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Rheumatology - Rutvi > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

What are the 4 things that you should be aware of for bone tumors to make the dx easier?

A
  1. age 2. sex 3. location 4. radiologic appearance of lesion
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2
Q

What is fibrous dysplasia?

A

benign, localized developmental arrest, no maturity of bone even though bone is present * 3 patterns - polyostotic, monostotic and McCure Albright Syndrome (poly)

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3
Q

What is McCure Albright syndrome?

A

cafe au lait skin pigmentation, endocrinpathies associated w/ this

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4
Q

What does histo for fibrous dysplasia look like?

A
  1. loose whorled pattern of fibroblastic tissue w/ irregular spicules of woven bone. 2. small islands of cartilage, chinese characters, poorly formed islets of bone. 3. Can undergo cystic degeneration.
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5
Q

x-ray for fibrous dysplasia?

A

large expansile, apparently medullary mass with a somewhat moth-eaten appearance adjacent to it

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6
Q

What is fibrous cortical defect?

A
  1. Eccentric, sharply delineated, metaphyseal lesion in long bones of adolescents
  2. usually occurs at metaphysis of femur and proximal tibia.
  3. Spontaneously resolves.
  4. 1/2 are bilateral or multiple, seen incidentally on xrays
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7
Q

What is the appearance of fibrous cortical defect?

A
  1. scooped out appearance w/ sclerotic margin.
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8
Q

What is a nonossiffying fibroma?

A

a large fibrous cortical defect (> 5/6 cm)

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9
Q

What is characteristic of nonossifying fibroma?

A

woven mat or storiform pattern

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10
Q

What are solitary bone cysts?

A
  1. benign fluid filled cysts
  2. thin, lytic bone lesions in males
  3. humerus/femur
  4. asymtompatic
  5. large lesion can lead to a fracture
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11
Q

What are aneurysmal bone cysts?

A
  1. bloody, cystic lesions
  2. usually in long bones/vertebral column,
  3. lesion is from the surface of the bone
  4. slow growing but can rapidly expand
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12
Q

This is aneurysmal bone cyst. What can be found in microscopic pathology?

A
  1. clotted blood
  2. giant cells – dont’ misDx giant cell tumor or TB
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13
Q

Tell me about benign bone neoplasms

A
  1. happens in 1st 3 decades in life mostly
  2. found on incidental xrays
  3. rarely undergo malignant transformation EXCEPT CHONDROMA
  4. usually removed only if cause pain
  5. examples : Osteoma, osteoid osteoma, osteochrondroma/chondroma, fibroma, giant cell tumor
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14
Q

What is an osteoma?

A
  1. round, projects from sub/endosteal surface of cortex
  2. slow growing
  3. usually solitary, mutiple seen in Gardner’s syndrome
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15
Q

What is osteoid osteoma?

A
  1. one of the more common representations of osteoma
  2. generally less than 2 cm
  3. teens/20’s – MALES
  4. 50% - in tibia/fibula
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16
Q

What is a primary characteristic of osteoid osteoma?

A
  1. Painful due to lesion making PGE2
  2. pain is more common at night, relieved by aspirin and alcohol
17
Q

What is osteochrondroma?

A
  1. also known as exostosis
  2. cartilage capped tumor – attached to underlying skeleton by stalk
  3. grows proximally to epiphyseal plate
18
Q

What is osteochrondoma due to?

A
  1. displacement of growth plate in endochrondal bones
  2. you can have a multiple hereditary exotosis which is AD and can give rise to chondrosarcoma
19
Q

What is a chrondroma?

A
  1. hyaline cartilage tumor
20
Q

What are the 2 types of chrondromas?

A
  1. endochrondroma - arises in medullary cavity
  2. juxtacortical - arises on surface of bones
21
Q

Where is an endochrondroma usually found?

A
  1. Metaphyses of tubular bones: hands/feet – usually solitary
  2. here is a pic of a phalanx - radiolucent nodules of hyaline cartilage scalloped endosteal surface
22
Q

What is it called when endochrondromas present w/ mutiple lesions?

A
  1. Ollier dz - nonhereditary syndrome
  2. Muffucci Syndrome - multiple enchondromas form as well as soft tissue hemangiomas
23
Q

What is Giant Cell Tumor of Bone?

A
  1. multinucleated osteoclast type giant cells that are locally aggressive
  2. cystic degeneration
24
Q

where is giant cell tumor of bone normally found?

A

in knee than bones of wrist.

* here is a pic of a soft, hazy neoplasm which appears to be destroying the distal femur

25
Q

tell me about malignant bone tumors

A
  1. rare
  2. 50% from blood forming cells and CT cells
  3. Mets are more common than primary bone tumors
26
Q

What is most common primary malignant bone tumor and where is it found in the body?

A

Osteosarcoma – in knee

* smaller peak of these in the elderly, in patients who have Paget disease of bone

27
Q

What is 2nd most common primary malignant bone tumor and where is it found in the body?

A

chrondrosarcoma – trunk and limb girdles

28
Q

What else has osteosarcoma been associated with?

A
  1. Retinoblastoma
  2. 20% have lung mets at time of dx
  3. Painful, progressively enlarging; fracture
29
Q

What is seen microscopically in osteosarcoma?

A

poorly formed bone spicules in between which is a cellular matrix with osteoid and malignant cells

30
Q

What is characteristic of an osteosarcoma? — BOARD QUESTION!

A

periosteal elevation on x-ray = Codman’s triangle

31
Q

What is chondrosarcoma?

A
  1. occur in the axial skeleton, characteristically in the trunk, pelvis, vertebrae and ribs
  2. May arise in association with preexisting enchondroma
  3. 35-60
  4. Rx = SURGERY
32
Q

What is characteristic of malignant bone tumor?

A

bulk of tumor is distal and some is proximal meaning that it doesn’t respect the joint spaces

33
Q

This is a chondrosarcoma - what do the cells look like at this level and what would they look like at a higher power?

A
  1. cellular neoplasm - mimic chondrocytes
  2. at higher power - look like malignant cells w/ high N:C ratio, nuclei, and mitotic figures
34
Q

What is Ewing Sarcoma?

A
  1. small, round blue cell tumor
  2. 10-15 yr, white
  3. arise in medulla of bone - diaphysis of long joints
  4. good prognosis - srugery and chemo!
35
Q

What cancer is this and what are you supposed to see in these cells?

A
  1. Ewing Sarcoma
  2. glycogen rich
  3. Homer-Wright Rosettes - tumor cells arranged in a circle about a central fibrillary space – possibly neural differentiation
36
Q

What do you see on xray for Ewing sarcoma – also what is the translocation?

A
  1. onion skin – layers of reactive perisoteum
  2. 11;22
37
Q

Tell me about bone Met tumors

A
  1. Adults > 75% of skeletal metastasis originate from prostate, breast, lung, and kidney
    • Kids: neuroblastoma, Wilms’ tumor, osteosarcoma, Ewing sarcoma (extraosseous) and rhabdomyosarcoma
    • Usually multifocal: vertebrae, pelvis, ribs, skull and sternum (marrow-rich areas)
    • XR: lytic, blastic or mixed lytic and blastic
    • Secrete substances that promote bone resorption

Rheumatology - Rutvi (7 decks)

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