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Pediatric EOR exam > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

characteristics of benign bone tumors

A
  • most are asymptomatic
  • do not weaken the bone typically
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2
Q

characteristics of malignant bone tumors

A
  • dull ache
  • progresses over time
  • worse with activity
  • constitutional sx
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3
Q

goal of the diagnostic evaluation for bone tumors

A
  • establish the tissue diagnosis
  • determine the extent of disease
  • consider surgical excision with aim to avoid amputation
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4
Q

initial imaging study of choice for bone tumor

A

Xray

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5
Q

xray findings for benign bone tumors

A
  • well defined
  • small
  • confined to natural barriers
  • lack of destruction of the cortex
  • lack of extension into the soft tissue
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6
Q

xray findings of malignant bone tumors

A
  • poorly defined borders
  • moth eaten appearance
  • spiculated
  • extension into soft tissue
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7
Q

what is an osteoid osteoma

A

overgrowth of bone tissue arising from osteoblasts

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8
Q

MC location for osteoid osteoma

A

femur

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9
Q

pathophys of osteoid osteoma

A

nidus surrounded by sclerotic bone is formed as the tissue proliferates and secretes prostaglandins

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10
Q

what is a Nidus

A

centrally located, disorganized mixture of small blood vessels, trabecula, and osteoid

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11
Q

what are s/s of osteoid osteoma

A
  • localized constant aching pain
  • worse at night
  • improves with NSAIDs or ASA
  • atypical juxta-articular presentation
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12
Q

what do you see on xray of osteoid osteoma

A

sclerosis around a lucent nidus (<1.5cm)

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13
Q

what is seen on bone scan of osteoid osteoma

A

double density

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14
Q

what is the management of osteoid osteoma

A
  • NSAIDs with f/u serial imaging
  • if sx become uncontrolled, refer to ortho
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15
Q

what is an osteoblastoma

A

slow growing tumor with nidus >2cm

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16
Q

mc location for osteoblastoma

A

posterior column of the spine

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17
Q

presentation of osteoblastoma

A
  • dull and achy pain not relieved with NSAIDs
  • sx depended to tumor location
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18
Q

what would you see on xray of osteoblastoma

A

well circumscribed radiolucent lesion with a nidus >2cm

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19
Q

how do you diagnose osteoblastoma

A

biopsy

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20
Q

what is the management of osteoblastoma

A

surgical resection

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21
Q

what are the methods of removal of osteoblastoma

A
  • curettage and burring followed by bone graft
  • marginal resection
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22
Q

what is an osteochondroma

A

benign, cartilage-capped bony projection

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23
Q

MC location for osteochondroma

A

knee and proximal humerus

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24
Q

t/f osteochondroma occurs adjacent to the growth plate

A

true

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25
Q

presentation of osteochondroma

A
  • most asx
  • painless mass near a joint
  • may have irritation of surrounding tendons, muscles, nerves
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26
Q

imaging of osteochondroma

A

bone spur

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27
Q

management of osteochondroma

A
  • asx: none
  • sx: surgical excision
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28
Q

malignant transformation of osteochondroma is suspected if…

A
  • new onset growth of lesion
  • new onset pain
  • rapid growth of lesion
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29
Q

what is an enchondroma

A

benign hyaline cartilage forming tumor that develops in the bone marrow of the long bones

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30
Q

mass growth of enchondroma occurs from (…) to (…)

A

metaphysis into diaphysis

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31
Q

mc location for enchondroma

A

hands and feet

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32
Q

enchondromatosis

A

non-hereditary, acquired, genetic mutation resulting in multiple enchondromas often with a unilateral predominance

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33
Q

s/s of enchondroma

A
  • most are asx
  • widening of bone
  • angular deformity
  • limb length discrepancy
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34
Q

enchondroma increases the risk of (…)

A

pathologic fractures

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35
Q

management of enchondroma

A
  • monitor with exam and imaging
  • curettage and bone grafting for sx lesions
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36
Q

risk factors for pathologic enchondroma fracture

A
  • weight bearing bone
  • > 25mm in diameter
  • involving >50% of the diameter of the cortex
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37
Q

t/f enchondromas are usually self limiting

A

true

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38
Q

enchondromas of the (…) may be complicated by malignant transformation to chondrosarcomas

A

long bones and pelvis

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39
Q

what is a chondroblastoma

A

benign cartilage forming tumor that usually arises in the epiphyses or apophyses of long bones

40
Q

MC site for chondroblastoma

A

epiphysis of the proximal humerus

41
Q

s/s of chondroblastoma

A
  • chronic pain that is middle and gradually progressive
  • constant and unrelated to activity
  • joint stiffness and swelling
42
Q

what would you see on xray of chondroblastoma

A

small, well defined lesion with a sclerotic border that may cross the physis

43
Q

(…) is indicated before surgery of chondroblastoma if lesion is atypical on imaging

A

biopsy

44
Q

management of chondroblastoma

A

curettage and bone grafting

45
Q

complications of chondroblastoma

A

benign pulmonary metastases

46
Q

what is fibrous dysplasia

A
  • abnormal fibrous tissue and trabecular bone replaces normal bone marrow and bone tissue
  • slow growing
47
Q

what genetic condition is associated with fibrous dysplasia

A

mccune albright syndrome

48
Q

s/s of fibrous dysplasia

A
  • pain/tenderness
  • shepherds crook (varus femur)
  • scoliosis
  • facial asymmetry
49
Q

what is seen on xray of fibrous dysplasia

A

lytic lesion with ground glass appearance

50
Q

what is the management of fibrous dysplasia

A
  • asx: serial exams and imaging
  • sx: curettage and bone graft and IV bisphosphonates
51
Q

what is an ossifying fibroma

A

destructive, deforming, slow growing, benign fibro osseous lesion

52
Q

MC location for ossifying fibroma

A
  • tibia and fibula in kids
  • mandible in adults
53
Q

what are the s/s of ossifying fibroma

A
  • localized, firm swelling in the area
  • bowed tibia
  • painless
54
Q

what would you see on xray of ossifying fibroma

A

well circumscribed intracortical lesion

55
Q

what is the management of ossifying fibroma

A
  • asx: repeat imaging and monitor
  • sx: resection, curettage, and bone graft after skeletal maturity
56
Q

MC benign bone lesion in kids

A

nonossifying fibroma

57
Q

what is a nonossifying fibroma

A

benign, non-aggressive tumor that consists mainly of fibrous tissue

58
Q

s/s nonossifying fibroma

A

-most are asx
-bone weakness and fracture

59
Q

what would you see on xray of nonossifying fibroma

A
  • small, well defined, eccentric, lytic lesions
  • usually in distal diaphysis/ metaphysis
60
Q

management of nonossifying fibroma

A
  • asx: none
  • curettage and grafting
61
Q

indications for surgical intervention of nonossifying fibroma

A
  • lesions of >50% of the bone
  • lesions in high stress area
62
Q

unicameral bone cysts

A

non-cancerous fluid filled lesions with fibrous lining

63
Q

what are the s/s of unicameral bone cysts

A
  • asx until pathologic fracture
  • growth plate dysfunction and limb length discrepancy
64
Q

what is seen on xray of unicameral bone cysts

A
  • well defined, cystic lesions at the metaphysis
  • generally involves entire diameter of bone
    -fallen leaf sign
65
Q

what is the management of unicameral bone cysts

A
  • spontaneous resolution after skeletal maturity
  • asx: observe and activity restrictions to avoid fractures
  • larger cysts: curettage and bone graft
66
Q

if concerned about risk of fracture due to unicameral bone cysts…

A

aspirate cyst and inject methylprednisolone or bone marrow

67
Q

what is an aneurysmal bone cyst

A

benign, rapidly growing and destructive blood-filled lesion

68
Q

MC site of aneurysmal bone cyst

A

tibia

69
Q

s/s of aneurysmal bone cyst

A

-localized pain, tenderness, and swelling

70
Q

xray of aneurysmal bone cyst

A
  • eggshell
  • soap bubble
71
Q

management of aneurysmal bone cyst

A
  • excision, curettage, and bone graft
  • surgical arterial embolization to prevent hemorrhage
72
Q

MC malignant bone tumor

A

Osteosarcoma

73
Q

MC location of Osteosarcoma

A

metaphysis of long bone

74
Q

risk factors for Osteosarcoma

A
  • prior radiation or chemo
  • paget disease, fibrous dysplasia
  • genetic predisposition
75
Q

s/s of Osteosarcoma

A
  • pain and swelling
  • worsened with activity
  • palpable mass
  • limping
76
Q

xray of Osteosarcoma

A
  • osteolytic and osteoblastic lesions
  • moth eaten appearance
  • starburst appearance
  • codman’s triangle
77
Q

codman’s triangle

A

new bone formation at periosteum

78
Q

what do you utilize after xray to look for multifocal or metastatic disease?

A

bone scan

79
Q

(…) is utilized for each lesion after identified on bone scan

A

CT/MRI

80
Q

management of Osteosarcoma

A
  • refer to oncology ortho for biopsy
  • pre- and post-op chemo with limb sparing surgery
81
Q

t/f Osteosarcoma responds to radiation

A

false

82
Q

chondrosarcoma

A

tumor arising from the chondrocytes

83
Q

s/s of chondrosarcoma

A
  • deep, dull aching pain that is gradually progressive
  • worse at night
84
Q

xray of chondrosarcoma

A
  • bony contour seems thinned and expanded
  • endosteal scalloping
  • > 5cm
85
Q

confirm dx of chondrosarcoma

A

biopsy

86
Q

MC metastasis location of chondrosarcoma

A

lungs

87
Q

management of chondrosarcoma

A

refer for surgical excision

88
Q

ewing sarcoma

A

rare, peripheral primitive neuroectodermal tumor that can proliferate in the bone and or soft tissue

89
Q

ewing sarcoma results from…

A

translocation of chromosomes 11 and 22

90
Q

mc sites of ewing sarcoma

A

femur and pelvis

91
Q

s/s of ewing sarcoma

A
  • pain and swelling
  • palpable mass
  • worse with activity or at night
  • constitutional sx
92
Q

what would you see on xray of ewing sarcoma

A
  • poorly marginated lesion
  • onion skin
93
Q

management of ewing sarcoma

A

multidrug chemo with surgery +- radiation

94
Q

s/s of metastatic bone disease

A
  • pain over metastatic location
  • pathologic fracture
  • anemia
95
Q

diagnosis of metastatic bone disease

A
  • xray first, then other imaging
  • biopsy to confirm and determine primary site
96
Q

treatment of metastatic bone disease

A
  • MC radiation + pain meds
  • chemo
  • bisphosphonates

Pediatric EOR exam (20 decks)

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