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Clin Med MSK: > Bone Cysts and Tumors > Flashcards

Bone Cysts and Tumors Flashcards

1
Q

What are bone tumors

A

can be benign or malignant
most primary tumors are benign
most lesions in children are benign
most benign tumors can be diagnosed based on plain radiographs

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2
Q

what is key to diagnosis of bone tumors

A

age of the patient, history and physical examination, radiographic appearance

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3
Q

what is found on an x-ray of a benign bone tumor

A

well defined
sclerotic border
no cortical destruction
no soft tissue extension

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4
Q

what is found on an x-ray of a malignant bone tumor

A

poorly defined
cortical destruction
moth-eaten
extend into soft tissue
spiculated periosteal reaction

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5
Q

what are typical clinical presentations of bone tumors

A

usually incidental finding
evaluation of symptoms - painless bony mass or pain
pathologic fracture
or part of a metastatic work-up in a patient with known cancer

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6
Q

what is a malignant lesion

A

metastatic disease from another primary source

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7
Q

what are the primary bone cancers

A

Osteosarcoma
multiple myeloma (hematologic)
Ewings sarcoma
chondrosarcoma

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8
Q

what is the most common bone tumor in older adults

A

metastatic cancer - usually hematogenously spread

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9
Q

what are the primary cancer sources that contribute to bone cancer

A

lung
breast
prostate
kidney
thyroid

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10
Q

what is the clinical presentation of bone cancer

A

can be asymptomatic, pain is the most common complaint that develops over weeks, usually localized
pathologic fracture
spinal cord compression (back pain)

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11
Q

what are the common diagnostic studies for bone tumors

A

plain x-rays
bone scan
PET scan
MRI
CT

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12
Q

when are x-rays indicated for patients

A

first step with patients with focal complaint
these tests are not very sensitive and lesion can by lytic or blastic depending on tumor type

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13
Q

what is a lytic lesion

A

destroy bone material (black hone in the bone)

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14
Q

what is a blastic lesion

A

fill the bone with extra cells (abnormal white areas)

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15
Q

What is used for a bone scan

A

bone scintigraphy - technetium 99

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16
Q

what type of test is a bone scan

A

nuclear study - overview of the entire skeleton and is more sensitive than plain films

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17
Q

what are the benefits of an MRI for bone tumor

A

No ionized radiation
more sensitive than bone scan - but not practical for whole body
Excellent for soft tissues - often used to evaluate bony tumors
especially useful for spinal cord compression

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18
Q

what are the benefits of CT

A

often used to guide biopsies
good for evaluating bony detail
dose of radiation

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19
Q

what is a PET scan

A

positron emission tomography - injection of radioactive tracer (FDG)

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20
Q

what is being looked at on a PET scan

A

an increased uptake in areas of increased metabolic activity (cancer) and whole skeleton can be looked at.

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21
Q

what should not be looked at on a PET scan

A

brain, heart, kidneys and infection because they will always light up

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22
Q

what is the most common primary malignant tumor in pediatrics

A

osteosarcoma

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23
Q

what is the most common non-hematogenous bone malignancy

A

osteosarcoma

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24
Q

what are the commmon age distrubutions for ostoesarcoma

A

teens and late 70s

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25
Q

when is the peak incidence of osteosarcoma

A

during adolescent growth spurt

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26
Q

what are risk factors of osteosarcoma

A

Paget’s disease of bone (elderly)
Previous radiation therapy/chemotherapy
inherited conditions like Li-fraumeni syndrome
?molecular theory of insult during period of rapid growth

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27
Q

what does Li-Fraumeni syndrome do

A

turns off the TP53 tumor suppressor gene

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28
Q

what are the pediatric risk factors for osteosarcoma

A

children have no risk factors other than adolescence.

29
Q

what is the presentation of osteosarcoma

A

pain over several months
soft tissue mass (often large and tender)
usually do not have systemic symptoms
10-20% have metastatic disease at presentation

30
Q

what is the primary location of osteosarcoma in pediatrics

A

metaphysis of the long bones (distal femur, proximal tib, and proximal humerus)
in kids 50% are in long bones around the knee

31
Q

how does osteosarcoma present on an x-ray

A

distructive (lytic lesion)
moth eaten
spiculated periosteal reaction “hair on end” “sunburst appearance”
codmans triangle

32
Q

what is codmans triangle

A

cuff of new bone formation at the edge of the soft tissue mass

33
Q

how is osteosarcoma worked up

A

imaging is diagnostic - labs are supportive

34
Q

what are the supportive lab results of osteosarcoma

A

alkaline phosphatease is increased in advanced disease
LDH increase in advance disease

35
Q

what is an MRI used for for osteosarcoma

A

show the entire bone affected

36
Q

what else needs to be looked at in patients with osteosarcoma

A

CT of chest for pulmonary mets
bone/PET scan for bony mets

37
Q

how is osteosarcoma diagnosed

A

biopsy

38
Q

how is osteosarcoma treated

A

surgery and chemotherapy

39
Q

what are the survival rates of osteosarcoma

A

70% overall

used to be 80-90% died of metastatic disease

40
Q

when are benign bone tumors usually found

A

incidentally and tend to be asymptomatic
age is commonly teens and early 20s

41
Q

what are the common types of benign bone tumors

A

osteoid-forming tumors (osteoid osteoma, osteoblastoma)
cartilage-forming tumors (ostochondroma, enchondroma)
bone cysts (simple and aneurysmal)
fibrous lesions (fibrous dysplasia)

42
Q

what is an osteoid osteoma

A

bone-forming benign tumor, no malignant potential
typically found ages 10-20 in Males>females

43
Q

where are osteoid osteomas usually found

A

long bones of the extremities (femur is the most common)

44
Q

what is the common presentation of osteoid osteoma

A

pain at night quickly relived with NSAIDs

45
Q

how is an osteoid osteoma diagnosed

A

plain x-rays and rarely needs biopsy

46
Q

what is the treatment of osteoid osteoma

A

resolve spontaneously; surgical excision and radio-ablation is curative

47
Q

what is the most common benign bone tumor

A

osteochondroma

48
Q

when do ostoechondromas usually occur

A

between ages 10-20 around knee or proximal humerus

49
Q

what is an osteochrondroma

A

cartilage-capped bone spur usually near the growth plate growing away
rare possibility of malignant transformation - multiple lesions increases risk of malignancy

50
Q

what is the presentation of osteochondromas

A

painless mass or pain with compression of nearby structures
decreased range of motion
fractures

51
Q

how are osteochondromas treated

A

usually observation

52
Q

what is an endochondroma

A

non-cancerous bone tumor beginning in the cartilage
may happen as one or multiple tumor

53
Q

where do endochondromas usually present

A

hand tumor

54
Q

what is the population of patients with endochondromas

A

M=F between ages 10-20 with variable symptoms that may resemble other medical problems

55
Q

what is the treatment of endochondromas

A

individualized for each patient but the options are surgery, bone grafting or watchful waiting

56
Q

when is fibrous dysplasia of the bone seen

A

it is rare, M=F
diagnosed earlier in children

57
Q

what is fibrous dysplasia

A

normal bone marrow is replaced with fibrous tissue (abnormal scar-like connective tissue)
causes bone formation that is weak and prone to expansion
can be part of larger disorders

58
Q

what other disorders can be associated with fibrous dysplasia

A

McCune-albright syndrome, Mazabroud syndrome, Jaffe-Lichtenstein syndrome

59
Q

what causes fibrous dysplasia

A

underlying cause is unknown but possibl related to mutation of GNAS1 gene

60
Q

what are the typical symptoms of fibrous dysplasia

A

depend on specific bones involved but may be asymptomatic

61
Q

what is the treatment of fibrous dysplasia

A

symptomatic management

62
Q

how is fibrous dysplasia diagnosed

A

history and physical CT and MRI, bone scan to determine the extend of the disease and bone biopsy

63
Q

what is a bone cyst

A

fluid-filled cavity that forms in the bone and can occur at any age but is more common in kids and adolescents

64
Q

where are bone cysts typically found

A

can develop in any bone but usually affect eh long bones 9most often humerus and femur)

65
Q

what is the treatment of bone cysts

A

treatment is based on size, location and risk of fracture
watchful-waiting and surgery are the primary treatment options

66
Q

what is common with unicameral bone cyst presentation on x-ray

A

fallen fragment sign

67
Q

when are bone cysts biospied

A

when the diagnosis is uncertain and to confirm diagnosis before treating

68
Q

how are benign bone tumors managed

A

most patients should be seen by ortho
many asymptomatic lesions can be followed with serial exams and x-rays

Clin Med MSK: (14 decks)

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