Bone Tumors

Question 1

Bosselated, round sessile tumor projecting from the subperiosteal surface on or inside the skull and facial bones in middle aged adults

Answer 1

Osteoma

Question 2

What is the osteoma composed of?

Answer 2

Woven or lamellar bone

Trabecular bone with marrow

Question 3

Happens in teens and 20s
Worse at night
Relieved by NSAIDs
Arises in femur or tibia

Answer 3

Osteiod osteoma

Question 4

What is a osteoblastoma composed of?

Answer 4

Woven bone and osteoblasts with stroma of loose CT and dilate congested capillaries

Question 5

Radiation promotes malignancy
Nidus
Need to resect to prevent recurrence

Answer 5

Osteoid osteoma/osteoblastoma

Question 6

How is an osteoblastoma different from and osteoid osteoma?

Answer 6

The pain is dull and achy
It doesn’t respond to NSAIDs
Involved the spine

Question 7

What is the most common primary malignancy of bone?

Answer 7

Osteosarcoma

Question 8

What are the genetic mutations associated with osteosarcoma?

Answer 8

Rb 
P53
Cdk4
P16
Ink4a
cyclin d1 
Mdm2

Question 9

Who gets osteosarcoma?

Answer 9

75% younger than 20
And the elderly with paget’s, irradiation, bone infarcts
Men

Question 10

Where is it most likely to show up?

Answer 10

In the metaphysis of long bones intramedullary - around the knee

Question 11

Forms bone with coarse lace like architecture, destroys cornices and produces soft tissue mass
X-ray: shows lytic and blastic lesions
Codman’s triangle

Answer 11

Osteosarcoma

Question 12

What other disease is osteosarcoma associated with?

Answer 12

Polyostotic paget’s

Poor prog

Question 13

Benign cartilage capped outgrowth near the growth plate of long tubular bones

Answer 13

Osteochondroma

Question 14

Mushroom shaped
Benign hyaline cartilage cap 
Painful if impinged in nerves or stalk is fractured 
Auto Dom
Late adolescence
Men

Answer 14

Osteochondroma

Question 15

What is the most common intraosseous cartilage tumor?

Answer 15

Chondroma

Question 16

Solitary, short tubular bones of hands and feet

Gray blue tumor

Answer 16

Chondroma

Question 17

What is Ollier disease?

Answer 17

Multiple endochondromas

Question 18

What is maffucci syndrome?

Answer 18

Endochondromatosis and soft tissue hemangiomas

Can lead to ovarian carcinoma and brain gliomas

Question 19

O ring sign on X-ray
Neoplastic chondrocytes that reside in lacunae
Unmineralized Nodules of cartilage on X-rays

Answer 19

Chondroma

Question 20

In young teens, males more than females
Epiphysis and apophyses
Composed of sheets of chondroblasts
Hyaline matrix with lace like configuration = chicken wire

Answer 20

Chondroblastoma

Question 21

X-ray shows spotty calcification

Painful with effusion and restrict joint mobility

Answer 21

Chondroblastoma

Question 22

Arise in metaphysis of long bones

Has chondrocytes in lacunae and stellate cells in the myxoid area

Answer 22

Chondromyxoid fibroma

Question 23

Dull achy pain
X-rays : eccentric geographic lucency with well delineated from adjacent bone by rim of sclerosis
No malignant transformation

Answer 23

Chondromyxoid fibroma

Question 24

Produces neoplasticism cartilage
Large bulky tumor of malignant hyaline and myxoid cartilage
Spotty calcification with central necrosis

Answer 24

Chondrosarcoma

Question 25

Broad pushing fronts
Arise in central skeleton
Different variants

Answer 25

Chondrosarcoma

Question 26

What clear cell chondrosarcoma?

Answer 26

Sheets of large malignant chondrocytes with abundant clear cytoplasm, intralesional reactive bone formation
Seen in teens
In epiphysis of long bones

Question 27

Islands of well differentiated hyaline cartilage with sheets of small round cells
Teens

Answer 27

Mesenchymal chondrosarcoma

Question 28

What is the most common tumor of adulthood?

Answer 28

Lipoma

Question 29

Doughy
Subcutis
Mobile painless mass

Answer 29

Lipoma

Question 30

Arise in deep soft tissues of proximal extremities and retroperitoneum
Has lipoblasts
Pleomorphic variants and round cell variants are aggressive with frequent mets

Answer 30

Liposarcoma

Question 31

Most common in the lower extremities
Translocation to ch.18 produces fusion of SYT-SSX1/2
Most common in 20s to 40s

Answer 31

Synovial sarcoma

Question 32

Biphasic differentiation: epithelial cells and spindle cells
Calcified concretions on X-rays
Rxns for keratin and epithelial membrane Ag

Answer 32

Synovial sarcoma

Question 33

What is the most common neoplasm in women?

Answer 33

Leiomyoma

Question 34

Spindle cells intersecting at right angles
Arise in uterus nipples, scrotum
Blunt ended, elongated nuclei

Answer 34

Leiomyoma

Question 35

Females
Develop in the skin and deep soft tissues of extremities and retroperitoneum
Cigar shaped nuclei
Malignant SMCs with dense bodies and pinocytotic vesicles

Answer 35

Leiomyosarcoma

Question 36

Stain with abs for vimentin, actin, SM actin, desmin

Answer 36

Leiomyosarcoma

Question 37

What is the most common soft tissue sarcoma of childhood?

Answer 37

Rhabdomyosarcoma

Question 38

Translocation 2;13 = PAX3 fuses with FKHR — dysregulation of muscle differentiation
Eccentric Eosinophilic granular cytoplasm rich in thick and thin filaments

Answer 38

Rhabdomyosarcoma

Question 39

Tadpole or strap cells

Sarcomeres stain with Ab to desmin, MYOD1, myogenin

Answer 39

Rhabdomyosarcoma

Question 40

What is the rhabdomyosarcoma variant with the worst prognosis?

Answer 40

Botryroid variant
Embryonal
Pleomorphic
Alveolar

Question 41

Children younger than 10
Grape like lesions in mucosal cavities
Allelic loss of ch.11p15.5
Cambium layer with hypercellularity

Answer 41

Embryonal rhabdomyosarcoma

Sarcoma Botryoides

Question 42

Resembles pulmonary alveolae
Cells with cross-striation
Has t(2;13) or (1;13)
In early to mid adolescence

Answer 42

Alveolar rhabdomyosarcoma