Bone Cysts and Tumors Flashcards
Osteolytic
Resorptive, darker hole in the gray- white bone image Disorders associates include: Renal cell cancer, Melanoma, amultiple myeloma, Non-small cell lung cancer, Thyroid cancer, Non-Hodkin lymphoma, Langerhans cell hystiocytosis
Osteoblastic
Bone forming, spots that are whiter than the bone around them. Disorders include: Prostate, Carcinoid, Small cell lung cancer, Hodkin lymphoma
Mixed osteoblastic and osteolytic
Both resorptive and bone forming activity. Disorders include: Breast cancer, Gastrointestinal cancers, Squamous cell cancers at most primary sites
Hypercalcemia
Elevated calcium levels in the blood “stones, bones, abdominal moans, and psychiatric groans.”
Symptoms: Nephrolithiasis (kidney stones), bone pain, osteoporosis, N/V constipation, abdominal pain, fatigue, weakness, impaired concentration
Metastatic Disease
Malignancy to the bone from another organ system.
Epidemiology: Most common in older adults 65+.
Common primary sources: 1. Lung 2. Breast 3. Prostate, kidney, thyroid, bladder.
Most common site: lumbar spine
Symptoms: Pain-worse at night, may present in setting of pathologic fracture, possibly nerve pain/complaints
Constitutional symptoms: unintentional weight loss, unexplained fatigue, fever or night sweats, pain, malaise, evidence of hypercalcemia
Diagnostics: Labs-calcium, alkaline-phosphatase (elevated)-determine liver vs bone, imaging: initially radiographs, then CT, if back pain spinal MRI, Positron Emission Tomography (PET): quantifies metabolic activity. Bone biobsy for definitive diagnosis
Treatment: Depends if local or if mets-local will have more focal treatment, mets-typically chemotherapy, and in addition biphosphonates(should be paired with calcium and vitamin D supplements), monoclonal antibodies, radiation, ablation
Codmans triangle
cuff of new bone formation at the edge of the soft tissue mass, aggressive periostal reaction at diaphyseal end of the lesion. MRI of the entire bone, sometimes chest CT, bone scan/PET scan. Defninitive diagnosis: core biopsy or surgical biopsy.
osteosarcoma (Osteogenic Sarcoma)
Bone cancer: excess osteoid matrix production by malignant cells (mesenchymal stem cells)
Incidence: 1,000 new cases per year in the US
Epidemiology: Bimodal distribution, Children 13-18, older adults 80-84, more common in males
Risk factors: radiation therapy, chemotherapy, Pagets Disease, Retinoblastoma, Li-Fraumeni syndrome
Symptoms: localized pain over weeks to months (worse at night), large tender soft tissue mass, limping (lower extremity), decreased ROM, regional lymphadenopathy.
Diagnostics: Lactate Dehydrogenase (LDH), Alkaline Phosphatase (ALP)-elevated in setting of inc osteoblastic activity. Imaging- radiograph-spiculated periostal reaction, “sunburst” appearance, “hair on end”; growing perpindicular to the bone cortex, Codmans triangle-cuff of new bone formation at the edge of the soft tissue mass, aggressive periostal reaction at diaphyseal end of the lesion. MRI of the entire bone, sometimes chest CT, bone scan/PET scan. Defninitive diagnosis: core biopsy or surgical biopsy.
Treatment: grade dependent (TNM staging)- excision with wide margins w/ limb sparing or amputation, +/- chemotherapy and radiation
Early detection very important for better survival rates!!
Locations: metaphysial regions of distal femur, proximal tibia, proximal humerus
What are the radiographic properties of a benign bone tumor?
Smooth sclerotic border, no cortical destruction, no soft tissue extension
What are the radiographic properties of a malignant bone tumor?
Poorly defines, cortical destruction, moth eaten, periostal reaction, possible extension into soft tissue
cartilage forming tumors (osteochondroma)
Benign hyaline cartilage capped bony spur on the external surface of the bone most commonly found in long bones of the leg, pelvis, shoulder blade.
Epidemiology- more common in males vs females
Symptoms: lump, if nerve involvement numbness/tingling, if vascular compression-edema (venous), pallor/loss of pulses (arterial).
Physical Exam: painless palpable lump, neurovascular assessment. Diagnostics: radiographs-bone spur usually near growth plate, grows AWAY from growth plate.
Treatment: only required if there is local irritation or deformity, concern for malignant transformation
Osteoid Osteoma
Benign bone tumor
Epidemiology males >females, typically in ages 5-25, 10% of all benign bone tumors.
Pathophysiology: Neoplasia or prior trauma INCREASE in prostaglandins (when compared to normal bone)
Symptoms: localized pain at night, NSAIDs provide relief, swelling, and in some cases limb length discrepancies.
Diagnostics: radiographs (round radiolucent nidus with surrounding sclerosis, CT
Treatment: conservative (watch it), surgical excision (CT guided RF ablation)
Osteoblastoma
Epidemiology: rare (1% primary cone tumors) average age 20 years old, more common in males
Pathophysiology: similar to osteoid osteoma but more vascularized and LACKS prostaglandins.
Symptoms: dull localized pain, no/minimal relief with NSAID’s
Diagnostics: XR (round, well defined margins, reactive sclerosis, CT
Treatment: Surgical excision
Simple/Unicameral bone cysts
-benign fluid filled cyst (SBC/UBC)
Epidemiology-most common in 10-20 year olds
Pathophysiology: Reactive bone lesion, near physis, due to venous stasis in cancellous bone
Symptoms: none, typically benign and incedentally found
Diagnostics: radiographs (well marginated no periostal reaction). Confirm with biopsy
Treatment: Non-operative, corticosteroid injection, may resolve on own
Aneurysmal Bone Cysts (ABC)
benign fluid filled cyst
Epidemiology- rare, <20 years old
Pathophysiology: 70% d/t recurrent chromosomal translocations causing gene fusions; long bones and spine
Symptoms: mild to moderate pain, weeks to months, tender, local swelling
Diagnostics: Radiographs (well marginated, smooth periostal reaction), confirm with biopsy.
Treatment: surgical excision, sclerotherapy, embolization of the vessel, denosumab
fibrous lesions
benign bone lesion
Epidemiology- Children and young adults 5% of all bone lesions
Pathophysiology: Proliferation of fibrous tissue due to missense mutation in the GNAS1 gene on chromosome 20
Symptoms: typically asymptomatic unless pathological fracture
Diagnosis: radiographs-internal ground glass matrix, CT/MRI to exclude other bone lesions
Treatment: conservative (1% of cases can progress to malignant), surgery if occuring in setting of fracture
