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Organ Systems- Rheum > Bone tumors > Flashcards

Bone tumors Flashcards

1
Q

What are the four pieces of information critical in diagnosis of a mass in bone?

A

Age, sex, location, radiographic appearance (NOT histo)

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2
Q

What malignant tumors occur in the diaphysis?

A

Ewing’s sarcoma, chondrosarcoma

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3
Q

What benign tumors occur in the diaphysis?

A

Endosarcoma, fibrous dysplasia

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4
Q

What malignant tumors occur in the metaphysis?

A

osteosarcoma, juxtacortical osteosarcroma

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5
Q

What benign tumors occur in the metaphysis?

A

osteoblastoma, osteochondroma, non-ossifying fibroma, osteoid osteoma, chondromyxoid fibroma, giant cell tumors

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6
Q

What benign tumors occur in the epiphysis?

A

Chondroblastoma and giant cell tumors

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7
Q

What are the 3 distinctive fibrous dysplasia patterns?

A

monostotic: single bone
polyostotic: multiple bones
McCune Albright syndrome: polyostotic, cafe au lait skin pigmentation, endocrinopathies

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8
Q

What kind of fibrous dysplasia may transform to osteosarcoma?

A

polyostotic disease

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9
Q

_____ is a benign lesion with localized developmental arrest. All components on bone are present but do not mature.

A

Fibrous dysplasia

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10
Q

Where in the bone is fibrous dysplasia usually seen?

A

Diaphysis

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11
Q

How does fibrous dysplasia look on x-ray?

A

ground-glass lucent appearance with well-demarcated borders. Can appear moth-eaten

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12
Q

Describe the histology of fibrous dysplasia.

A

Loose, whorled “Chinese Characters” pattern of FIBROBLASTIC tissue with irregular spicules of bone. Lack osteoblastic activity–> lots of collagen. Can undergo cystic degeneration.

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13
Q

How common are fibrous cortical defects?

A

Very- 30-50% of all children less than 2 y/o have these.

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14
Q

Where in the bone are fibrous cortical defects seen?

A

metaphysis of femur and proximal tibia

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15
Q

How many lesions are present with fibrous cortical defects?

A

1/2 are bilateral or multiple

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16
Q

What is a nonossifying fibroma?

A

A fibrous cortical defect that is bigger than 5-6 cm

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17
Q

How does fibrous cortical defect look in X-ray? What age is it usually presented in?

A

“Ice cream scoops” eccentric, sharply delineated, metaphyseal lesion with dense sclerotic borders. Usually adolescents.

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18
Q

Clinical features of fibrous cortical defect?

A

Seen in adolescents, few or no symptoms except pain, usually found incidentally on xray, fractures can occur through thinned cortex

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19
Q

Gross pathology of fibrous cortical defect

A

granular and brown or dark red, eccentric, sharply delimited

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20
Q

What is the histological appearance of nonossifying fibroma?

A

Storiform- woven mat

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21
Q

Describe solitary bone cysts.

A

benign, fluid-filled cyst, thing lytic bone lesion,that is not a true neoplasm but a growth abnormality and is usually asymptomatic.

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22
Q

Where are solitary bone cysts usually seen?

A

humerus or femur (2/3)

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23
Q

Who do solitary bone cysts usually occur in?

A

children and adolescents, usually male

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24
Q

Symptoms of solitary bone cysts

A

usually asymptomatic but can contribute to pathological fracture

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25
Q

____ are very bloody, cystic lesions that appear like a “sponge filled with blood” that can contribute to fractures.

A

aneurysmal bone cyst

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26
Q

What does an aneurysmal bone cyst look like histologically?

A

Clotted blood and highly vascularized tissue. Giant cells could be present as well.

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27
Q

T or F. Aneursymal bone cyst is a true tumor.

A

F

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28
Q

Where do aneurysmal bone cysts usually arise?

A

Arise from surface of the bone. Long bones and vertebral column

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29
Q

What age group can present with aneurysmal bone cysts?

A

children and young adults

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30
Q

How fast to aneursymal bone cysts grow?

A

usually slow, but can rapidly expand

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31
Q

What may be encountered in surgery with aneurysmal bone cysts?

A

brisk bleeding.

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32
Q

What are the benign primary bone neoplasms?

A

osteoma, osteoid osteoma, osteochondroma/chondroma, fibroma, giant cell tumor

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33
Q

When is the greatest frequency of benign primary bone neoplasms?

A

first3 decades of life

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34
Q

Do benign primary bone neoplasms undergo malignant transformation?

A

rarely EXCEPT FOR CHONDROMA–> CHONDROSARCOMA

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35
Q

Describe osteoma.

A

Benign primary bone neoplasm. Bone forming tumor. Round tumors that project from sub- or endosteal surfaces of cortex. Slow growing usually of little significance unless they cause obstruction

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36
Q

Describe the number of lesions seen in osteoma.

A

usually solitary. multple seen in Garnder’s syndrome which involves GI tract

37
Q

____ is a benign primary bone neoplasm of osteoblasts.

A

osteoid osteoma

38
Q

Size of osteoid osteoma lesion

A

less than 2 cm

39
Q

Age group presenting with osteoid osteoma

A

teens and twenties

40
Q

Location of osteoid osteoma

A

50% involve tibia and fibula, usually cortical.

41
Q

Describe symptoms associated with osteoid osteoma.

A

Painful- produce PGE2 and have characteristic pattern of pain. They are more commonly painful at night and they are relieved by aspirin. Intake of alcohol causes a massive increase in pain.

42
Q

Sex predominance of osteoid osteoma

A

M 2:1

43
Q

Describe osteochondroma

A

benign, cartilage capped tumor that is attached to underlying skeleton by a stalk. Involves displacement of growth plate in endochondral bone.

44
Q

What genetic condition exists with osteochondroma

A

Mutliple hereditary exostosis. AD that rarely gives rise to chondrosarcoma

45
Q

What do osteochondromas look like on x-ray

A

cauliflower at epiphyseal plate

46
Q

___ are benign tumors of hyaline cartilate

A

Chondroma

47
Q

What kind of chondroma arises in medullary cavity of tubular bones like hand and feet?

A

enchondroma

48
Q

What kind of chondroma arises on the surface of bones?

A

Juxtacortical

49
Q

How many lesions are usually seen with enchondromas?

A

usually solitary

50
Q

What part of the bone is enchondroma usually associated with?

A

metaphysis of tubular bones of hands and feet

51
Q

What are they syndromes of multiple enchondromas?

A
  1. Ollier disease: non hereditary syndrome of multiple formation enchondromas
  2. Maffucci syndrome: multiple enchondromas form as well as soft tissue hemangiomas
52
Q

What do enchondromas cause?

A

pathologic fracture of phalanx

53
Q

What do enchondromas look like radiologically?

A

radiolucent nodules of hyaline cartilage scalloped endosteal surface

54
Q

What age group do you see giant cell tumors in?

A

20s to 40s

55
Q

Where do giant cell tumors occur

A

most commonly around the knee, can also be wrist

56
Q

Describe giant cell tumors

A

multinucleated osteoclast type giant cells. Benign but uncommon. Locally aggressive and can undergo cystic degeneration

57
Q

Does histology help in diagnosis of giant cell tumors? What should you watch out for?

A

yes- look for multinucleated giant cells. But you dont want to miss TB.

58
Q

Are you more likely to get malignant primary bone tumor or secondary?

A

secondary

59
Q

Half of primary malignant bone tumors are derived from what?

A

blood forming cells and connective tissue cells like, the commenest condition being MM

60
Q

Sites from which metastases occur to the bone are:

A

breast, prostate, lung, kidney, thyroid cancers

61
Q

____ is the most common primary bone tumor

A

osteogenic sarcoma

62
Q

Where is osteosarcoma commonly seen?

A

knee joing

63
Q

Where is chondrosarcoma seen?

A

trunk and limb girdles

64
Q

Where is ewings sarcoma usually seen?

A

diaphysis of bone

65
Q

75% of osteogenic sarcomas occur in what age group?

A

people under 20

66
Q

There is a peak of osteogenic sarcomas in the elderly that have what?

A

Paget’s disease or irradiation

67
Q

What cancer associations can be made with osteogenic sarcoma?

A

Retinoblastoma, Rb, M2M2, 20% have lung metastases at presentation

68
Q

Symptoms of osteogenic sarcoma

A

Painful lesions that are progressively enlarging and cause fracture. Often these come to attention because of some other sporting injury.

69
Q

What is different about the location of osteogenic sarcomas in the elderly?

A

seen in bones of pelvis and skull

70
Q

radiological appearance of osteosarcoma (osteogenic sarcoma)

A

Lifted periosteum forms triangular shell of reactive bone; CODMAN TRIANGLE. Prominant bone formation that extends into soft tissue.

71
Q

Age group for chondrosarcoma

A

35-60

72
Q

____ is the 2nd most common primary malignant bone tumor.

A

Chondrosarcoma

73
Q

Chondrosarcoma may arise with preexisting ____.

A

enchondroma

74
Q

XRAY appearance of chondrosarcoma

A

can traverse joint spaces, appears lytic but isnt, scalloped endosteal surfaces

75
Q

Age group of Ewing’s sarcoma

A

white 10-15

76
Q

85% of Ewing’s sarcoma have what genetic signature?

A

PNETs: t(11:22)–> relate them to neuroectodermal tumors

77
Q

Survival rate of Ewing’s sarcoma?

A

75% 5yr survival with surgery and chemo

78
Q

Where do Ewing’s sarcomas occur?

A

diaphysis of long bone- arise in medulla

79
Q

What do ewings sarcomas look like on x-ray?

A

onion skin

80
Q

______ is a small round blue cell tumor

A

Ewings sarcoma

81
Q

What do Ewings sarcoma look like histologically?

A

Small round blue cells, glycogen rich, Homer-wright rossettes: tumor cells are arranged in a circle about a central fibrillary space- possible neural differentiation

82
Q

_____ are the most common tumors in bone

A

metastatic bone tumors

83
Q

in adults, over 75% of metastatic bone tumors arise from _____.

A

prostate, breast, lung, and kidney

84
Q

What metastatic bone tumors are common in children?

A

neuroblastoma, wilms tumor, osteosarcoma, ewing sarcoma, and rhabdomyosarcoma

85
Q

Describe metastatic bone tumors

A

usually multifocal, vertebrae, pelvis, ribs, skull, sternum, lytic, blastic, or mixed lytic and blastic

86
Q

_____ secrete substances that promote bone resorption

A

metastatic bone tumros

87
Q

What do metatstatic bone tumors from renal cancer look like

A

white neoplasms with red centers that bleed easily and can have hemosiderin

88
Q

Breast carcinoma metastases are mostly ____.

A

sclerotic

Organ Systems- Rheum (10 decks)

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