Bone Cysts and Tumors Flashcards
What are bone tumors
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
what is key to diagnosis of bone tumors
age of the patient, history and physical examination, radiographic appearance
what is found on an x-ray of a benign bone tumor
well defined
sclerotic border
no cortical destruction
no soft tissue extension
what is found on an x-ray of a malignant bone tumor
poorly defined
cortical destruction
moth-eaten
extend into soft tissue
spiculated periosteal reaction
what are typical clinical presentations of bone tumors
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
what is a malignant lesion
metastatic disease from another primary source
what are the primary bone cancers
Osteosarcoma
multiple myeloma (hematologic)
Ewings sarcoma
chondrosarcoma
what is the most common bone tumor in older adults
metastatic cancer - usually hematogenously spread
what are the primary cancer sources that contribute to bone cancer
lung
breast
prostate
kidney
thyroid
what is the clinical presentation of bone cancer
can be asymptomatic, pain is the most common complaint that develops over weeks, usually localized
pathologic fracture
spinal cord compression (back pain)
what are the common diagnostic studies for bone tumors
plain x-rays
bone scan
PET scan
MRI
CT
when are x-rays indicated for patients
first step with patients with focal complaint
these tests are not very sensitive and lesion can by lytic or blastic depending on tumor type
what is a lytic lesion
destroy bone material (black hone in the bone)
what is a blastic lesion
fill the bone with extra cells (abnormal white areas)
What is used for a bone scan
bone scintigraphy - technetium 99
what type of test is a bone scan
nuclear study - overview of the entire skeleton and is more sensitive than plain films
what are the benefits of an MRI for bone tumor
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
what are the benefits of CT
often used to guide biopsies
good for evaluating bony detail
dose of radiation
what is a PET scan
positron emission tomography - injection of radioactive tracer (FDG)
what is being looked at on a PET scan
an increased uptake in areas of increased metabolic activity (cancer) and whole skeleton can be looked at.
what should not be looked at on a PET scan
brain, heart, kidneys and infection because they will always light up
what is the most common primary malignant tumor in pediatrics
osteosarcoma
what is the most common non-hematogenous bone malignancy
osteosarcoma
what are the commmon age distrubutions for ostoesarcoma
teens and late 70s
when is the peak incidence of osteosarcoma
during adolescent growth spurt
what are risk factors of osteosarcoma
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
what does Li-Fraumeni syndrome do
turns off the TP53 tumor suppressor gene
what are the pediatric risk factors for osteosarcoma
children have no risk factors other than adolescence.
what is the presentation of osteosarcoma
pain over several months
soft tissue mass (often large and tender)
usually do not have systemic symptoms
10-20% have metastatic disease at presentation
what is the primary location of osteosarcoma in pediatrics
metaphysis of the long bones (distal femur, proximal tib, and proximal humerus)
in kids 50% are in long bones around the knee
how does osteosarcoma present on an x-ray
distructive (lytic lesion)
moth eaten
spiculated periosteal reaction “hair on end” “sunburst appearance”
codmans triangle
what is codmans triangle
cuff of new bone formation at the edge of the soft tissue mass
how is osteosarcoma worked up
imaging is diagnostic - labs are supportive
what are the supportive lab results of osteosarcoma
alkaline phosphatease is increased in advanced disease
LDH increase in advance disease
what is an MRI used for for osteosarcoma
show the entire bone affected
what else needs to be looked at in patients with osteosarcoma
CT of chest for pulmonary mets
bone/PET scan for bony mets
how is osteosarcoma diagnosed
biopsy
how is osteosarcoma treated
surgery and chemotherapy
what are the survival rates of osteosarcoma
70% overall
used to be 80-90% died of metastatic disease
when are benign bone tumors usually found
incidentally and tend to be asymptomatic
age is commonly teens and early 20s
what are the common types of benign bone tumors
osteoid-forming tumors (osteoid osteoma, osteoblastoma)
cartilage-forming tumors (ostochondroma, enchondroma)
bone cysts (simple and aneurysmal)
fibrous lesions (fibrous dysplasia)
what is an osteoid osteoma
bone-forming benign tumor, no malignant potential
typically found ages 10-20 in Males>females
where are osteoid osteomas usually found
long bones of the extremities (femur is the most common)
what is the common presentation of osteoid osteoma
pain at night quickly relived with NSAIDs
how is an osteoid osteoma diagnosed
plain x-rays and rarely needs biopsy
what is the treatment of osteoid osteoma
resolve spontaneously; surgical excision and radio-ablation is curative
what is the most common benign bone tumor
osteochondroma
when do ostoechondromas usually occur
between ages 10-20 around knee or proximal humerus
what is an osteochrondroma
cartilage-capped bone spur usually near the growth plate growing away
rare possibility of malignant transformation - multiple lesions increases risk of malignancy
what is the presentation of osteochondromas
painless mass or pain with compression of nearby structures
decreased range of motion
fractures
how are osteochondromas treated
usually observation
what is an endochondroma
non-cancerous bone tumor beginning in the cartilage
may happen as one or multiple tumor
where do endochondromas usually present
hand tumor
what is the population of patients with endochondromas
M=F between ages 10-20 with variable symptoms that may resemble other medical problems
what is the treatment of endochondromas
individualized for each patient but the options are surgery, bone grafting or watchful waiting
when is fibrous dysplasia of the bone seen
it is rare, M=F
diagnosed earlier in children
what is fibrous dysplasia
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
what other disorders can be associated with fibrous dysplasia
McCune-albright syndrome, Mazabroud syndrome, Jaffe-Lichtenstein syndrome
what causes fibrous dysplasia
underlying cause is unknown but possibl related to mutation of GNAS1 gene
what are the typical symptoms of fibrous dysplasia
depend on specific bones involved but may be asymptomatic
what is the treatment of fibrous dysplasia
symptomatic management
how is fibrous dysplasia diagnosed
history and physical CT and MRI, bone scan to determine the extend of the disease and bone biopsy
what is a bone cyst
fluid-filled cavity that forms in the bone and can occur at any age but is more common in kids and adolescents
where are bone cysts typically found
can develop in any bone but usually affect eh long bones 9most often humerus and femur)
what is the treatment of bone cysts
treatment is based on size, location and risk of fracture
watchful-waiting and surgery are the primary treatment options
what is common with unicameral bone cyst presentation on x-ray
fallen fragment sign
when are bone cysts biospied
when the diagnosis is uncertain and to confirm diagnosis before treating
how are benign bone tumors managed
most patients should be seen by ortho
many asymptomatic lesions can be followed with serial exams and x-rays
