Bone Neoplasia - El Hefnawy Flashcards
1
Q
radiolucent lesions
A
- multiple myeloma –> punched out lesions
- Giant cell tumor, NOF –> expansile, soap bubble lesions
- chondroma/enchondroma/GCT/NOF/aneurysm –> radiolucent expansion
2
Q
opaque lesions
A
- osteoid osteoma –> lucent nidus (Lucent center, sclerotic rim)
- osteochondroma (aka exostosis) –> extension from growth plate (medullary canal continuation)
- osteosarcoma –> sunburst; soft tissue rxn; calcification
3
Q
osteoma
A
- benign, compact lamellar bone growth (not cancellous)
- can compress nerve, sinus, blood vessel
- multiple –> familial polyposis coli of Gardner’s syndrome (GI tract)*
4
Q
osteoid osteoma
A
- benign, never malignant
- osteoblasts lay down osteoid matrix –> ossifies to cancellous/trabecular bone
- Lucent nidus* –> surrounded by sclerosis and thick cortex
- produce PGE2 –> pain at night –> relieve with NSAIDS* 50%
- radiofrequency ablation –> high success 95%
- target sign if osteoid matrix calcifies
- smaller than osteoblastoma* (<2cm)
- in long bones*
5
Q
enostosis
A
- not a neoplasm
- compact bone inside cancellous bone
- asymptomatic
6
Q
osteoblastoma
A
- benign
- can be aggressive –> aggressive osteoblastoma (no metastasis)
- chronic low back pain –> not relieved by NSAIDs*
- osteoid matrix
- larger than osteoid osteoma (>2cm)
- in axial skeleton and vertebrae*
- less success with radio frequency
- 20% recurrence with excision
7
Q
osteogenic sarcoma/osteosarcoma
A
- most common primary malignant bone tumor (besides myeloma)
- osteoid producing bone tumor
- cause: chemo and radiation –> damage DNA
- metaphysis of long bones (distal femur, proximal tibia, proximal humerus)*
- usually around knee (proximal tibia, distal femur)***
- retinoblastoma increases risk*
- Codman’s triangle and starburst pattern*
- risk factors: Paget’s, fibrous dysplasia, radiation
- metastasis to lungs
- high grade tumors –> osteoid matrix
- mostly intramedullary (intraosseous) lesion*
8
Q
chondroma
A
- most common benign tumor in bones (cartilaginous tumor)
- small bones of hands/feet* –> risk of fracture
- enchondroma from diaphysis
- genetic –> rearranged 11q13-15
- multiple chondromas (Maffuci’s)–> mostly develop chondrosarcoma
- multiple enchondromas (Ollier’s) –> 25% develop chondrosarcoma
- can have calcification/mineralization –> arcs and rings
- no medullary continuation
- bright T2 weighted MRI*
- double nucleated chondrocytes –> produce cartilaginous matrix
- Lucent, no invasion of cortex
- vascular tumor
9
Q
chondroblastoma
A
- in calcaneus –> Codman tumor*
- benign tumor, painful
- arise from epiphysis
- less matrix than chondroma*
- radiolucent, cortex intact
- bright T2 if there is enough matrix
- chicken wire cell membrane
10
Q
osteochondroma (aka ostestosis/exostosis)
A
- benign
- medullary continuation outgrowth
- epiphysial cartilage does not grow past 30 yo*
- appendicular skeleton
- hyaline cap grows away form epiphysial plate –> form cancellous bone
- multiple –> malignant (hereditary multiple exostosis)
11
Q
chondrosarcoma
A
- 3rd most common bone malignancy*
- cartilage growth –> malignant
- in long bones, ribs, pelvis*
- intramedullary lesion most common
- bright T2 MRI if matrix is present
- rings and arcs like chondroma
- entrapment of bone trabeculae (islands)*
12
Q
grade 1 tumor
A
- low cellularity
- rare metastasis
- good prognosis
13
Q
grade 2 tumor
A
- increased cellularity
- greater nuclear pleomorphism
- low metastasis
14
Q
grade 3 tumor
A
- highest cellularity and nuclear pleomorphism
- sparce matrix
- spindle appearance
- high metastatic rate
15
Q
Giant cell bone tumor
A
- 6th most common bone neoplasm*
- multinucleated giant cells mixed with stromal (mono nucleated) cells and no matrix
- soap bubbles*
- lung metastasis rare
- primarily in knee, mandible, and distal radius
- treat with curettage
