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MSK 1 > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

primary bone tumors

A

arise from bone itself

often caught incidentally and are asymptomatic

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2
Q

secondary bone tumors

A

arise from other sides and metastasize to bones

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3
Q

which type of bone tumors are more common?

A

secondary bone tumors

benign mc PRIMARY bone tumor

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4
Q

CAs that typically metastasize to bone

A 
Thyroid 
Renal 
Luns 
Prostate 
Breast (MC)
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5
Q

multiple myeloma

A

CA of plasma cells in bone marrow

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6
Q

multiple myeloma pt presentation

A

65 y.o pt

bone pain (MC Spine)

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7
Q

diagnosis of MM by

A

SPEP or UPEP

will have clonal plasma cells in marrow (tissue bx)

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8
Q

systemic damage from MM

A

anemia
kidney disease
bone pain
infection

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9
Q

management of symptomatic bone tumors

A

steroids
NARCOTICS
radiation

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10
Q

what type of lesion looks like bone being eaten away,

A

Osteolytic lesion

clear area with no bone on X Ray
can cause fracture

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11
Q

mets of these types of cancers cause osteolytic lesions

A

mets TO skull

thyroid and renal cells

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12
Q

osteolytic lesions differential Dx

A

FOG MACHINES

Fibrous dysplasia 
Osteoscarcoma 
Giant cell tumor
Met bone dz/myeloma
Aneurysmal bone cysts 
chontroblastoma
hyperarathyroid 
Infection (osteomyelitis) 
Non-ossifying fibroma 
Endochondroma 
Simple cysts
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13
Q

osteosclerotic lesion

A

bone becomes pathologically thicker

lesions may be both lytic and sclerotic

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14
Q

osteosclerotic lesions DDX

A

VINDICATE

vascular 
Infection 
Neoplasm 
drugs 
Idiopathic
Congenital 
autoimmune 
trauma 
Endocrine
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15
Q

malformed growths of bone tissue that grow in an abnormal pattern

A

hamarthomas

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16
Q

symptomatic benign primary bone tumors

A

localized pain and swelling over WEEKS to MONTHs `

benign tumors are MC asymptomatic

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17
Q

malignant tumor presentation

A

malignant tumors cause pain (mild but exacerbated by exercise and worse at night)

fixed in place if found on exam

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18
Q

initial evaluation of bone tumors

A

plain film X Ray

will show you if lesion is likely malignant or benign

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19
Q

why must we image the entire bone on Xray

A

must evaluate for skip lesions

metastatic spread of bone CA outside of what is deemed “active rim” but within same bone

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20
Q

CT and MRI in bone imaging

A

CT is superior to MRI in visualizing bone detail

MRI is superior to CT to evaluate marrow infiltration and soft tissues

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21
Q

bone scan

A

radioactive technetium given and taken up in large quantities by metabolically active tissues

sensitive but not specific

MC used for staging

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22
Q

bone scan is positive in

A

trauma
tumor
infection

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23
Q

bone scan is negative in

A

multiple myeloma and osteoporosis

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24
Q

confirmative test of a primary bone tumor?

A

tissue diagnosis

operative bc or core needly bx

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25
bone tumors common at epiphyseal
giant cell tumor | aneurysmal bone cyst
26
metaphysical bone tumors common
osteosarcoma chondrosarcoma osteochondroma fibrious dysplasia
27
diaphysial bone tumors MC
Ewing's sarcoma osteoid osteoma osteochondroma
28
characteristics of a benign tumor
geographic bone destruction WELL DEFINED sclerotic margin no soft tissue mass
29
malignant bone tumor characteristics
poorly defined margins interrupted periosteal region moth eatn appearance soft tissue mass
30
MC benign lesion of bone
osteochondroma
31
epidemiology osteochondroma
pts <20 | M:F = 3:1
32
where are osteochondroma MC located?
at metaphysical aspect of growth plates stop growing at skeletal maturity ****metaphysics of long bones (knees) ****
33
diagnostic work up of osteochondroma
plain films are used initially MRI is benign, show suspicious behavior
34
tx of osteochondroma
surgical excision only if causing pain or pathologic fracture
35
malignancy of osteochondroma
rare chondrosarcoma malignant transformation of existing dz = growth and new onset pain
36
osteoid osteoma (definition and epidemiology)
benign osteoblastic lesion b/t ages 10-35 y/o , M>F
37
osteoid osteoma MC location
long bones of lower extremity femur or tibia
38
osteoid osteoma symptoms
MC = pain, deep continuous aching with varying quality or severity worse at night improves with ASA, worsened with EtOH typically occurs before lesion visible on Xray
39
osteoid osteoma dx
initial study of choice = plain film most sensitive study = bone scan followed by CT
40
tx of osteoid osteoma
ASA/NSAID surgical excision if accessible
41
enchondroma
benign, solitary, cartilaginous neoplasms in intramedullary bone bone is replaced with hyaline cartilage
42
maffucci syndrome
rare, multiple enchondroma occur ass. w/hemangiomas and phleboliths
43
enchondroma location
2nd mc benign bone tumor short, tubular hand bones
44
presentation of enchondroma
asymptomatic until complication development (I.e. pathologic fracture or malignant transformation)
45
dx and tx of enchondroma
plain films = "rings and arcs" cartilaginous calcifications "scalloped edges" of phalanges tx = surgical curettage and grafting
46
MC fibrous lesion of bone
non-ossifying fibroma developmental defect of bone where ossifying center is replaced with fibrous connective tissue
47
non-ossifying fibroma diagnosis
found incidentally, will regress on own at first fibroma is radiolucent --> ossified and osteosclerotic appearing
48
surgical management of non-ossifying fibroma
large lesions (>50% of medullary cavity) = need curettage and bone grafting
49
aneurysmal bone cyst epidemiology
90% in those < 20 MC in girls than boys
50
aneurysmal bone cyst causes
reaction to non-neoplastic processes OR vascular malformation or may arise de novo
51
MC site of aneurysmal bone cyst
metaphysics of long bone
52
work up aneurysmal bone cyst
rapidly growing mass, pain, and development of pathological fractures radiographs
53
hallmark aneurysmal bone cyst
multi cystic, soap bubble lesion (blow out) of bone with very thin shell.rim of periosteal rxn
54
giant cell tumors
osteoclastoma seen after skeletal maturity (30s, MC in females) occur near knee and at articular ends of bone
55
giant cell tumors presentation
pain and welling, deformity and pathological fracture tend to be very destructive and may metastasize to lung
56
giant cell tumors diagnosis
plain films and MRI for diagnosis and staging
57
giant cell tumors tx
low grade= Curettage and packing with PMMA adjuvant use of phenol. nitrogen, or argon laser can reduce reoccurrence
58
management of pulmonary mets
resection if possible, chemo/radiatoin if not
59
MC malignant bone tumor
osteosarcoma
60
osteosarcoma appearance
osteolytic or osteosclerotic solitary lesions in long bones of kids found in femur, tibia, humerus
61
osteosarcoma epidemiology/RF
males and blacks MC RF: rapid bone growth, genetic tendency, radiation exposure ALSO Paget's dz increased risk
62
osteosarcoma presentation
pain worsens with activity often initially attributed to trauma, sprain or growing pain **PATHOLOGIC FRACTURES and SYSTEMIC SX are uncommon ***
63
osteosarcoma work up | radiographs
radiographs of bone and joint medullary and cortical destruction, aggressive periosteal reaction and soft tissue mass
64
osteosarcoma imaging
CT of chest w/wo contrast to evaluate for pulmonary mets Labs: Alk Phos, LDH, LFTs, CBC< chem panel
65
osteosarcoma tx
depends on stage neoadjuvant chemo = shrink tumor then excise en bloc with clear margins amputation preferred to sub optimal resection
66
osteosarcoma mets
pulmonary mets are resected at same time as none sx thoracotomy with wedge resection insensitive to radiation
67
chondrosarcoma
second most common heterogenous group of tumors arising from cartilage either slow growing, low malignant, or rapidly growth
68
chondrosarcoma pt presentation
50-70 y.o slight male predominance MC axial skeleton (pelvis, ribs, femur, tibia)
69
chondrosarcoma pain
dull deep aching pain n. or joint fxn may be impacted
70
chondrosarcoma work up
plain films (lg > 5 cm mass w/ surface erosions and perisoteal elevation -- flecks and ringlets) MRI is study of choice, evaluates soft tissue infxn
71
chondrosarcoma tx
complete sx resection but is difficult to resect pulmonary mets are resected chemo radiation dont work
72
chondrosarcoma prognosis
dependent on histological grade and ability to perform resection
73
Ewing's sarcoma cause
boney tumor resulting from common genetic locus (translocation of 22 and 11)
74
Ewing's sarcoma presentation
pain. limited movement, tenderness (similar to sports injury) FEVER, WEIGHT LOSS
75
where is Ewing's sarcoma found?
diaphysis of long bones
76
plain film Ewing's sarcoma
ILL DEFINED permeative bone destruction with aggressive periosteal run and large soft tissue mass
77
Ewing's sarcoma distinguishing features (3)
1. systemic symptoms (fever, weight loss) 2. white boys 3. hazing of periosteal reactions
78
Ewing's sarcoma w/u
XR, MRI, CT to evaluate pulmonary mets PET scan/bone scan for metastatic disease
79
Ewing's sarcoma tx
surgical resection and adjuvant chemo (risk of neutropenic fever(

MSK 1 (9 decks)

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