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Rheum Lectures > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

What areas of the body with Paget’s disease most likely afflict?

A

Skull, Pelvis, Vertebrae, Tibia (Long bone)

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2
Q

What areas of the body with fibrous displasia most likely afflict?

A

Shoulder (Joints)

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3
Q

What areas of the body will enchondroma most likely afflict?

A

Wrist and Ankle (hands and feet)

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4
Q

What areas of the body will Osteochondroma and Chondroblastoma likely afflict?

A

Elbow and Knee (bones on either side of the joint)

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5
Q

What areas of the body with Chordoma likely afflict?

A

Nose and Ribs

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6
Q

What areas of the body with osteoblastoma likely afflict?

A

Neck (Vertebrae)

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7
Q

What ares of the body will Osteosarcoma likely afflict?

A

Long bones (proximal humerus, shaft of the femur, distal femur, proximal tibia shown)

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8
Q

What areas of the body will Chondrosarcoma likely affect?

A

Hip

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9
Q

What areas of the body will Giant cell tumors affect?

A

Shown are distal radius, all parts of the femur, and proximal tibia

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10
Q

What benign tumors occur in the epiphysis?

A

Chondroblastoma and Giant Cell tumors

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11
Q

What benign tumors occur in the metaphysis?

A

Osteoblastoma, osteochondroma, non-ossifying fibroma, osteoid osteoma, chondromyxoid fibroma, giant cell tumor

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12
Q

What benign tumors occur in the diaphysis?

A

Enchondroma, Fibrous dysplasia

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13
Q

What malignant tumors occur in the diaphysis?

A

Ewing’s sarcoma, chondrosarcoma

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14
Q

What malignant tumors occur in the metaphysis?

A

Osteosarcoma, juxacortical osteosarcome

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15
Q

Describe fibrous dysplasia.

A

Benign, localized developmental arrest in which all components of the bone are present but do not mature

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16
Q

What are the 3 distinctive patterns of fibrous dysplasia?

A

Monostotic (single bone), polyostotic (multiple bones), and McCune Albright syndrome which is polyostotic, cafe-au-lait skin pigmentation, and endocrinopathies

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17
Q

What may polyostotic disease progress to?

A

Osteosarcoma

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18
Q

On x-ray describe fibrous dysplasia

A

Lucent ground glass appearance with well demarcated borders

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19
Q

What are the histologic buzzwords of fibrous dysplasia?

A

Loose whorled pattern of fibroblastic tissue; irregular spicules

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20
Q

What is fibrous corticol defect?

A

An eccentric, sharply delineated, metaphyseal lesion in long bones of adolescents (A.K.A. benign fibrous histiocytoma if mass forming and involving medullary cavity)

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21
Q

What are the clinical features of fibrous corticol defect?

A

30-50% of all children > 2 (COMMON!), few to no symptoms except pain, and fractures can occur in thinned cortex

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22
Q

Where does fibrous corticol defect occur and how is it found?

A

Proximal tibia or distal femur and detected incidentally on radiography (Scooped out lesions! and about half are bilateral)

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23
Q

How is fibrous corticol defect treated?

A

It isn’t, usually resolves spontaneously

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24
Q

Describe gross pathology of fibrous corticol defect.

A

Granular dark brown/red, eccentric, sharply delimited

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25
Q

What is the buzzword for Nonossifying fibromas for x-ray?

A

Scerotic margin with a woven mat/storiform pattern

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26
Q

What are solitary bone cysts?

A

They are benign fluid filled cysts and tend to have very thin margins of bone that appear lytic

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27
Q

Where do solitary bone cysts occur?

A

Generally in the humerus or femur (2/3rds)

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28
Q

What are the clinical features of solitary bone cysts?

A

Usually asymptomatic but if large enough they can contribute to a fracture

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29
Q

What are aneurysmal bone cysts?

A

They are bloody, cystic lesions that are also not true tumors

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30
Q

Where do aneurysmal bone cysts form?

A

Anywhere but usually found in the long bones and vertebral column

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31
Q

What is the complication with aneurysmal bone cysts?

A

May contribute to fractures, but if not expected can lead to operative challenges due to bleeding; generally grow slowly but can come to attention from rapid expansion

32
Q

When are benign primary bone neoplasms most frequent?

A

First 3 decades of life

33
Q

How are benign primary bone neoplasms found and treated?

A

They are usually found only incidentally on x-ray and only removed if they cause pain

34
Q

Do primary bone neoplasms undergo malignant transformation?

A

Rarely, except chondromas

35
Q

What lesions are included in the group of benign primary bone lesions?

A

Osteoma, osteoid osteoma, osteochrondroma/chondroma, fibroma, giant cell tumors

36
Q

What is an osteoma?

A

It is a bone forming tumor; they are round tumors that project from sub or endosteal surfaces

37
Q

Are osteomas multiple or single?

A

Usually single and multiple in Gardner’s syndrome

38
Q

Are osteomas clincally significant?

A

Generally no, slow growing, and only a problem if they cause obstruction

39
Q

What is an osteoid osteoma?

A

A more common representation of osteomas and generally <2 cm in size, occurring in teens/twenties and more in males

40
Q

Where are osteoid osteomas usually found?

A

50% in tibia and fibula, usually cortical

41
Q

What is the primary characteristic of osteoid osteomas?

A

They are painful, and produce PGE2; more painful at night; relieved by aspirin; alcohol increases pain

42
Q

What is an osteochondroma?

A

Synonym: exostosis; they are benign cartilage capped tumors that attach to underlying skeleton by a stalk

43
Q

What are osteochondromas related to?

A

Displacement of growth plate in endochondral bone

44
Q

What is multiple hereditary exostosis?

A

It is AD and rarely gives rise to chondrosarcomas

45
Q

If you see a little outpouch of cartilage near the epiphyseal plate, waht is it?

A

Osteochondromas

46
Q

What is a chondroma?

A

A benign tumor of hyaline cartilage

47
Q

What are endhondromas?

A

chondromas that arise in medullary cavity, typically in the hands and feet

48
Q

What are juxtacortical chondromas?

A

They arise on the surface of bones

49
Q

Are enchondromas usually multiple or solitary?

A

Solitary

50
Q

What diseases are multiple enchondromas/enchondromatosis seen in?

A

Ollier dz (nonhereditary syndrome) and Maffucci syndrome (multiple enchondromas and hemangiomas)

51
Q

What are giant cell tumors of bone?

A

Multinucleated osteoclast type giant cells that are benign but uncommon, locally aggressive, occur from 20’s-40’s, undergo cystic degeneration, and arise around the knee (2ndary area is wrist)

52
Q

What are malignant bone tumors?

A

They are rare primary bone neoplasms, half of which are derived from blood forming cells (commonest is multiple myeloma)

53
Q

What are the most common bone tumors?

A

(Secondary) metastatic bone tumors

54
Q

What are the sites from which metastases occur to the bone?

A

Breast, prostate, lung, kidney, and thyroid

55
Q

What is special about the occurrence of malignant primary bone tumors?

A

They occur in specific bones at certain ages

56
Q

Where do osteosarcomas occur and how common are they (with respect to primary lesions)?

A

Most common primary malignant bone tumor in the knee

57
Q

Where do chondrosarcomas occur and when?

A

Adults and in cartilage, trunk and limb girdles

58
Q

What is ewing’s sarcoma?

A

Peripheral primitive neuroectodermal tumor, occurs in children and young adults at the diaphysis of bones

59
Q

75% of osteosarcomas occur in what patient group?

A

Patients younger than 20; but also in the elderly, in patients with Paget’s, or who have been irradiated.

60
Q

What are osteosarcomas associated with?

A

Retinoblastomas; Rb; MDM2

61
Q

Are osteosarcomas painful?

A

Yes, also enlarging, and fracture

62
Q

When osteosarcomas result in periosteal elevation what is this called?

A

The codman triangle on radiography; it is NOT necessarily diagnostic

63
Q

Where do chondrosarcomas occur?

A

In the axial skeleton: trunk, pelvis, vertebrae, ribs; rare in the distal extremeties; In the diaphysis or metaphysis

64
Q

What age group are chondrosarcomas prevalent in?

A

Ages 35-60

65
Q

How common are chondrosarcomas?

A

2nd most common primary malignant bone tumor

66
Q

How do you treat chondrosarcomas?

A

Surgery, insensitive to chemotherapy

67
Q

What is an Ewing sarcoma?

A

Small round blue cell tumor

68
Q

When do ewing sarcomas occur?

A

Ages 10-15; in whites

69
Q

What translocation is Ewing sarcoma associated with?

A

t(11,22)+

70
Q

Where do ewing sarcomas arise?

A

Medulla; primarily in diaphysis of long bones

71
Q

In cross section, what is unique about ewing sarcoma?

A

Their onion skin appearance; layers of reactive periosteum

72
Q

What is the treatment for ewing sarcoma?

A

75% 5-year survival with surgery and chemo

73
Q

What cells are characteristic of ewing sarcoma?

A

Cmall round blue cells; they are glycogen rich cells that tend to form small structures called Homer-Wright rosettes which are tumor cells arranged in a circle around a central fibrillary space

74
Q

How frequent are metastatic bone tumors?

A

They are the MOST COMMON TUMORS IN BONE! and >75% of skeletal metastasis originate from prostate, breast, lung, and kidney

75
Q

What are metastatic bone tumors associated with in children?

A

Neuroblastoma, wilm’s tumor, osteosarcoma, ewing sarcoma, and rhabdomyosarcoma

76
Q

Are metastatic bone tumors multifocal?

A

Yes: vertebrae, pelvis, ribs, skull, and sternum (marrow rich areas)

77
Q

What will you see with an XR with metastatic bone tumors?

A

Lytic, blastic, or mixed

Rheum Lectures (7 decks)

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