Bone Tumors Flashcards
characteristics of benign bone tumors
- most are asymptomatic
- do not weaken the bone typically
characteristics of malignant bone tumors
- dull ache
- progresses over time
- worse with activity
- constitutional sx
goal of the diagnostic evaluation for bone tumors
- establish the tissue diagnosis
- determine the extent of disease
- consider surgical excision with aim to avoid amputation
initial imaging study of choice for bone tumor
Xray
xray findings for benign bone tumors
- well defined
- small
- confined to natural barriers
- lack of destruction of the cortex
- lack of extension into the soft tissue
xray findings of malignant bone tumors
- poorly defined borders
- moth eaten appearance
- spiculated
- extension into soft tissue
what is an osteoid osteoma
overgrowth of bone tissue arising from osteoblasts
MC location for osteoid osteoma
femur
pathophys of osteoid osteoma
nidus surrounded by sclerotic bone is formed as the tissue proliferates and secretes prostaglandins
what is a Nidus
centrally located, disorganized mixture of small blood vessels, trabecula, and osteoid
what are s/s of osteoid osteoma
- localized constant aching pain
- worse at night
- improves with NSAIDs or ASA
- atypical juxta-articular presentation
what do you see on xray of osteoid osteoma
sclerosis around a lucent nidus (<1.5cm)
what is seen on bone scan of osteoid osteoma
double density
what is the management of osteoid osteoma
- NSAIDs with f/u serial imaging
- if sx become uncontrolled, refer to ortho
what is an osteoblastoma
slow growing tumor with nidus >2cm
mc location for osteoblastoma
posterior column of the spine
presentation of osteoblastoma
- dull and achy pain not relieved with NSAIDs
- sx depended to tumor location
what would you see on xray of osteoblastoma
well circumscribed radiolucent lesion with a nidus >2cm
how do you diagnose osteoblastoma
biopsy
what is the management of osteoblastoma
surgical resection
what are the methods of removal of osteoblastoma
- curettage and burring followed by bone graft
- marginal resection
what is an osteochondroma
benign, cartilage-capped bony projection
MC location for osteochondroma
knee and proximal humerus
t/f osteochondroma occurs adjacent to the growth plate
true
presentation of osteochondroma
- most asx
- painless mass near a joint
- may have irritation of surrounding tendons, muscles, nerves
imaging of osteochondroma
bone spur
management of osteochondroma
- asx: none
- sx: surgical excision
malignant transformation of osteochondroma is suspected if…
- new onset growth of lesion
- new onset pain
- rapid growth of lesion
what is an enchondroma
benign hyaline cartilage forming tumor that develops in the bone marrow of the long bones
mass growth of enchondroma occurs from (…) to (…)
metaphysis into diaphysis
mc location for enchondroma
hands and feet
enchondromatosis
non-hereditary, acquired, genetic mutation resulting in multiple enchondromas often with a unilateral predominance
s/s of enchondroma
- most are asx
- widening of bone
- angular deformity
- limb length discrepancy
enchondroma increases the risk of (…)
pathologic fractures
management of enchondroma
- monitor with exam and imaging
- curettage and bone grafting for sx lesions
risk factors for pathologic enchondroma fracture
- weight bearing bone
- > 25mm in diameter
- involving >50% of the diameter of the cortex
t/f enchondromas are usually self limiting
true
enchondromas of the (…) may be complicated by malignant transformation to chondrosarcomas
long bones and pelvis
what is a chondroblastoma
benign cartilage forming tumor that usually arises in the epiphyses or apophyses of long bones
MC site for chondroblastoma
epiphysis of the proximal humerus
s/s of chondroblastoma
- chronic pain that is middle and gradually progressive
- constant and unrelated to activity
- joint stiffness and swelling
what would you see on xray of chondroblastoma
small, well defined lesion with a sclerotic border that may cross the physis
(…) is indicated before surgery of chondroblastoma if lesion is atypical on imaging
biopsy
management of chondroblastoma
curettage and bone grafting
complications of chondroblastoma
benign pulmonary metastases
what is fibrous dysplasia
- abnormal fibrous tissue and trabecular bone replaces normal bone marrow and bone tissue
- slow growing
what genetic condition is associated with fibrous dysplasia
mccune albright syndrome
s/s of fibrous dysplasia
- pain/tenderness
- shepherds crook (varus femur)
- scoliosis
- facial asymmetry
what is seen on xray of fibrous dysplasia
lytic lesion with ground glass appearance
what is the management of fibrous dysplasia
- asx: serial exams and imaging
- sx: curettage and bone graft and IV bisphosphonates
what is an ossifying fibroma
destructive, deforming, slow growing, benign fibro osseous lesion
MC location for ossifying fibroma
- tibia and fibula in kids
- mandible in adults
what are the s/s of ossifying fibroma
- localized, firm swelling in the area
- bowed tibia
- painless
what would you see on xray of ossifying fibroma
well circumscribed intracortical lesion
what is the management of ossifying fibroma
- asx: repeat imaging and monitor
- sx: resection, curettage, and bone graft after skeletal maturity
MC benign bone lesion in kids
nonossifying fibroma
what is a nonossifying fibroma
benign, non-aggressive tumor that consists mainly of fibrous tissue
s/s nonossifying fibroma
-most are asx
-bone weakness and fracture
what would you see on xray of nonossifying fibroma
- small, well defined, eccentric, lytic lesions
- usually in distal diaphysis/ metaphysis
management of nonossifying fibroma
- asx: none
- curettage and grafting
indications for surgical intervention of nonossifying fibroma
- lesions of >50% of the bone
- lesions in high stress area
unicameral bone cysts
non-cancerous fluid filled lesions with fibrous lining
what are the s/s of unicameral bone cysts
- asx until pathologic fracture
- growth plate dysfunction and limb length discrepancy
what is seen on xray of unicameral bone cysts
- well defined, cystic lesions at the metaphysis
- generally involves entire diameter of bone
-fallen leaf sign
what is the management of unicameral bone cysts
- spontaneous resolution after skeletal maturity
- asx: observe and activity restrictions to avoid fractures
- larger cysts: curettage and bone graft
if concerned about risk of fracture due to unicameral bone cysts…
aspirate cyst and inject methylprednisolone or bone marrow
what is an aneurysmal bone cyst
benign, rapidly growing and destructive blood-filled lesion
MC site of aneurysmal bone cyst
tibia
s/s of aneurysmal bone cyst
-localized pain, tenderness, and swelling
xray of aneurysmal bone cyst
- eggshell
- soap bubble
management of aneurysmal bone cyst
- excision, curettage, and bone graft
- surgical arterial embolization to prevent hemorrhage
MC malignant bone tumor
Osteosarcoma
MC location of Osteosarcoma
metaphysis of long bone
risk factors for Osteosarcoma
- prior radiation or chemo
- paget disease, fibrous dysplasia
- genetic predisposition
s/s of Osteosarcoma
- pain and swelling
- worsened with activity
- palpable mass
- limping
xray of Osteosarcoma
- osteolytic and osteoblastic lesions
- moth eaten appearance
- starburst appearance
- codman’s triangle
codman’s triangle
new bone formation at periosteum
what do you utilize after xray to look for multifocal or metastatic disease?
bone scan
(…) is utilized for each lesion after identified on bone scan
CT/MRI
management of Osteosarcoma
- refer to oncology ortho for biopsy
- pre- and post-op chemo with limb sparing surgery
t/f Osteosarcoma responds to radiation
false
chondrosarcoma
tumor arising from the chondrocytes
s/s of chondrosarcoma
- deep, dull aching pain that is gradually progressive
- worse at night
xray of chondrosarcoma
- bony contour seems thinned and expanded
- endosteal scalloping
- > 5cm
confirm dx of chondrosarcoma
biopsy
MC metastasis location of chondrosarcoma
lungs
management of chondrosarcoma
refer for surgical excision
ewing sarcoma
rare, peripheral primitive neuroectodermal tumor that can proliferate in the bone and or soft tissue
ewing sarcoma results from…
translocation of chromosomes 11 and 22
mc sites of ewing sarcoma
femur and pelvis
s/s of ewing sarcoma
- pain and swelling
- palpable mass
- worse with activity or at night
- constitutional sx
what would you see on xray of ewing sarcoma
- poorly marginated lesion
- onion skin
management of ewing sarcoma
multidrug chemo with surgery +- radiation
s/s of metastatic bone disease
- pain over metastatic location
- pathologic fracture
- anemia
diagnosis of metastatic bone disease
- xray first, then other imaging
- biopsy to confirm and determine primary site
treatment of metastatic bone disease
- MC radiation + pain meds
- chemo
- bisphosphonates
