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MSK > Bone Neoplasm, Myelitis, Necrosis > Flashcards

Bone Neoplasm, Myelitis, Necrosis Flashcards

1
Q

Characteristics of osteoma

A

Benign, slow growing
Most commonly arise on the surface of bones (facial bones, some long bones)
Associated with Gardner syndrome (Familial adenomatous polyposis FAP, multiple osteomas, GI polyps)

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2
Q

Osteoma histology

A

well circumscribed nodular growth distorting the smooth contour of the skull.
composed of mature lamellar bone

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3
Q

Osteoid Osteoma characteristics

A

Small (1cm), benign tumor
Arise from osteoblast and make osteoid (surrounded by a rim of reactive sclerotic bone)
Young Male 13-20
Cortex of the long bone (femur tibia) usually on diaphysis
Painful - nocturnal pain relieved by aspirin, most likely due to prostaglandin E2 produced by proliferating osteoblasts

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4
Q

Radiographic findings of osteoid osteoma

A

Intracortical
round radiolucency with cintral mineralization of osteoid
surrounded by abundant reactive bone

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5
Q

Osteoid osteoma Histology

A

Haphazardly interconnecting trabeculae of woven bone
rimmed and prominent osteoblasts
intertrabecular spaces filled by vascularized loose connective tissue

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6
Q

Osteoblastoma

A

Uncommon but histologically similar to osteoid osteoma
benign
no boney reactive rim
vertebral
larger than 2 cm
lass painful and pain does not respond to aspirin
10% recur and some become osteosarcoma

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7
Q

osteosarcoma

A

most common primary malignant tumor of bone
proliferation of osteoblast
Bimodal incidence Distibution
peak incidence in younger than 20 (75%) - Familial Rb, growth plate activity
second peak older adults - Paget’s, bone infarc, prior radiation

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8
Q

Osteosarcoma body distribution

A 
Metaphyseal area of long bone
Knee - 50%
Shoulder - 10%
Jaw - 8%
Pelvis/hip - 15%
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9
Q

Osteosarcoma presentation

A

Highly aggressive - 10-20% have metastisis to long at time of diagnosis, 90% who die have mets to lungs, bone, brain and others

Complex molecular phenotype in: Rb, INK4a, TP53, MDM2, and CDK4

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10
Q

Subtypes of osteosarcoma

A

Site of origin
histological grade
primary or secondary preexisting disorder
histological features

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11
Q

Osteosarcoma key findigns

A

Tumor breaks through the cortex and lifts the periosteum off the bone - Codman triangle

Sunburst periosteal bony reaction

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12
Q

Osteosarcoma histology

A

Anaplastic malignant tumor cells with abnormal and mitotic figures and characteristic basophilic osteoid and bone

Strong alkaline phosphatase and/or osteocalcin

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13
Q

Osteochondroma characteristics

A 
Also know as exostosis
benign cartilage-capped tumor
most common benign tumor of the bone
late adolescent to early adulthood
Male
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14
Q

Osteochondroma appearance (self described)

A

Little nubbin coming off on the diaphysis like a new head

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15
Q

Chondroma and Enchondromas characteristics

A

Well-circumscribed benign tumors of hyaline cartilage (enchondromas arise from medullary cavity, juxtacortical chondromas if arise on surface of bone)
Hands and feet
age 20-50
rarely over 2 cm
May erode adjacent cortex and expand bone

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16
Q

Olliers disease

A

Multiple lesions
mutations in IDH1 or IDH2 gene
large bumps along the joints of fingers: look like cysts or baloons under skin

17
Q

Maffucci’s syndrome

A

familial, hemangiomas of the skin; increased risk of ovarian or liver cancer
cause unknown
Purple spots on hand

18
Q

Chondrosarcoma

A

Malignant cartilage tumor
Second most common malignant matrix-forming tumor of bone
arise in the central skeleton: ribs, shoulder, medulla of pelvis
May arise from preexisting enchondroma or osteochondroma
Types: conventional, clear cell, dedifferentiated, mesenchymal

19
Q

Chondrosarcoma histology

A

Tissue sis still recognizable as cartilage - chondrocytes within clear lacunae, surrounded by a bluish matrix
No orderly pattern - increased cellularity and atypia
Can see some chondrosarcomas invading and destroying bone

20
Q

Ewing Sarcoma/PNET characteristics

A

Neuroectodermal malignant tumor - poorly differentiated round cell tumor
Ewing Sarcoma family tumors = Ewing + primitive neuroectodermal tumor (PNET)
Second most common bone sarcoma in children
younger than 20 yo
White, Male
Medullary cavity of diaphysis of long bone
very aggressive - presents with metastasis, treatment combination of surgery, chemo, and radiation

21
Q

Ewing Sarcoma presentation

A

painful, tender, warm, swollen
Mimic infection - fever, elevated sed rate, anemia, leukocytosis
Radiographically “onion-skin” appearance, turnover grows and pushes periosteum in reactive bone formation

22
Q

Ewing Sarcoma histology

A

Small round blue cells with glycogen-rich cytoplasm
resembles lymphocytes, oten confused with lymphoma or chronic osteomyelitis
Twice the size of lymphocytes, periodic acid-schiff positive (glycogen),
CHROMOSOME 11:22
stain for CD99

23
Q

Giant Cell tumor characteristics

A

Multinucleated giant cells and stomal cells
majority benign but can be locally aggressive
Age: 20-40
Ephiphysis of long bones: tibia, femur
Treated by curettage or resection

24
Q

Giant cell tumor facts

A

often destroy overlaying cortex

radiographically soap bubble appearance

25
Q

Giant cell tumor histology

A

Minority of cells: neoplastic, primitive, osteoblastic precursors (High levels of RANKL, stimulate osteoclast activity)

Majority of cells: non-neoplastic osteoclasts and precursors

26
Q

Fibrous cortical defect/Nonossifyig fibroma

A

Fibrous cortical defects usually found incidentally - spontaneous resolution within several years
Extremely common 30-50% of children under 2 y.o.
Small and eccentric in metaphysis of distal femur and proximal tibia
Grow 5-6 cm = nonossifying fibromas

27
Q

fibrous displasia

A

localized developmental arrest: all components of normal bone present, do not differentiate into mature structures, arise during skeletal development

Distinctive, overlapping, types: Monostatic, Polystatic, Mazabraud syndrome (polystatic with myxomas) McCune-Albright syndrome: polystatic with cafe-au-lait skin pigmentation

28
Q

Metastatic tumors

A

More common than primary tumors of bone
pathways of spread: direct extension, lymphatic or blood dissemination, intraspinal seeding via batson plexus
Axial skeleton
Radiographically: osteolytic (kidney, lung, GI, melenoma) osteoblastic (prostate and breat)

29
Q

Osteomyelitis overview

A

pyrogenic bacterial infection
80-90% Staph aureus (may see E coli, N gonorrhoeae, H influenza, sickle cell = salmonella
Reach bone by: blood, extension from contiguous site, direct implant
Healthy children: blood to long bone, mucosal injury
Adults: open fractures, surgery, diabetic infection

30
Q

Child osteomyelitis areas

A

infection in Knee (tibia, or femur), shoulder, wrist

31
Q

Adult osteomyelitis location

A

infection in mid femur, vertebrae, foot

32
Q

Child spread of infection

A

younger than 1 blood flow allows infection into epiphysis from diaphysis

up to 15 the infection is restricted to below the ephiphysis because of iteruption of vessels

33
Q

Tubeerculous osteomyelitis

A

incidence higher in los/middle income countries
1-3% of individuals with pulmonary or extrapulmonary tuberculosis
present in localized pain, low-grade fever, chills and weight loss
tends to be more destructive than pyogenic osteomyelitis

34
Q

tuberculous osteomyelitis histology

A

characterisitc caseating granulomas which cause progressive destuction of the bony trabeculae, necrosis

35
Q

skeletal syphilis

A

Syphilis and yaws
rare today
slowly progressive, chronic, inflammatory disease
edematous granulomas containing numerous plasma cells and necrotic bone
spirochetes localize to areas of active enchondral ossification and in periosteum

36
Q

skeletal syphilis key findings

A

extensive anterior cortical and periosteal thickening of the tibial diaphysis
saddle-shaped nasal deformity

37
Q

Osteonecrosis

A

fairly common
infarction of bone marrow causing bone necrosis
occurs in medullary cavity, involve medulla or cortex
complications: osteoarthritis and fracture

38
Q

Causes of osteonecrosis

A 
alcohol abuse
bisphosphonate therapy
connective tissue disorder
corticosteroid 
chronic pancreatitis
dysbarism (the bends)
gaucher disease
infection
pregnancy
radiation therapy
sickle cell crisis
trauma
tumors

MSK (6 decks)

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