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Rheumatology Exam > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

osteoblast (first aid)

A

*builds bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP
*differentiates from mesenchymal stem cells in periosteum
*osteoblastic activity measured by bone ALP, osteocalcin, propeptides of type I procollagen

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2
Q

osteoclast (first aid)

A

*dissolves (“Crushes”) bone by secreting H+ and collagenases
*differentiates from a fusion of monocyte/macrophage lineage precursors
*RANK receptors on osteoclasts are stimulated by RANKL (RANK ligand, expressed on osteoblasts)
*OPG binds RANKL to prevent RANK-RANKL interaction → decreased osteoclast activity

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3
Q

parts of the bone: epiphysis

A

*the end of a long bone between the growth plate and the joint, in which there is the center for ossification

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4
Q

parts of the bone: metaphysis

A

*the portion of a developing long bone between the diaphysis (shaft) and the epiphysis (end)
*the growing portion of the bone

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5
Q

parts of the bone: diaphysis

A

*the tubular shaft that runs between the proximal and distal ends of the long bone

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6
Q

tumors in the bone - general principles

A

*metastatic disease is far more common than primary bone tumors
*common cancers that metastasize to bone:
-prostate
-multiple myeloma
-breast
-lung
-thyroid
-kidney
*primary bone tumors are rare

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7
Q

benign primary bone tumors

A

*osteoid osteoma
*osteoma
*osteoblastoma
*osteochondroma
*chondroblastoma
*giant cell tumor of bone

recall - “-oma” indicates benign

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8
Q

malignant primary bone tumors

A

*osteosarcoma
*Ewing sarcoma
*chondrosarcoma

recall - “-sarcoma” indicates malignant

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9
Q

most common site of metastasis of primary bone tumors

A
  1. lungs
  2. other bones
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10
Q

approach for bone tumors

A
  1. look for patterns
  2. age of patient
  3. location of lesion
  4. other clinical history: painful vs. painless; response to medications
  5. radiology patterns
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11
Q

bone tumors by location: diaphysis

A

*osteoid osteoma
*Ewing sarcoma

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12
Q

bone tumors by location: metaphysis

A

*osteosarcoma
*osteochondroma

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13
Q

bone tumors by location: epiphysis

A

*giant cell tumor

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14
Q

bone tumors by location: face

A

*osteoma

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15
Q

bone tumors by location: hands/feet

A

*chondroma

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16
Q

bone tumors by location: spine

A

*osteoblastoma
*chondrosarcoma

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17
Q

osteoid osteoma - epidemiology

A

*most commonly: young males (teens to early 20s)
*adults < 25 yo
*males > females

recall: BENIGN bone tumor; location = DIAPHYSIS

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18
Q

osteoid osteoma - type of tumor

A

*benign tumor of osteoblasts

recall: BENIGN bone tumor; location = DIAPHYSIS

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19
Q

osteoid osteoma - location

A

*cortex of long bones (diaphysis)

recall: BENIGN bone tumor; location = DIAPHYSIS

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20
Q

osteoid osteoma - characteristics

A

*classically presents as bone pain, worse at night caused by prostaglandins
*relieved by NSAIDs

recall: BENIGN bone tumor; location = DIAPHYSIS

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21
Q

osteoid osteoma - radiology

A

*bony mass with radiolucent osteoid core with reactive bone formation

recall: BENIGN bone tumor; location = DIAPHYSIS

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22
Q

Ewing Sarcoma - epidemiology

A

*young males < 15yo
*classically, white pts

recall: MALIGNANT bone tumor; location = DIAPHYSIS

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23
Q

Ewing Sarcoma - type of tumor

A

*malignant tumor of small blue cells of neuroectoderm

recall: MALIGNANT bone tumor; location = DIAPHYSIS

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24
Q

Ewing Sarcoma - location

A

*diaphysis of long bones (esp femur)
*can be pelvic flat bones

recall: MALIGNANT bone tumor; location = DIAPHYSIS

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25
Ewing Sarcoma - characteristics
*classically presents with **painful, warm, swollen mass, plus fever** ***leukocytosis** *histology: **anaplastic small blue cells of neuroectodermal (mesenchymal) origin** (resemble lymphocytes) recall: MALIGNANT bone tumor; location = DIAPHYSIS
26
Ewing Sarcoma - FISH genetics
**t(11;22)** fusion protein: EWS-FLI1 recall: MALIGNANT bone tumor; location = DIAPHYSIS
27
Ewing Sarcoma - radiology
*layering of periosteum looking like an **onion skin** recall: MALIGNANT bone tumor; location = DIAPHYSIS
28
Ewing Sarcoma - treatment
*aggressive with early metastases, but responsive to chemotherapy recall: MALIGNANT bone tumor; location = DIAPHYSIS
29
osteosarcoma - epidemiology
*most common in males < 20 yo *can present in older adults due to other associated conditions: -Paget's disease of the bone -radiation -familial retinoblastoma -Li Fraumeni syndrome recall: MALIGNANT bone tumor; location = METAPHYSIS
30
osteosarcoma - type of tumor
***malignant** tumor of the **osteoblasts** recall: location = METAPHYSIS
31
osteosarcoma - location
***metaphysis of long bones** (often in knee region) recall: MALIGNANT bone tumor; location = METAPHYSIS
32
osteosarcoma - characteristics
*classically presents with a **painful enlarging mass or a pathologic fracture** recall: MALIGNANT bone tumor; location = METAPHYSIS
33
osteosarcoma - radiology
**1. Codman's triangle** (from elevation of periosteum - left) **2. sunburst pattern** - right recall: MALIGNANT bone tumor; location = METAPHYSIS
34
Codman's triangle - image & associated tumor
*associated with osteosarcoma *due to elevation of the periosteum recall: MALIGNANT bone tumor; location = METAPHYSIS
35
sunburst pattern on X-ray - image & associated tumor
*associated with osteosarcoma recall: MALIGNANT bone tumor; location = METAPHYSIS
36
osteosarcoma - treatment
*presumed there are metastases *tx = surgery followed by chemotherapy recall: MALIGNANT bone tumor; location = METAPHYSIS
37
osteochondroma - epidemiology
*most common benign bone tumor *males < 25 years old recall: BENIGN bone tumor; location = METAPHYSIS
38
osteochondroma - type of tumor
***benign** tumor recall: location = METAPHYSIS
39
osteochondroma - location
***metaphysis (at growth plate)** *most common around knee to distal femur recall: BENIGN bone tumor; location = METAPHYSIS
40
osteochondroma - characteristics
***lateral bony projection of growth plate, covered by cartilaginous cap; points AWAY from joint** *asymptomatic often *EXT1 or EXT2 gene mutation recall: BENIGN bone tumor; location = METAPHYSIS
41
osteochondroma - radiology
***lateral bony projections** of growth plate (continuous with marrow space) covered by cartilaginous cap **pointing away from the joint** recall: BENIGN bone tumor; location = METAPHYSIS
42
osteochondroma - treatment
*stops growing when growth place closes *surgical excision or watch *rarely transforms to chondrosarcoma recall: BENIGN bone tumor; location = METAPHYSIS
43
giant cell tumor - epidemiology
*20-40 years old *females > males (slight female predominance) recall: BENIGN bone tumor; location = EPIPHYSIS
44
giant cell tumor - type of tumor
***benign** tumor of **osteoclasts** recall: location = EPIPHYSIS
45
giant cell tumor - location
***epiphysis** of long bones *after skeletal maturation *often in knee region recall: BENIGN bone tumor; location = EPIPHYSIS
46
giant cell tumor - clinical symptoms
*joint pain *swelling recall: BENIGN bone tumor; location = EPIPHYSIS
47
giant cell tumor - pathology
***multinucleated giant cells *expressing RANKL** recall: BENIGN bone tumor; location = EPIPHYSIS
48
giant cell tumor - radiology
***"soap-bubble" appearance** on x-ray recall: BENIGN bone tumor; location = EPIPHYSIS
49
giant cell tumor - treatment
*varied - based on location, age, etc recall: BENIGN bone tumor; location = EPIPHYSIS
50
osteoma - epidemiology
***middle aged adults** *association: **Gardner syndrome** recall: BENIGN bone tumor; location = FACIAL BONES
51
osteoma - type of tumor
***benign** tumor recall: location = FACIAL BONES
52
osteoma - location
*surface of **facial bones** (skull, mandible) recall: BENIGN bone tumor; location = FACIAL BONES
53
chondroma - type of tumor
***benign** tumor of cartilage recall: location = small bones of hands/feet
54
chondroma - location
*medulla of small bones of **hands/feet** recall: BENIGN tumor; location = small bones of hands/feet
55
osteoblastoma - epidemiology
*males > females recall: BENIGN tumor; location = VERTEBRAE
56
osteoblastoma - type of tumor
***benign** tumor recall: location = VERTEBRAE
57
osteoblastoma - location
***vertebrae** recall: BENIGN tumor; location = VERTEBRAE
58
osteoblastoma - characteristics
***pain *NOT RESPONSIVE to NSAIDs** (contrast to osteoid ostoma) recall: BENIGN tumor
59
chondrosarcoma - epidemiology
*adults > 50 yo recall: MALIGNANT tumor
60
chondrosarcoma - type of tumor
***malignant** tumor of chondrocytes
61
chondrosarcoma - location
***medulla of pelvis, proximal femur, and humerus** recall: MALIGNANT tumor
62
chondrosarcoma - radiology
***intralesional calcifications** *cortex breach, endosteal erosion recall: MALIGNANT tumor
63
"soap bubble" appearance on radiology - description
*expansile, osteolytic, radiolucent lesion with a non-sclerotic, sharply defined border *associated with the benign **giant cell tumor** of bone

Rheumatology Exam (20 decks)

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