bone tumors

Question 1

4 typical presentations of bone tumors

Answer 1

1. pain
2. mass
3. patho fracture
4. incidental finding on x-ray

Question 2

what is where quality of pain

Answer 2

• most are painful and have pain attributable to lesion

Question 3

when features of pain

Answer 3

• activity and weight bearing

- night pain

Question 4

quantity of pain

Answer 4

• usually severe

Question 5

quality of pain

Answer 5

• constant deap seated ache

- may be burning if close to a nerve

Question 6

Alleve and aggravation features

Answer 6

alleve - anagesia

agg - weight bearing

Question 7

what does soft tissue mass tell us

Answer 7

• is affixed to bone - likely malig

- most benign tumors do not have tissue mass

Question 8

3 other features of malig on clinical exam

Answer 8

1. constitutional sx - ewings
2. Ca elsewhere -mets
3. Hx of radiation or pagets

Question 9

4 possible radio features

Answer 9

1. bone destruciton
2. periosteal rxn
3. soft tissue mass
4. matrix

Question 10

what does bone destruction look like

Answer 10

lysis

• appears darker
• tumor activates clasts
• can be benign or malig

Question 11

what is periosteal reaction

Answer 11

• reaction as it is lifted off the bone by tumor
• ## some malig, other s benign

Question 12

3 malig. reactions

Answer 12

1. onionskinning
2. sunburst
3. codman’s triangle

Question 13

1 benign

Answer 13

neocortex

Question 14

what is soft tissue mass

Answer 14

feature or 1ry malig
- mass grows through haversian system
-

Question 15

what is matrix

Answer 15

extracellular matrix produced by tumors

Question 16

3 types of matrix

Answer 16

1. osteoid - clouds from osteosarcoma
2. chondroid - popcorn (good or bad)
3. collagen - ground glass ( benign)

Question 17

summary 4 malig radio features

Answer 17

1. often destroy bone
2. onionskin, codman’s, subrust
3. soft tissue mass
4. produce matrix

Question 18

4 bengn features

Answer 18

1. don’t usually destroy bone
2. neocortex
3. no soft tissue mass
4. may or may not have matrix

Question 19

def. enchondroma

Answer 19

benign neoplasm of hyaline cart. involving medullary bone

- also called central chondroma

Question 20

sites of enchondroma

Answer 20

• small bones of hand and feet
• ## long tubular bones

Question 21

gross path of enchondroma

Answer 21

• small

Question 22

micro path of enchondroma

Answer 22

• hypocellular tumor that closely resembles normal hyaline cart.
• lacks invasion of surrounding tissues

Question 23

path of enchondroma

Answer 23

• unknown

- majority have IDH1 and IDH 2 mutation

Question 24

def. chondrosarcoma

Answer 24

malig. neoplasm of the hyaline cart.

Question 25

gross path of chondrosarcoma

Answer 25

large, blue gritty

- invasive

Question 26

micro path of chondrosarcoma

Answer 26

• invades
• pleomorphism
• mitotic activity

Question 27

patho of chondrosarcoma

Answer 27

• unknown

- majority havd IDH1 and 2

Question 28

treat of enchondroma

Answer 28

benign and non-progressive

- may have patho fracture

Question 29

treat of chondrosarcoma

Answer 29

• CT for staging
• non-responsive to chome or rads
• wide surgical resection

Question 30

def. ewings

Answer 30

• primitive small cell neoplasm

- neuroectodermal diff.

Question 31

gross path of ewings

Answer 31

• soft and friable

- tan-grey

Question 32

micro path of ewings

Answer 32

• small round cell tumor
• cells arranged in sheets
• cytoplasm with abundant glycogen

Question 33

path of ewings

Answer 33

• translocation of EWS with ETS trans. factor family

Question 34

treat of ewings

Answer 34

• stage
• very respnsive to chem - oncologist
• surg. removal of tumor
• maybe rads after

Question 35

def. giant cell tumor of the bone

Answer 35

benign, locally aggressive neoplasm composed of sheets of neoplastic mononuclear cells interspersed with reactive osteoclast-type giant cells

Question 36

sitses of giant cell tumor of the bone

Answer 36

metaphysis of the long bones

Question 37

gross path of giant cell tumor of the bone

Answer 37

firable, hemmoragic, brown

Question 38

micro path of giant cell tumor of the bone

Answer 38

• sheets of polygonal mononuclear cells

- osteoclast-type giant cells

Question 39

patho of giant cell tumor of the bone

Answer 39

not fully est.

• histone driver mutations
• monocells express RANKL, which stim formation and maturation of osteoclasts from monocyte precursor

Question 40

treatment of giant cell tumor of the bone

Answer 40

surgical resection

- may require adjuvant nitrogen

Question 41

def. osteosarcoma

Answer 41

intramedullary high grade malignant tumor in which the neoplastic cells produde osteoid

Question 42

gross path of osteosarcoma

Answer 42

large, hard, fleshy

Question 43

micro path of osteosarcoma

Answer 43

• sheets of pleomorphic cells producing osteoid

Question 44

3 subtypes of osteosarcoma

Answer 44

• osteoblastic
• chondroblastic
• fibroblastic

Question 45

patho of osteosarcoma

Answer 45

• poorly understood

- genes (RB and P53)

Question 46

treat of osteosarcoma

Answer 46

stage
- chemo
- surgical resection
70% cure rate

Question 47

def of bone met.

Answer 47

neoplasm originating from another site

Question 48

epi of bone met

Answer 48

• 3rd most common site

- breast, lung, prostate, kidney, thyrpid most common

Question 49

micro of bone met.

Answer 49

• tumor attempts to recapitulte the primary

Question 50

patho of bone met.

Answer 50

usually hematologic spread

- rarely tumor invasion