Bone Tumors- Handorff

Question 1

What are the four pieces of information you need when attempting to identify a bone lesion/tumor?

Answer 1

Age and sex of pt, location of lesion, radiographic appearance of lesion

Question 2

Malignant tumor of the skull or lumbar vertebrae

Answer 2

chordoma

Question 3

Benign tumor of the spinal cord=

Answer 3

osteoblastoma

Question 4

Malignant bone lesion of the shoulder=

Answer 4

osteosarcoma

Question 5

malignant lesion of the pelvis=

Answer 5

chondrosarcoma

Question 6

Malignant lesion of the head of the femur or radius=

Answer 6

Giant cell tumor…and most are actually benign

Question 7

Also look at the diagram for non-malignants

Answer 7

ok

Question 8

Malignant bone tumors occuring in the metaphysis are?

Answer 8

Osteosarcoma and juxtacortical osteosarcoma

Question 9

Malignant tumors occuring in the diaphysis include

Answer 9

Ewing’s Sarcoma and chondrosarcoma

Question 10

Bnign tumors occuring at the epiphysis include…

Answer 10

Chondroblastoma and Giant cell Tumor

Question 11

Benign tumors in the diaphysis include

Answer 11

Enchondroma and fibrous dysplasia

Question 12

What is the issue in fibrous dysplasia?

Answer 12

All components of the bone are present but do not mature

Question 13

What are the 3 distinctive patterns of bone involvement?

Answer 13

monostotic, polyostotic, McCune Albright SYndrome

Question 14

What is monostotic fibrous dysplasia

Answer 14

characterized by single bone involvement

Question 15

What is polyostotic fibrous dysplasi

Answer 15

characterized by multiple bones being involved

Question 16

McCune Albright Syndrome

Answer 16

Polyostotic, Cafe-Au Lait skin pigmentation, Endocrinopathies

Question 17

Polyostotic fibrous dysplasi may transform to?

Answer 17

Osteosarcoma

Question 18

x-ray appearance of a fibrous cortical defect?

Answer 18

scooped out with borders that are scalloped and sclerotic/ denser than the bone which surrounds them

Question 19

Is a fibrous cortical defect common or uncommon

Answer 19

COMMON. over 50% of kids over 2

Question 20

Most common site of fibrous cortical defect

Answer 20

Metaphysis of femur and proximal tibia

Approximately half of these are bilateral or multiple

Question 21

If you see that the fibrous cortical defect is over 5-6 cm, what do you suspect?

Answer 21

nonossifying fibroma

Question 22

Fibrous cortical defects ususally resolve…..

Answer 22

spontaneously

Question 23

Definition of fibrous cortical defect

Answer 23

eccentric, sharply delineated, metaphyseal lesion in long bones of adolescents…Also known as benign fibrous histiocytom is mass forming

Question 24

Fibrous cortical defect age group

Answer 24

adolescents

Question 25

Symptoms of FCD

Answer 25

pain

Question 26

Solitary bone cysts are benign fluid-filled cysts

Answer 26

truth

Question 27

2/3 of solitary bone cysts occur where?

Answer 27

in the humerus or femur

Question 28

Solitary bone cysts are usually asymptomatic

Answer 28

true

Question 29

Very bloody cystic lesion=

Answer 29

aneurysmal bone cyst

Question 30

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.

Answer 30

all true

Question 31

Greatest frequency of bone neoplasms is when?

Answer 31

First 3 decades of life

Question 32

What type of benign neoplasm may become malignant?

Answer 32

Chondroma

Question 33

Osteomas are

Answer 33

bone forming tumors

Question 34

Osteomas are generally solitary unless....

Answer 34

Gardners Syndrome, multiple osteomas and GI nodules

Question 35

Osteomas are of little clinical significance unless they are where

Answer 35

in the skull eye, oral cavity, etc...)

Question 36

Osteoid Osteomas are generally what size, seen in what age groups, involve what bones?

Answer 36

less than 2cm, involve mostly males in their teens and twenties, involve tibia and fibula

Question 37

Osteoid osteomas are........

Answer 37

PAINFUL!!! They secrete prostaglandin E2 and have a characteristic pattern of pain. Most commonly painful at night are relieved by asprin

Question 38

Intake of alcohol causes a massive increase in pain in....

Answer 38

osteoid osteomas

Question 39

Osteochondromas are what:

Answer 39

benign cartillage capped tumors that are attached to underlying skeleton by a stalk. They may displace growth plates in endochondral bones

Question 40

What is multiple hereditary exostosis

Answer 40

a condition characterized by multiple osteochondromas, it is autosomal dominant and may give rise to malignant chondrosarcoma (rare)

Question 41

Chondroma

Answer 41

benign tumor of hyaline cartillage

Question 42

Enchondromas are where

Answer 42

arise in medullary cavity of hands and feet

Question 43

Juxtacortical chondromas arise where

Answer 43

surface of bones

Question 44

Ollier disease

Answer 44

multiple enchondromas

Question 45

Maffucci syndrome

Answer 45

multiple enchondromas as well as hemangiomas

Question 46

Giant cell tumor definition, location, age

Answer 46

multinucleated osteoclast giant cells, benign but uncommon and locally aggressive, arise in ppl age 20-40's. Arise around the knee

Question 47

WHat must you not confuse giant cell tumors with?

Answer 47

TB, if it is a granuloma think TB

Question 48

Malignant bone tumors are rare:

Answer 48

Truth

Question 49

The most common bone tumors are:

Answer 49

Metastatic, BPLKT, Breast, Prostate, lung, kidney, thyroid...KNOW

Question 50

Finish bone tumors

Answer 50

ok

Question 51

Osteosarcoma generally appears in what age group

Answer 51

under 20.

Question 52

Where in the body does osteosarcoma most commonly appear

Answer 52

Knee, shoulder, pelvis. Or as Robbins puts it, the METAPPHYSIS of distal femur, humerus, and proximal tibia

Question 53

Osteosarcoma has the tendency to grow out of the cortex and do what to the periosteum? What does this form?

Answer 53

Lift it, forms a codman triangle

Question 54

Chondrosarcoma occurs where most frequently

Answer 54

SHoulder, pelvis, proximal femur, rib | Very centrally located.

Question 55

WHat is the age range for chondro sarcoma

Answer 55

35-60,

Question 56

Treatment for chondrosarcoma?

Answer 56

Surgery, it is insensitive to radiation and chemo

Question 57

Ewing Sarcoma most commonly affects who>

Answer 57

Children. ...white ppl under 15 specifically

Question 58

Ewing's sarcoma typically arises where?

Answer 58

diaphysis of long bone

Question 59

Gross appearance of Ewing's

Answer 59

Onion skin with layers of reactive periosteum and neoplasm

Question 60

Ewing's on Histology

Answer 60

"Small round blue cells"

Question 61

What is the characteristic structure of Ewing's sarcoma

Answer 61

Homer Wright rosettes: tumor cells arranged in a circle around a central fibrillary space....Dark blue cells around a pink fibrillar area

Question 62

In adults, more than 75% of skeletal metastases come from where?

Answer 62

cancer of prostate, breast, kidney, lung

Question 63

In children, metastatic metastses to the skeleton are from:

Answer 63

neuroblastoma, wilms tumor, osteosarcoma, Ewing sarcoma, rhabadomyosarcoma

Question 64

Most metastases involve what part of the skeletal structure

Answer 64

Axial skeleton, proximal femur, humerus, in descending order | Most include a mixed lytic and blastic reaction...(break boine and make bone).

Question 65

Key words for metastasis?

Answer 65

Multiple lytic punched out lesions!