bone tumors Flashcards
4 typical presentations of bone tumors
- pain
- mass
- patho fracture
- incidental finding on x-ray
what is where quality of pain
- most are painful and have pain attributable to lesion
when features of pain
- activity and weight bearing
- night pain
quantity of pain
- usually severe
quality of pain
- constant deap seated ache
- may be burning if close to a nerve
Alleve and aggravation features
alleve - anagesia
agg - weight bearing
what does soft tissue mass tell us
- is affixed to bone - likely malig
- most benign tumors do not have tissue mass
3 other features of malig on clinical exam
- constitutional sx - ewings
- Ca elsewhere -mets
- Hx of radiation or pagets
4 possible radio features
- bone destruciton
- periosteal rxn
- soft tissue mass
- matrix
what does bone destruction look like
lysis
- appears darker
- tumor activates clasts
- can be benign or malig
what is periosteal reaction
- reaction as it is lifted off the bone by tumor
- ## some malig, other s benign
3 malig. reactions
- onionskinning
- sunburst
- codman’s triangle
1 benign
neocortex
what is soft tissue mass
feature or 1ry malig
- mass grows through haversian system
-
what is matrix
extracellular matrix produced by tumors
3 types of matrix
- osteoid - clouds from osteosarcoma
- chondroid - popcorn (good or bad)
- collagen - ground glass ( benign)
summary 4 malig radio features
- often destroy bone
- onionskin, codman’s, subrust
- soft tissue mass
- produce matrix
4 bengn features
- don’t usually destroy bone
- neocortex
- no soft tissue mass
- may or may not have matrix
def. enchondroma
benign neoplasm of hyaline cart. involving medullary bone
- also called central chondroma
sites of enchondroma
- small bones of hand and feet
- ## long tubular bones
gross path of enchondroma
- small
micro path of enchondroma
- hypocellular tumor that closely resembles normal hyaline cart.
- lacks invasion of surrounding tissues
path of enchondroma
- unknown
- majority have IDH1 and IDH 2 mutation
def. chondrosarcoma
malig. neoplasm of the hyaline cart.
gross path of chondrosarcoma
large, blue gritty
- invasive
micro path of chondrosarcoma
- invades
- pleomorphism
- mitotic activity
patho of chondrosarcoma
- unknown
- majority havd IDH1 and 2
treat of enchondroma
benign and non-progressive
- may have patho fracture
treat of chondrosarcoma
- CT for staging
- non-responsive to chome or rads
- wide surgical resection
def. ewings
- primitive small cell neoplasm
- neuroectodermal diff.
gross path of ewings
- soft and friable
- tan-grey
micro path of ewings
- small round cell tumor
- cells arranged in sheets
- cytoplasm with abundant glycogen
path of ewings
- translocation of EWS with ETS trans. factor family
treat of ewings
- stage
- very respnsive to chem - oncologist
- surg. removal of tumor
- maybe rads after
def. giant cell tumor of the bone
benign, locally aggressive neoplasm composed of sheets of neoplastic mononuclear cells interspersed with reactive osteoclast-type giant cells
sitses of giant cell tumor of the bone
metaphysis of the long bones
gross path of giant cell tumor of the bone
firable, hemmoragic, brown
micro path of giant cell tumor of the bone
- sheets of polygonal mononuclear cells
- osteoclast-type giant cells
patho of giant cell tumor of the bone
not fully est.
- histone driver mutations
- monocells express RANKL, which stim formation and maturation of osteoclasts from monocyte precursor
treatment of giant cell tumor of the bone
surgical resection
- may require adjuvant nitrogen
def. osteosarcoma
intramedullary high grade malignant tumor in which the neoplastic cells produde osteoid
gross path of osteosarcoma
large, hard, fleshy
micro path of osteosarcoma
- sheets of pleomorphic cells producing osteoid
3 subtypes of osteosarcoma
- osteoblastic
- chondroblastic
- fibroblastic
patho of osteosarcoma
- poorly understood
- genes (RB and P53)
treat of osteosarcoma
stage
- chemo
- surgical resection
70% cure rate
def of bone met.
neoplasm originating from another site
epi of bone met
- 3rd most common site
- breast, lung, prostate, kidney, thyrpid most common
micro of bone met.
- tumor attempts to recapitulte the primary
patho of bone met.
usually hematologic spread
- rarely tumor invasion
