Bone Tumors - Most Flashcards
Olliers disease is associated with which tumors
Enchondromas and chondrosarcoma
Maffucci’s syndrome is associated with which tumors?
Endondromas, chondrosarcoma, vascular tumors
Retinoblastoma syndrome (Rb gene) is associated with which bone tumor?
Osteosarcoma
Li-Fraumeni Syndrome (p53) is associated with which brain tumors?
Osteosarcoma, multiple malignancies
Bening bone tumors are usually asymptomatic, but what are the symptoms of malignant bone tumors?
Pain - due to stretching of periosteum or nerve
Pathologic fracture - more common in lytic lesions
Increased serum Calcium
What are some of the words used to describe bone cancers?
Lytic vs Blastic
Indolent vs Aggressive
What are the predisposing factors for osteosarcoma
Previous irradiation
Paget’s disease
Where on the bone is the common location for metastatic bone tumor?
The metaphysis (“meta -meta” as metastatic tumors are in the metaphysis) and also the Diaphysis. The epiphysis is a rare place for metastatic bone tumors to be located
Describe the characteristics of a benign bone tumor
- Well-circumscribed
- Geographic border – well-defined boundaries
- No destructive growth
- No invasion of soft tissues or joint
- Usually small
- Typically seen in younger patients
What are chondroid tumors?
Give an example
These are cartilage forming tumors
They are mostly bening:
Osteochondroma - grow on the side of bone
Enchondroma - grow within bone
Osteochondroma
What special type of bone does it occur in?
In whom is this cancer mostly seen in?
This is a chondroid tumor that grows on the side of the bone
Its a benign cartilage tumor of metaphysis
It occurs in bone that undergoes endochondrial ossiification
Mostly seen in children and young adults
It can be “Solitary” or “Multiple Hereditary Exostosis”
Multiple Hereditary Exostosis:
- EXT1/EXT2 genes
- Autosomal dominant inheritence
- M:F 3:1
- 10% malignancy rate (secondary chondrosarcoma)
Enchondrome
In which bones can it be seen?
Benign cartilaginous tumor
Extremely common; 10% all skeletal neoplasms
50% arise in the small tubular bones of the hands and feet
Remainder in the long bones
No treatment required unless symptoms
<1% malignant degeneration (solitary enchondroma)
- Multiple enchondromatosis
- Ollier’s disease – 25-50% malignancy risk
- Maffucci syndrome – with angiomas/myxomas,50-100% malignancy risk
Osteosarcoma
At what age is it seen?
Location?
Describe its appearence
M/F?
What is the marker for bone turnover that is increased in osteosarcoma
This is the most common primary malignant bone sarcoma
- Bimodal age distribution:
- Children, young adults - 75%
- Elderly (Secondary osteosarcoma - Paget’s, radiation)
- Location
- Youth - metaphyseal (long bones)
- Elderly - flat and long bones eqaully involved
X-ray: lytic, sclerotic, or mixed
Infiltrative/destructive:
- Metaphysis/Diaphysis
- Cortex → soft tissue
- Epiphysis → joint
- “Sunburst” appearance
Cortical Break → periosteal reaction new bone formation → Codman’s triangle
Rapid growth – Large
Pain, fever, constitutional symptoms
M>F 1.6:1
↑ Alkaline phosphatase
Chondrosarcoma
Age?
Typical location?
Subtypes?
• Second most common primary
malignant bone tumor
• Typically occurs in older adults- 4th
decade or older
• Central skeleton- Pelvis, scapula, ribs, humerus, proximal femur
Several subtypes:
– Secondary chondrosarcoma
• Intramedullary- arise in enchondroma
(low grade)
• Juxtacortical- arise in osteochondroma
– Dedifferentiated – poor prognosis
Metastatic tumors to bone
Which type of tumors are most common
What typical cancer metastasize to the bone
• Carcinoma >>> Sarcoma
• Axial and appendicular skeleton
– Spine: usually vertebral body
– Extremities: generally proximal to knee/elbow
– Acral metastases –> most likely lung primary
- May be osteoblastic, lytic or mixed
- Multifocal or solitary. Once one is there there is usually more soon
- Older patient with pertinent history
• Osteophilic tumors
– B (breast), L (lung), T (thyroid) and a Kosher (kidney) Pickle (prostate)
