Bone Tumors- Handorff Flashcards
What are the four pieces of information you need when attempting to identify a bone lesion/tumor?
Age and sex of pt, location of lesion, radiographic appearance of lesion
Malignant tumor of the skull or lumbar vertebrae
chordoma
Benign tumor of the spinal cord=
osteoblastoma
Malignant bone lesion of the shoulder=
osteosarcoma
malignant lesion of the pelvis=
chondrosarcoma
Malignant lesion of the head of the femur or radius=
Giant cell tumor…and most are actually benign
Also look at the diagram for non-malignants
ok
Malignant bone tumors occuring in the metaphysis are?
Osteosarcoma and juxtacortical osteosarcoma
Malignant tumors occuring in the diaphysis include
Ewing’s Sarcoma and chondrosarcoma
Bnign tumors occuring at the epiphysis include…
Chondroblastoma and Giant cell Tumor
Benign tumors in the diaphysis include
Enchondroma and fibrous dysplasia
What is the issue in fibrous dysplasia?
All components of the bone are present but do not mature
What are the 3 distinctive patterns of bone involvement?
monostotic, polyostotic, McCune Albright SYndrome
What is monostotic fibrous dysplasia
characterized by single bone involvement
What is polyostotic fibrous dysplasi
characterized by multiple bones being involved
McCune Albright Syndrome
Polyostotic, Cafe-Au Lait skin pigmentation, Endocrinopathies
Polyostotic fibrous dysplasi may transform to?
Osteosarcoma
x-ray appearance of a fibrous cortical defect?
scooped out with borders that are scalloped and sclerotic/ denser than the bone which surrounds them
Is a fibrous cortical defect common or uncommon
COMMON. over 50% of kids over 2
Most common site of fibrous cortical defect
Metaphysis of femur and proximal tibia
Approximately half of these are bilateral or multiple
If you see that the fibrous cortical defect is over 5-6 cm, what do you suspect?
nonossifying fibroma
Fibrous cortical defects ususally resolve…..
spontaneously
Definition of fibrous cortical defect
eccentric, sharply delineated, metaphyseal lesion in long bones of adolescents…Also known as benign fibrous histiocytom is mass forming
Fibrous cortical defect age group
adolescents
Symptoms of FCD
pain
Solitary bone cysts are benign fluid-filled cysts
truth
2/3 of solitary bone cysts occur where?
in the humerus or femur
Solitary bone cysts are usually asymptomatic
true
Very bloody cystic lesion=
aneurysmal bone cyst
Aneurysmal bone cysts are not true tumors, they arise from the surface of bone and are usually found in the long bones and vertebral column.
all true
Greatest frequency of bone neoplasms is when?
First 3 decades of life
What type of benign neoplasm may become malignant?
Chondroma
Osteomas are
bone forming tumors
Osteomas are generally solitary unless….
Gardners Syndrome, multiple osteomas and GI nodules
Osteomas are of little clinical significance unless they are where
in the skull eye, oral cavity, etc…)
Osteoid Osteomas are generally what size, seen in what age groups, involve what bones?
less than 2cm, involve mostly males in their teens and twenties, involve tibia and fibula
Osteoid osteomas are……..
PAINFUL!!! They secrete prostaglandin E2 and have a characteristic pattern of pain. Most commonly painful at night are relieved by asprin
Intake of alcohol causes a massive increase in pain in….
osteoid osteomas
Osteochondromas are what:
benign cartillage capped tumors that are attached to underlying skeleton by a stalk.
They may displace growth plates in endochondral bones
What is multiple hereditary exostosis
a condition characterized by multiple osteochondromas, it is autosomal dominant and may give rise to malignant chondrosarcoma (rare)
Chondroma
benign tumor of hyaline cartillage
Enchondromas are where
arise in medullary cavity of hands and feet
Juxtacortical chondromas arise where
surface of bones
Ollier disease
multiple enchondromas
Maffucci syndrome
multiple enchondromas as well as hemangiomas
Giant cell tumor definition, location, age
multinucleated osteoclast giant cells, benign but uncommon and locally aggressive, arise in ppl age 20-40’s. Arise around the knee
WHat must you not confuse giant cell tumors with?
TB, if it is a granuloma think TB
Malignant bone tumors are rare:
Truth
The most common bone tumors are:
Metastatic, BPLKT, Breast, Prostate, lung, kidney, thyroid…KNOW
Finish bone tumors
ok
Osteosarcoma generally appears in what age group
under 20.
Where in the body does osteosarcoma most commonly appear
Knee, shoulder, pelvis. Or as Robbins puts it, the METAPPHYSIS of distal femur, humerus, and proximal tibia
Osteosarcoma has the tendency to grow out of the cortex and do what to the periosteum? What does this form?
Lift it, forms a codman triangle
Chondrosarcoma occurs where most frequently
SHoulder, pelvis, proximal femur, rib
Very centrally located.
WHat is the age range for chondro sarcoma
35-60,
Treatment for chondrosarcoma?
Surgery, it is insensitive to radiation and chemo
Ewing Sarcoma most commonly affects who>
Children. …white ppl under 15 specifically
Ewing’s sarcoma typically arises where?
diaphysis of long bone
Gross appearance of Ewing’s
Onion skin with layers of reactive periosteum and neoplasm
Ewing’s on Histology
“Small round blue cells”
What is the characteristic structure of Ewing’s sarcoma
Homer Wright rosettes: tumor cells arranged in a circle around a central fibrillary space….Dark blue cells around a pink fibrillar area
In adults, more than 75% of skeletal metastases come from where?
cancer of prostate, breast, kidney, lung
In children, metastatic metastses to the skeleton are from:
neuroblastoma, wilms tumor, osteosarcoma, Ewing sarcoma, rhabadomyosarcoma
Most metastases involve what part of the skeletal structure
Axial skeleton, proximal femur, humerus, in descending order
Most include a mixed lytic and blastic reaction…(break boine and make bone).
Key words for metastasis?
Multiple lytic punched out lesions!
