferentiated CS

A

UNIQUE

low grade conventional CS w/ pleomorphic or spindle cell sarcoma

299
Q

symptoms dedifferentiated CS

A 
pain - ST swelling/mass
path fx (10-40%)
300
Q

location dedifferentiated CS

A

similar to conventional…
LTB and innominate
proximal femur/humerus/tibia

301
Q

rad appearance dedifferentiated CS

A

similar to conventional - lytic moth-eaten bone destruction
can have some ca++ but has distinct region w/ none
periostitis not prominent**

302
Q

prognosis dedifferentiated CS

A

extremely poor - ave survival is less than 1 yr

303
Q

dedifferentiated CS has beens een w/…

A

solitary/multiple OCs

304
Q

pathology of clear cell CS

A

cysts w/ clear hemorrhagic fluid
olsteoclast type giant cells
ca++ strands = chicken wire pattern (like CB)
stroll cells = lace like osteoid (like OS)

Tumors (3 decks)

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