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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
Q

bone tumors common at epiphyseal

A

giant cell tumor

aneurysmal bone cyst

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26
Q

metaphysical bone tumors common

A

osteosarcoma
chondrosarcoma
osteochondroma

fibrious dysplasia

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27
Q

diaphysial bone tumors MC

A

Ewing’s sarcoma
osteoid osteoma
osteochondroma

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28
Q

characteristics of a benign tumor

A

geographic bone destruction

WELL DEFINED sclerotic margin

no soft tissue mass

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29
Q

malignant bone tumor characteristics

A

poorly defined margins

interrupted periosteal region

moth eatn appearance

soft tissue mass

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30
Q

MC benign lesion of bone

A

osteochondroma

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31
Q

epidemiology osteochondroma

A

pts <20

M:F = 3:1

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32
Q

where are osteochondroma MC located?

A

at metaphysical aspect of growth plates

stop growing at skeletal maturity

**metaphysics of long bones (knees) **

33
Q

diagnostic work up of osteochondroma

A

plain films are used initially

MRI is benign, show suspicious behavior

34
Q

tx of osteochondroma

A

surgical excision only if causing pain or pathologic fracture

35
Q

malignancy of osteochondroma

A

rare

chondrosarcoma

malignant transformation of existing dz = growth and new onset pain

36
Q

osteoid osteoma (definition and epidemiology)

A

benign osteoblastic lesion

b/t ages 10-35 y/o , M>F

37
Q

osteoid osteoma MC location

A

long bones of lower extremity

femur or tibia

38
Q

osteoid osteoma symptoms

A

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
Q

osteoid osteoma dx

A

initial study of choice = plain film

most sensitive study = bone scan followed by CT

40
Q

tx of osteoid osteoma

A

ASA/NSAID

surgical excision if accessible

41
Q

enchondroma

A

benign, solitary, cartilaginous neoplasms in intramedullary bone

bone is replaced with hyaline cartilage

42
Q

maffucci syndrome

A

rare, multiple enchondroma occur

ass. w/hemangiomas and phleboliths

43
Q

enchondroma location

A

2nd mc benign bone tumor

short, tubular hand bones

44
Q

presentation of enchondroma

A

asymptomatic until complication development (I.e. pathologic fracture or malignant transformation)

45
Q

dx and tx of enchondroma

A

plain films = “rings and arcs” cartilaginous calcifications “scalloped edges” of phalanges

tx = surgical curettage and grafting

46
Q

MC fibrous lesion of bone

A

non-ossifying fibroma

developmental defect of bone where ossifying center is replaced with fibrous connective tissue

47
Q

non-ossifying fibroma diagnosis

A

found incidentally, will regress on own

at first fibroma is radiolucent –> ossified and osteosclerotic appearing

48
Q

surgical management of non-ossifying fibroma

A

large lesions (>50% of medullary cavity) = need curettage and bone grafting

49
Q

aneurysmal bone cyst epidemiology

A

90% in those < 20

MC in girls than boys

50
Q

aneurysmal bone cyst causes

A

reaction to non-neoplastic processes OR vascular malformation or may arise de novo

51
Q

MC site of aneurysmal bone cyst

A

metaphysics of long bone

52
Q

work up aneurysmal bone cyst

A

rapidly growing mass, pain, and development of pathological fractures

radiographs

53
Q

hallmark aneurysmal bone cyst

A

multi cystic, soap bubble lesion (blow out) of bone with very thin shell.rim of periosteal rxn

54
Q

giant cell tumors

A

osteoclastoma

seen after skeletal maturity (30s, MC in females)

occur near knee and at articular ends of bone

55
Q

giant cell tumors presentation

A

pain and welling, deformity and pathological fracture

tend to be very destructive and may metastasize to lung

56
Q

giant cell tumors diagnosis

A

plain films and MRI for diagnosis and staging

57
Q

giant cell tumors tx

A

low grade= Curettage and packing with PMMA

adjuvant use of phenol. nitrogen, or argon laser can reduce reoccurrence

58
Q

management of pulmonary mets

A

resection if possible, chemo/radiatoin if not

59
Q

MC malignant bone tumor

A

osteosarcoma

60
Q

osteosarcoma appearance

A

osteolytic or osteosclerotic

solitary lesions in long bones of kids

found in femur, tibia, humerus

61
Q

osteosarcoma epidemiology/RF

A

males and blacks MC

RF: rapid bone growth, genetic tendency, radiation exposure

ALSO Paget’s dz increased risk

62
Q

osteosarcoma presentation

A

pain worsens with activity

often initially attributed to trauma, sprain or growing pain

**PATHOLOGIC FRACTURES and SYSTEMIC SX are uncommon ***

63
Q

osteosarcoma work up

radiographs

A

radiographs of bone and joint

medullary and cortical destruction, aggressive periosteal reaction and soft tissue mass

64
Q

osteosarcoma imaging

A

CT of chest w/wo contrast to evaluate for pulmonary mets

Labs: Alk Phos, LDH, LFTs, CBC< chem panel

65
Q

osteosarcoma tx

A

depends on stage

neoadjuvant chemo = shrink tumor then excise en bloc with clear margins

amputation preferred to sub optimal resection

66
Q

osteosarcoma mets

A

pulmonary mets are resected at same time as none sx

thoracotomy with wedge resection

insensitive to radiation

67
Q

chondrosarcoma

A

second most common

heterogenous group of tumors arising from cartilage

either slow growing, low malignant, or rapidly growth

68
Q

chondrosarcoma pt presentation

A

50-70 y.o slight male predominance

MC axial skeleton (pelvis, ribs, femur, tibia)

69
Q

chondrosarcoma pain

A

dull deep aching pain

n. or joint fxn may be impacted

70
Q

chondrosarcoma work up

A

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
Q

chondrosarcoma tx

A

complete sx resection but is difficult to resect

pulmonary mets are resected

chemo radiation dont work

72
Q

chondrosarcoma prognosis

A

dependent on histological grade and ability to perform resection

73
Q

Ewing’s sarcoma cause

A

boney tumor resulting from common genetic locus (translocation of 22 and 11)

74
Q

Ewing’s sarcoma presentation

A

pain. limited movement, tenderness (similar to sports injury)

FEVER, WEIGHT LOSS

75
Q

where is Ewing’s sarcoma found?

A

diaphysis of long bones

76
Q

plain film Ewing’s sarcoma

A

ILL DEFINED

permeative bone destruction with aggressive periosteal run and large soft tissue mass

77
Q

Ewing’s sarcoma distinguishing features (3)

A
  1. systemic symptoms (fever, weight loss)
  2. white boys
  3. hazing of periosteal reactions
78
Q

Ewing’s sarcoma w/u

A

XR, MRI, CT to evaluate pulmonary mets

PET scan/bone scan for metastatic disease

79
Q

Ewing’s sarcoma tx

A

surgical resection and adjuvant chemo (risk of neutropenic fever(

MSK 1 (9 decks)

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