Bone Tumors Flashcards
How common are bone tumors?
Malignant bone tumors are what percent of all cancers?
How treatable are they?
bone tumors are very rare compared to carcinomas and hematopoeitic cancers. 0.2% of all cancers.
Relatively good prognosis with multimodal tx.
Clinical Presentation of bone tumors (4)
often asymptomatic (incidental findings)
Mass (parosteal osteosarcomas)–painless mass in popliteal fossa
Pain (osteoid osteoma or any tumor)
Pathological fractures
–in general very non-specific presentations
What to consider when diagnosing?
4
Age, Sex, location of lesion (bone and location on bone), and radiographic appearance.
What are common bone tumors in children/adolescents?
Osteosarcoma, Ewing’s sarcoma
What are common bone tumors in young adults?
Giant Cell tumors
What are common bone tumors in elderly adults?
Chondrosarcoma
What kind of margins usually indicates benign tumor vs. what kind of margins indicate malignant tumor?
sclerotic margins–>slowly growing tumor that is confined by bone tissue
ill defined margins–>fast growing, malignant neoplasm
What radiographic patterns are seen in malignant bone tumors?
What radiographic patterns are seen in chondroid tumors?
- malignant bone-matrix forming tumors appear with ivory dense white appearance.
- chondroid tumors within bone appear to have “rings and arcs”
histologic types of primary bone tumors (8)
What percentages for the top 3 origins?
Hematopoeitic (40%) Chondrogenic (22%) Osteogenic (19%) Fibrogenic Unknown (10%) Neuroectodermal Vascular Notochordal
(REVIEW THE CHART IN NOTES/PICS)
Benign Bone-Forming Tumors (2)
Osteoid osteoma; Osteoblastoma
Patient presents with bone pain and you suspect either primary or secondary cancer. What do you do?
(4) and (5) for male patients? THIS IS HOW YOU STAGE A PT
- xray
- whole body bone scan or skeletal survey
- CT chest/abd/pelvis, or PET
- Serum protein electrophoresis, urine protein electrophoresis, serum free light chain labs (good for multiple myeloma and plasmacytoma)
- PSA for male patients to test for prostate cancer
What is the staining marker for plasma cells?
CD 138
Multiple Myeloma
- What cell origin is the cancer derived from? What can you stain for? what do these cells often produce?
- What is the median age?
- What part of bone is primarily affected?
- which bones are affected?
- what are some common clinical presentations? (2)
- Treatment?
- It is a lymphoid origin cancer. Stain for CD138. These often produce a monoclonal IgG
- median age is 70 years
- It affects bone marrow
- Affects bone all over.- skull, vertebrae, ribs, pelvis, long bones, scapula…everything)
- Bone pain and pathological fractures
- treat primary tumor surgically. Then treat the rest of the lesions with chemotherapy
What staining marker is used to stain for B cells?
CD 20; B cell lymphoma
What is the definition of “lymphoma”
neoplasms composed of lymphocytes resembling a normal stage of differentiation
B cell lymphoma
- What age is it usually seen in?
- what kind of cells is it derived from?
- Diagnostic features? Sx? PET? Histology? Staining?
- It is the most common lymphoma in adults
- derived from clonal B cells
- sx include pain; PET likely show primary tumor and other sites of spread in long bones; large lymphoid (blue) cells can be seen upon histology. CD20 can be used to stain
Osteosarcoma
- x-ray appearance?
- usual location?
- histology appearance?
- Treatment?
- xray: blown out bone; lytic; no sclerotic borders; can have chunks of mineralization
- usually around knee area
- histology: pleomorphic cells producing a lot of osteoid
- treat with chemo; remove bone portion with lesion; either replace or implant donor bone;
What are good tests for multiple myeloma/ to rule out multiple myeloma?
- xray
- skeletal survey
- CT/PET
- serum protein electrophoresis, urine protein electrophoresis
- PSA if male
Bone lesions due to primary lung adenocarcinoma.
-what do you see upon histology?
-What can you stain the tissue to identify? (2)
-
you see glands
- stain for TTF1 for lung tissue origin
- stain for cytokeratin for carcinoma origin
metastatic bone lesions.
-treatment?
-because the lesion is NOT the primary source of the problem. Be least invasive. scrape out the bone, cement it, and plate it, then followup with chemo.
Name the 6 childhood bone tumors.
- osteochondromas
- enchondromas
- UBC
- ABC
- Osteosarcoma
- Ewing’s sarcoma
Where are giant cell tumors usually located?
Epiphyseal
Unicameral Bone cyst
- radiographic appearance
- age group?
- location on bone and which bone?
- Clinical presentation?
- is it benign or malignant?
- histology features; what are possible findings upon histology and why?
- prognosis? and treatment?
x-ray: expansile bone “bubble”; can see area is fenced off
age group: children adolescents
-long bones; metaphysis; proximal femur and humerus
-pathological fractures
-benign
-histology shows CLEAR-yellowish fluid filled cyst lined by thin fibrous membrane. Can see hemosiderin and granulation tissue due to breakage/remodeling.
-prognosis is good… ususally people simply grow out of it.
-treatment: scrape out and fill with graft OR aspirate and inject with calcium phosphate matrix.
Aneurysmal Bone Cyst (ABC)
- radiographic appearance
- location
- age group
- clinical presentation
- What is in the cyst? and what is lacking?
- Histology features? gross features?
- is it benign or malignant?
- what is the etiology?
- treatment?
- blown out bone with ill defined margins. very much like Ewings
- Long bones; metaphyseal regions
- Less than 20 years
- bone pain and swelling
- blood filled cysts without endothelial lining
- Gross features: honey combed tumor with cystic spaces and osseous tissue
- histology: giant cell, immature bone, blood, no endothelial cells
- etiology is due to a translocation
- curettage (scrape it), embolize… essentially empty it and preserve bone integrity.
Giant Cell tumor Features
- (xray findings) (2)
- histology features (1)
- treatment (3)
purely lytic–cannot see minneralization
epiphyseal involvement
-Histology: cells jumped off the pond.
-Tyrasine kinase inhibitor (Imatinib), surgery, embolization
Ewing’s sarcoma
- what is the etiology?
- radiographic appearnce
- histology features, what is used to stain?
- treatment?
- t (11;22)
- ill defined; lytic; no mineralization; soft tissue mass
- large blue cells, CD 99
- treat with chemo; then remove the bone plus the surrounding tissue
4 major types of adult tissue masses
- Lipoma
- Soft tissue sarcoma
- Desmoid fibromatosis
- Lymphoma
Pt comes in with mass you think is a lipoma… what do you do?
if s lipoma for sure.. remove it.
if larger than 3cm or deep. GET MRI
If you suspect Lipoma.
- what should you compare it to upon MRI?
- What color is it in T1 MRI?
compare it to subQ fat and bone marrow
-it should be bright upon T1 MRI
Lipoma treatment?
surgery removal
Desmoid fibromatosis
- Clinical features
- Histological features; stain?
- prognosis? treatment?
- very firm mass
- spindle cells that stains with Beta catenin
- benign so not a huge deal, but VERY high recurrence rate. Therefore treat this medically. Not surgically
What are the stains used to stain for in what disease? CD138 CD99 CD20 Beta catenin TTF1 Cytokeratin
CD138: plasma cells in multiple myeloma CD99: Ewing sarcoma CD20: B cell lymphoma Beta catenin: Desmoid fibromatosis TTF1: lung tissue origin Cytokeratin: Carcinoma
High grade undifferentiated pleomorphic Sarcoma
- histo features
- treatment?
high atypia; high pleomorphism
-irradation; wide excision
How does cartilage appear on T1 and T2 MRI
dark on T1 and bright on T2
Name three types of cartilage tumors/cancers?
enchonroma; osteochondroma; chondrosarcoma
Enchondroma
- radiographic appearance
- histo appearance
- well circumscribed area of cartilage by sclerotic cortex.
- histology: bone with low grade chondroid with very little binucleation and pleomorphism
Osteochondroma
- radiographic appearance
- histology features
- radiographic: you should be able to see the marrow flow from the bone to the area of the “spur”
- histology: you can clearly see areas of cartilage cap then bone as expected
Chondrosarcoma
- histology characteristics
- treatment
- chondroid invaiding bone areas… with atypia amongst the chondrocytes
- scrape it out and resection with wide margins
How do you stage soft tissue problems?
CT chest, abd, pelvis OR PET/CT
Biopsy:
- who should pick the location of the biopsy?
- Why is this important?
- the person doing the surgery should decide
- do not want to contaminate the surrounding tissue, because it may be a sarcoma.
