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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
Q

Ewing Sarcoma - characteristics

A

*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

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26
Q

Ewing Sarcoma - FISH genetics

A

t(11;22)
fusion protein: EWS-FLI1

recall: MALIGNANT bone tumor; location = DIAPHYSIS

27
Q

Ewing Sarcoma - radiology

A

*layering of periosteum looking like an onion skin

recall: MALIGNANT bone tumor; location = DIAPHYSIS

28
Q

Ewing Sarcoma - treatment

A

*aggressive with early metastases, but responsive to chemotherapy

recall: MALIGNANT bone tumor; location = DIAPHYSIS

29
Q

osteosarcoma - epidemiology

A

*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
Q

osteosarcoma - type of tumor

A

*malignant tumor of the osteoblasts

recall: location = METAPHYSIS

31
Q

osteosarcoma - location

A

*metaphysis of long bones (often in knee region)

recall: MALIGNANT bone tumor; location = METAPHYSIS

32
Q

osteosarcoma - characteristics

A

*classically presents with a painful enlarging mass or a pathologic fracture

recall: MALIGNANT bone tumor; location = METAPHYSIS

33
Q

osteosarcoma - radiology

A

Codman’s triangle** (from elevation of periosteum - left)
**sunburst pattern - right

recall: MALIGNANT bone tumor; location = METAPHYSIS

34
Q

Codman’s triangle - image & associated tumor

A

*associated with osteosarcoma
*due to elevation of the periosteum

recall: MALIGNANT bone tumor; location = METAPHYSIS

35
Q

sunburst pattern on X-ray - image & associated tumor

A

*associated with osteosarcoma

recall: MALIGNANT bone tumor; location = METAPHYSIS

36
Q

osteosarcoma - treatment

A

*presumed there are metastases
*tx = surgery followed by chemotherapy

recall: MALIGNANT bone tumor; location = METAPHYSIS

37
Q

osteochondroma - epidemiology

A

*most common benign bone tumor
*males < 25 years old

recall: BENIGN bone tumor; location = METAPHYSIS

38
Q

osteochondroma - type of tumor

A

*benign tumor

recall: location = METAPHYSIS

39
Q

osteochondroma - location

A

*metaphysis (at growth plate)
*most common around knee to distal femur

recall: BENIGN bone tumor; location = METAPHYSIS

40
Q

osteochondroma - characteristics

A

*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
Q

osteochondroma - radiology

A

*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
Q

osteochondroma - treatment

A

*stops growing when growth place closes
*surgical excision or watch
*rarely transforms to chondrosarcoma

recall: BENIGN bone tumor; location = METAPHYSIS

43
Q

giant cell tumor - epidemiology

A

*20-40 years old
*females > males (slight female predominance)

recall: BENIGN bone tumor; location = EPIPHYSIS

44
Q

giant cell tumor - type of tumor

A

*benign tumor of osteoclasts

recall: location = EPIPHYSIS

45
Q

giant cell tumor - location

A

*epiphysis of long bones
*after skeletal maturation
*often in knee region

recall: BENIGN bone tumor; location = EPIPHYSIS

46
Q

giant cell tumor - clinical symptoms

A

*joint pain
*swelling

recall: BENIGN bone tumor; location = EPIPHYSIS

47
Q

giant cell tumor - pathology

A

*multinucleated giant cells
*expressing RANKL

recall: BENIGN bone tumor; location = EPIPHYSIS

48
Q

giant cell tumor - radiology

A

*“soap-bubble” appearance on x-ray

recall: BENIGN bone tumor; location = EPIPHYSIS

49
Q

giant cell tumor - treatment

A

*varied - based on location, age, etc

recall: BENIGN bone tumor; location = EPIPHYSIS

50
Q

osteoma - epidemiology

A

*middle aged adults
*association: Gardner syndrome

recall: BENIGN bone tumor; location = FACIAL BONES

51
Q

osteoma - type of tumor

A

*benign tumor

recall: location = FACIAL BONES

52
Q

osteoma - location

A

*surface of facial bones (skull, mandible)

recall: BENIGN bone tumor; location = FACIAL BONES

53
Q

chondroma - type of tumor

A

*benign tumor of cartilage

recall: location = small bones of hands/feet

54
Q

chondroma - location

A

*medulla of small bones of hands/feet

recall: BENIGN tumor; location = small bones of hands/feet

55
Q

osteoblastoma - epidemiology

A

*males > females

recall: BENIGN tumor; location = VERTEBRAE

56
Q

osteoblastoma - type of tumor

A

*benign tumor

recall: location = VERTEBRAE

57
Q

osteoblastoma - location

A

*vertebrae

recall: BENIGN tumor; location = VERTEBRAE

58
Q

osteoblastoma - characteristics

A

*pain
*NOT RESPONSIVE to NSAIDs (contrast to osteoid ostoma)

recall: BENIGN tumor

59
Q

chondrosarcoma - epidemiology

A

*adults > 50 yo

recall: MALIGNANT tumor

60
Q

chondrosarcoma - type of tumor

A

*malignant tumor of chondrocytes

61
Q

chondrosarcoma - location

A

*medulla of pelvis, proximal femur, and humerus

recall: MALIGNANT tumor

62
Q

chondrosarcoma - radiology

A

*intralesional calcifications
*cortex breach, endosteal erosion

recall: MALIGNANT tumor

63
Q

“soap bubble” appearance on radiology - description

A

*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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