Bone Tumors

Question 1

What are the three patterns of bone destruction seen with bone tumors?

Answer 1

Moth eaten: More agressive, intermediate zone of transition, benign or low-grade malignancy.

Geographic: Well-defined, short zone of transition, benign or low grade malignancy.

Permeative: Poorly-defined, wide zone of transition, malignant.

Question 2

What is a geographic lesion?

Answer 2

A well defined area with short zones of transition.

Correlates to a benign or low grade malignancy.

Question 3

What is a Moth-Eaten lesion?

Answer 3

A more agressive form of tumors with an intermediate zone of transition.
Correlates to a benign or malignant tumor.

Question 4

What is a permeative bone lesion?

Answer 4

A poorly defined lesion with a wide zone of transition.

Most commonly correlates to a malignant tumor.

Question 5

What is onion skinning?

Answer 5

A form of periosteal reaction seen with bone tumors.

Is most commonly malignant with multiple layers of periosteum.

Question 6

What is sunburst patterning?

Answer 6

This is a type of periosteal reaction in which there are spiculated rays within the bone.

Question 7

What is a hair on end patterning?

Answer 7

Hair on end patterning shows parallel rays along the periosteum.

Question 8

What is Codman’s triangle?

Answer 8

A form of periostitis in which there is a triangular elevation of periosteum.

Question 9

F
O
G
M
A
C
H
I
N
E
S

Answer 9

Benign bone tumors of the foot!

Fibrous dysplasia
Osteochondroma
Giant cell tumor
Myeloma
Aneurysmal bone cyst
Chondroblastoma, chondromyoid fibroma, clear cell
Hemangioma
Infection
Non-ossifying fibroma
Eosinophillic granuloma, enchondroma, epidermal inclusion cyst
Solitary bone cyst

Question 10

Name the malignant bone tumors of the foot

Answer 10

Chondrosarcoma
Osteosarcoma
Periosteal sarcoma
Ewings sarcoma
Fibrosarcoma
Multiple myeloma

Question 11

What is the most common benign primary bone tumor?

Answer 11

Osteochondroma

Question 12

What is the most common, malignant primary bone tumor?

Answer 12

Multiple myeloma

Question 13

What three primary bone tumors are more common in females?

Answer 13

Giant cell tumor
ABC
Parosteal osteosarcoma

Question 14

What are the most common cancers that metastasize to the foot?

Answer 14

Breast, prostate, lung, kidney

Question 15

What bone tumor is described as being benign with dull pain that is worse at night and relieved with ASA

Answer 15

Osteoid osteoma

Question 16

What differentiates osteoid osteoma from osteoblastoma?

Answer 16

Osteoblastoma starts benign and can become malignant.

It is less symptomatic than osteoid osteoma, PAIN IS NOT RELEIVED BY ASA

Question 17

What is Ollier disease?

Answer 17

Multiple enchondromatosis

May become malignant and is seen in the first decade of life.

Question 18

What is Maffuccis disease?

Answer 18

Multiple enchondromas with soft tissue hemangiomas

Most become malignant presenting in the first decade of life.

Question 19

Cartilage capped hyperplastic bone pointing away from the joint.

Answer 19

Osteochondroma

Question 20

What are the characteristics of a fibrous dysplasia?

Answer 20

Benign, geographic, fibro-osseous lesion with GROUND GLASS MATRIX

Question 21

What are the characteristics of a unicameral bone cyst?

Answer 21

Benign, geographic, medullary lesion that is fluid-filled
Commonly found in the calcaneus

“Fallen fragment sign” Fracture in which the cortex lies within the lesion.

Question 22

Lytic bone lesion with ground glass, “Soap bubble” appearance

Answer 22

Giant cell tumor

Question 23

Punched out lesions or diffusely osteopenic with hair on end radiating spicules

Answer 23

Multiple myeloma!!

Most common primary malignant bone tumor.

Question 24

Suburst periosteal reaction with codman triangle and cloud-like, dense bone formation

Answer 24

Osteosarcoma!

Most common primary malignant bone tumor

Question 25

What is the most common bone tumor associated with Pagets disease

Answer 25

Osteosarcoma

Question 26

Agressive bone tumor that is permeative, lytic, with hair-on-end, codman triangle and onion skinning

Answer 26

“Wings and Onion Rings”

Ewings Sarcoma!!

Usually under 20 y/o, painful with fever, weight loss, and elevated ESR.

Question 27

What study is most useful in searching for metastatic bone disease?

Answer 27

Total skeletal bone scan

Malignant lesions will show increased uptake