bone, joint, soft tissue 2

Question 1

what cartilage tumor is more common in younger people

Answer 1

enchondroma

benign

Question 2

what cartilage tumor is more common in older people

Answer 2

chondrosarcoma

malignant

Question 3

osteochondroma

Answer 3

aka exostosis
benign cartilage-capped tumor that is attacehd to underlying skeleton by bony stalk
most common benign bone tumor
85% solitary

Question 4

osteochondroma morphology

Answer 4

sessile or pedunculated
1-20cm
cap is benign hyaline cartilagecovered in perichondrium

Question 5

osteochondroma x-ray

Answer 5

can see mm pull lines

Question 6

osteochondroma clinical

Answer 6

usually stop growing at time of growth plate closure

symptomatic tumors are cured by simple excision

Question 7

multiple hereditary exostosis

Answer 7

5-20% progress to chondosarcoma

Question 8

chondromas

Answer 8

benign tumors of hyaline cartilage that usually occur in bones of enchondral origin

Question 9

chondromas that arise in medullary cavity

Answer 9

enchondromas

Question 10

chondromas that arise on surface of bone

Answer 10

juxtacortical chondromas

Question 11

enchondromas

Answer 11

most common intraosseous cartilage tumros
20-50
appear as soliatry metaphyseal lesions of tubular bones of hand and feet

Question 12

chondromas xray

Answer 12

circumscribed lucencies with central irregular calcifications, sclerotic rim and intact Cx
<3cm

Question 13

what NONHEREDITARY disorders can cause multiple enchondromas

Answer 13

ollier disease
maffucci syndrome
can both be more cellular with cytologic atypia

Question 14

chondromas clinical

Answer 14

growth potential limited
Tx-usually observation or curettage
solitary rarely undergo sarcomatous transformation

Question 15

maffucci syndrome

Answer 15

also have spindle cell hemangiomas

at risk for ovarian carcinomas and brain gliomas

Question 16

chondrosarcoma

Answer 16

malignant tumors that produce cartilage
2nd most common malignant tumor of bone
usually 40+

Question 17

where do chondrosarcomas commonly arise

Answer 17

axial skeleton, pelvis, shoulder, ribs

Question 18

chondrosarcomas xray

Answer 18

calcified matrix appears as foci of flocculent densities

Question 19

chondrosarcomas clinical

Answer 19

painful, progressively enlarging masses
direct correlation btwn grade and behavior of tumor
most present as grade I which rarely metastasize
grade 3- 70% mets to lungs

Question 20

Tx of chondrosarcomas

Answer 20

surgical excision

chemo

Question 21

Ewing sarcomas

Answer 21

malignant bone tumor with primitive round cells w/o obvious differentiation
now grouped with PNET tumors

Question 22

Ewing sarcomas presentation

Answer 22

80% <20
usually arise in diaphysis of long bones and flat bones of pelvis
painful enlarging masses with warmth and swelling and leukocytosis mimicking infection

Question 23

ewings xray

Answer 23

destructive lytic tumor with permeative margins that extends into surrounding soft tissue
onion skinning
homer-wright rosettes

Question 24

Tx of Ewings

Answer 24

neoadjuvant chemo with surgery and +/- radiation

long term cure 50%

Question 25

giant cell tumor

Answer 25

``` dominated by multinucleated osteoclast-type giant cells aka osteoclastoma uncommon benign, but locally aggressive 20-40 ```

Question 26

giant cell xray

Answer 26

soap bubble

Question 27

Tx of giant cell

Answer 27

curettage 40-60% locally recur RANKL inhibitor denosumab

Question 28

giant cell mets

Answer 28

4% mets to lungs, but can spontaneously regress and seldom fatal

Question 29

aneurysmal bone cyst (ABC)

Answer 29

multiloculated blood-filled cystic spaces usually first 2 decades metaphysis of long bones and post vertebral bodies pain and swelling

Question 30

ABC xray

Answer 30

eccentric expansible lesion with well defined margins most are completely lytic and often contain thin shell of reactive bone at periphery fluid-fluid levels

Question 31

ABC clinical

Answer 31

surgery | low recurrence rate

Question 32

lesions stimulating primary neoplasms

Answer 32

fibrous cortical defect- small (.5cm) | nonossifying fibromas- (5-6cm)

Question 33

fibrous cortical defects

Answer 33

aka metaphyseal fibrous defects extremely common 30-50% of kids 2+ cast majority arise in distal femur and proximal tibia, almost half are b/l or multiple

Question 34

fibrous cortical defect histo

Answer 34

pinwheel

Question 35

clinical fibrous cortical defect

Answer 35

asymptomatic detected incidentally Bx rarely needed spontaneous resolution

Question 36

clinical nonossifying fibromas-

Answer 36

pathologic fracture and may require Bx and surgery

Question 37

fibrous dysplasia

Answer 37

benign tumor likened to localized developmental arrest | all normal components are present, just do not differentiate into mature structures

Question 38

fibrous dysplasia clinical patterens

Answer 38

monostotic- single bone polystotic- multiple bones mazabraud syndrome McCune-Albright syndrome

Question 39

mazabraud syndrome

Answer 39

fibrous dysplaisa (usually poly) and soft tissue myxomas

Question 40

McCune-Albright syndrome

Answer 40

polyostotic disease, cafe-au-lait spots, endocrine abnormalities, (precocious puberty)

Question 41

fibrous dysplasia xray

Answer 41

ground glass appearance | well defined margins

Question 42

monostotic fibrous dysplasia clincal

Answer 42

B=G usually early adolescence often stops enlarging when growth plate closes femur, tibia, ribs, jaw, calvarium, and humerus usually asymptomatic, but may cause pain, fracture, or leg length discrepancies Tx- only if symptomatic curettage

Question 43

polystotic fibrous dysplasia clincal

Answer 43

manifests earlier then mono may continue to be symptomatic into adulthood femur, skull, tibia, humerus, ribs, fibula, radius, ulan, mandible, vertebrae may require multiple sugeries bisphosphonates can Tx pain rarely transforms into sarcoma

Question 44

75% of bone mets are from what

Answer 44

``` prostate breast kidney lungs metastatic bone CA much more common then primary bone CA ```

Question 45

prostate mets

Answer 45

usually blastic

Question 46

kidney, GI, and melanoma mets

Answer 46

lytic

Question 47

what translocation is assocaited with Ewing sarcoma

Answer 47

t(11,22)