bone tumors Flashcards

1
Q

4 typical presentations of bone tumors

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

what is where quality of pain

A
  • most are painful and have pain attributable to lesion
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3
Q

when features of pain

A
  • activity and weight bearing

- night pain

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4
Q

quantity of pain

A
  • usually severe
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5
Q

quality of pain

A
  • constant deap seated ache

- may be burning if close to a nerve

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6
Q

Alleve and aggravation features

A

alleve - anagesia

agg - weight bearing

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7
Q

what does soft tissue mass tell us

A
  • is affixed to bone - likely malig

- most benign tumors do not have tissue mass

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8
Q

3 other features of malig on clinical exam

A
  1. constitutional sx - ewings
  2. Ca elsewhere -mets
  3. Hx of radiation or pagets
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9
Q

4 possible radio features

A
  1. bone destruciton
  2. periosteal rxn
  3. soft tissue mass
  4. matrix
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10
Q

what does bone destruction look like

A

lysis

  • appears darker
  • tumor activates clasts
  • can be benign or malig
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11
Q

what is periosteal reaction

A
  • reaction as it is lifted off the bone by tumor
  • ## some malig, other s benign
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12
Q

3 malig. reactions

A
  1. onionskinning
  2. sunburst
  3. codman’s triangle
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13
Q

1 benign

A

neocortex

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14
Q

what is soft tissue mass

A

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

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15
Q

what is matrix

A

extracellular matrix produced by tumors

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16
Q

3 types of matrix

A
  1. osteoid - clouds from osteosarcoma
  2. chondroid - popcorn (good or bad)
  3. collagen - ground glass ( benign)
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17
Q

summary 4 malig radio features

A
  1. often destroy bone
  2. onionskin, codman’s, subrust
  3. soft tissue mass
  4. produce matrix
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18
Q

4 bengn features

A
  1. don’t usually destroy bone
  2. neocortex
  3. no soft tissue mass
  4. may or may not have matrix
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19
Q

def. enchondroma

A

benign neoplasm of hyaline cart. involving medullary bone

- also called central chondroma

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20
Q

sites of enchondroma

A
  • small bones of hand and feet
  • ## long tubular bones
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21
Q

gross path of enchondroma

22
Q

micro path of enchondroma

A
  • hypocellular tumor that closely resembles normal hyaline cart.
  • lacks invasion of surrounding tissues
23
Q

path of enchondroma

A
  • unknown

- majority have IDH1 and IDH 2 mutation

24
Q

def. chondrosarcoma

A

malig. neoplasm of the hyaline cart.

25
gross path of chondrosarcoma
large, blue gritty | - invasive
26
micro path of chondrosarcoma
- invades - pleomorphism - mitotic activity
27
patho of chondrosarcoma
- unknown | - majority havd IDH1 and 2
28
treat of enchondroma
benign and non-progressive | - may have patho fracture
29
treat of chondrosarcoma
- CT for staging - non-responsive to chome or rads - wide surgical resection
30
def. ewings
- primitive small cell neoplasm | - neuroectodermal diff.
31
gross path of ewings
- soft and friable | - tan-grey
32
micro path of ewings
- small round cell tumor - cells arranged in sheets - cytoplasm with abundant glycogen
33
path of ewings
- translocation of EWS with ETS trans. factor family
34
treat of ewings
- stage - very respnsive to chem - oncologist - surg. removal of tumor - maybe rads after
35
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
36
sitses of giant cell tumor of the bone
metaphysis of the long bones
37
gross path of giant cell tumor of the bone
firable, hemmoragic, brown
38
micro path of giant cell tumor of the bone
- sheets of polygonal mononuclear cells | - osteoclast-type giant cells
39
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
40
treatment of giant cell tumor of the bone
surgical resection | - may require adjuvant nitrogen
41
def. osteosarcoma
intramedullary high grade malignant tumor in which the neoplastic cells produde osteoid
42
gross path of osteosarcoma
large, hard, fleshy
43
micro path of osteosarcoma
- sheets of pleomorphic cells producing osteoid
44
3 subtypes of osteosarcoma
- osteoblastic - chondroblastic - fibroblastic
45
patho of osteosarcoma
- poorly understood | - genes (RB and P53)
46
treat of osteosarcoma
stage - chemo - surgical resection 70% cure rate
47
def of bone met.
neoplasm originating from another site
48
epi of bone met
- 3rd most common site | - breast, lung, prostate, kidney, thyrpid most common
49
micro of bone met.
- tumor attempts to recapitulte the primary
50
patho of bone met.
usually hematologic spread | - rarely tumor invasion