Bone Path II Quiz 2 Flashcards
What is the most common benign tumor of BONE?
Osteochondroma
Who does Osteochondromas affect?
<20= 75%
What do Osteochondromas look like on film?
Single Lesion
Sessile or Pedunculated
Bony exostosis: cortex continuous projecting away from joint.
Cartilagenous cap
Where are most Osteochondromas?
85% in Femur, Humerus, Tibia
Metaphysis of long bone
Any bone with cartilagenous cap.
Can Osteochondromas turn malignant?
Yes in >30.
Look for Pain, Osseous destruction, ST mass, Thickening of cartilaginous cap
Multiple Osteochondromas are called…
Hereditary Multiple Exocytosis
How many lesionsa re seen in Hereditary Multiple Exocytosis?
Ave 10, but hundreds possible
What age group does Hereditary Multiple Exocytosis affect?
Dx at 2-10
Can Hereditary Multiple Exocytosis become malignant?
Yes in 20% cases
What are the signs/symptoms of Hereditary Multiple Exocytosis
Painless, lumpy joints
30% of time, Hereditary Multiple Exocytosis results in _ of the wrist
Beyonet wrist deformity (Madenlung’s)
What is the most common benign tumor of SPINE
Hemangioma
What age group does Hemangiomas affect?
Most >40
What do Hemangiomas look like on x-ray
Single lesion (lytic)
Normal Cortex
Rare body expansion
Coarse vertical striation “corduroy cloth” appearance
Where do you most commonly find Hemangiomas?
75% in Spine & Skull
What are the symptoms of Hemangiomas?
Most ASYMPTOMATIC, but can cause neurologic compromise due to location in spine and skull.
Where do you find Osteomas and what do they look like?
Osteomas are round/oval well defined sclerotic lesions found in membranous bones (frontal & ethmoid bone)
Are osteomas painful?
No, most asymptomatic
What is the Triad of _ called
- Multiple osteomas
- Chronic polyps
- Soft tissue fibromas
Gardner’s Syndrome
Is Gardners Syndrome a genetic disorder?
Yes, Autosomal dominalt
What is the big dea about polyps found in Gardners Syndrome?
They are considered premalignant.
Where can you find Bone Islands?
Any bone except skull. Rare in vertebrae.
Describe Bone Islands
Sclerotic Sharp margins Solitary Lesion Round Homogeneously dence Radiating Specules (diagnostic)
What is another name for a Bone Island?
Enostoma
What age population do Osteoid Osteomas affect?
10-25 y.o
What are the Classic Symptoms of Osteoid Osteomas?
Increasingly severe, deep, aching pain.
Not relieved by rest, worse at night.
Relieved by asprin.
Can osteoid Osteomas referr pain?
Yes, 30% refer to nearby joint.
Do you see swelling, tenderness, or stiffness in osteoid osteomas?
Yes.
Where to most Osteoid Osteomas occur?
Any bone
Cortical most common
50% in femur and tibia
What are the plain film findings of Osteoid Osteomas?
Cortical Lesion (80%)
Reactive Sclerosis
Lucent round nidus
Intramedullary and intracapsilar much less sclerotic
What do you DDX with Osteoid Osteomas?
Stress Fracture
Brodies Abscess
Bone Island (normal to bone scan)
Osteoblastoma
Histologically, what are Osteoblastomas similar to?
Osteoid Osteomas
What age group does Osteoblastomas affect?
70% are <20
What are the common locations for Osteoblastomas?
Neural Arch of Spine
Long bone Meta/Diaphysis
Hands, Feet, Skull, Face
How do Osteoblastomas and Osteoid Osteomas compare in symptoms?
Less Painful
Not nocturnal
Not Relieved by Asprin
50% of Osteoblastomas in the spine result in what?
Painful Scoliosis
How does Osteoblastomas affec surrounding tissue?
Spasms
Rigidity
Referred pain
Spinal Steonosis
What to Osteoblastomas look like in the Spine?
Espansile
Thin cortical periphery
Most Lytic
What do Osteoblastomas look like in the Extremities?
Lytic, expansile
Epiphysis spared
Cortex thin, may disrupt
What is the 2nd most common benign tumor of bone?
Enchondroma
What age groups do Enchondromas usually affect?
10-30
Are pathologic fractures common with enchondromas?
Yes
Where do you most commonly find Enchondromas?
50% phalanges
50% femur, tibia humerus, ribs.
What is noteworthy about Enchondromas near the axial skeleton?
They are more ofyten symptomatic and higher likelihood of becoming malignant
What do Enchondromas look like on film?
Geographic Lytic Expansile Thinned Cortex Metaphyseal-Diaphyseal Calcification in 50% No ST mass
What is another name for Multiple Enchondromastosis?
Olliers Disease
Are Multiple Enchondromasosis bilateral?
No, they are unilateral
Can Multiple Enchondromatosis Cause growth changes?
Yes, often result in shortened limb
What is the Malignant Transformation rate of Multiple Enchondromatosis?
25-50%->
Osteosarcoma, Chondrosarcoma, Fibrosarcoma
Multiple Enchondromatosis with Soft Tissue Hemangiomas/Phleboliths is called _
Maffucci’s Syndrome
Chondroblastomas are AKA
Codman’s Tumor
What age group does Chondroblastomas usually affect?
5-25
What is the local recurrance rate of Chondroblastomas?
20%
Where do you most often find Chondroblastomas?
2/3 lower extermity (50% knee)
Epiphyseal, but may extend into metaphysis.
What do Chondroblastomas look like on plain film?
Lytic Geographic Epiphyseal Sharp Zone of Transition Calcification in 50%
What do you DDX with Chondroblastomas?
Giant Cell
Clear Cell Chondrosarcomas
What age group does Chondromyxoid Fibroma affect?
10-30 yo
What are the sx of Chondromyxoid Fibromas?
Local Pain & Swelling.
What is the most common location for Chondromyxoid Fibromas?
50% in tibia
What are the film findings for Chondromyxoid Fibromas?
Eccentric
Lytic
Soap Bubbly
Fibrous Xanthomas comprise what two bone tumors?
Nonossifying Fibroma
Fibrous Cortical Defect
What are the difference between Nonossifying Fibroma and Fibrous Cortical Defect?
Nonossifying Fibroma
- 8-20 yo
- > 2cm
- Extends to medullary cavity
Fibrous Cortical Defect
- 2-8 yo
- <2cm
- Cortex
What is the outlook for Fibrous Xanthomas? (NOF & FCD)
Spontaneous resolution over 2-4 years
What % of children have FCD?
30-40%
Where are Fibrous Xanthomas most often found?
90% in tibia or fibula
What are the plain film findings for Fibrous Xanthomas?
Lytic, ovoid Eccentric Sclerotic boarder Sclerotic when healing Mild on bone scan
Are Simpe Bone Cysts true neoplasms?
No, they are fluid filled cyst
What age group does Simple Bone cyst affect?
3-14 y/o
What are the symptoms of Simple Bone Cysts?
They are asymptomatic
What is the big risk with Simple Bone cysts?
Pathologic fracture
How do you reduce recurrance of Simple Bone Cysts?
Steroid injection into cyst
What is the location of Simple Bone Cysts?
Central
75% in Proximal Humerus or Femur
What are the plain film findings for Simple Bone Cysts?
Geographic, Lytic.
Bone expansion, but not beyond physis.
“Fallen Fragment” sign with fracture
A cystic blood filled cavility tumor is called _
Aneurysmal Bone Cyst
What age group does Aneurysmal Bone Cyst affect?
5-20
What is the big risk o Aneurysmal Bone Cyst.
What is the recurrence rate?
Pathologic Fracture.
Recurrance high
What is the treatment for Aneurysmal Bone cyst?
Surgery
What is the location for Aneurysmal Bone Cysts?
Long Tubular Bones
Metaphysis/Diaphyseal
Posterior arch of spine (painful scoliosis)
What are the plain film findings of Aneurysmal Bone Cysts?
Expansile Lytic Eccentric Thinned cortex Metaphysis/Diaphysis
What is the only benign tumor to cross growth plate?
Aneurysmal Bone Cyst
What tumors have a fluid level seen on CT and MRI?
Aneurysmal Bone Cyst
Osteosarcomas
Giant Cell Tumors
Chondroblastomas
