CH 12--DISEASES OF BONES--Bone 4/Tumors

Question 1

BONE NEOPLASIA
1–• Bone tumors are clinically rare (benign or malignant)
2–• Malignant bone tumors can be primary or secondary
3–• Primary malignant tumors are twice as common in adults as benign tumors.
4–• ________- is the most common primary malignant bone
tumors (excluding multiple myeloma, a tumor of B cells)
5–• _________– is the most common form of SECONDARY malignant bone tumors in adults
6–• The prostate, breast, lung, kidney & thyroid (in that order) are the most common forms of cancer to metastasize to bone.

Answer 1

Osteosarcoma

Metastasis

Question 2

BONE NEOPLASIA can be

____________ =

1. Ivory osteoma —Bone forming tumors
2. Osteoid osteoma —Bone forming tumors
3. Enchondroma —Cartilage forming tumors

_______________ =

1. Osteosarcoma–Bone forming tumors
2. Chondrosarcoma—Cartilage forming tumors
3. Ewing’s sarcoma—Tumors of unknown origin
4. Giant cell tumor (osteoclastoma)–Tumors of unknown origin

Answer 2

Benign

Malignant

Question 3

BONE FORMING TUMORS

1. Ivory osteoma = RARE benign tumor of the bone

A. Features:
Site: Bones of ______(parietal, frontal) and face (orbit, paranasal sinuses)
B. Pathology: Round, sessile mass of dense lamellar bone = pressure, obstruction

Answer 3

skull

Question 4

BONE FORMING TUMORS

2. Osteoid osteoma = SMALL, painful, benign tumor

Features:
Ages: young individuals (below 30 years)
Sex: more in males (2:1)
Site: within the cortex of the__________ of LONG bones

Pathology:
N.E.: Round or oval mass surrounded by dense
sclerotic bone. Usually 1 cm in size
Micr.: Thin irregular trabeculae of osteoid tissue
Vascular C.T. matrix + Dense sclerotic shell

Clinically:- Severe pain
Treatment:- _________ and resection

Answer 4

diaphysis

Aspirin

Question 5

BONE FORMING TUMORS

3. Osteosarcoma

Features:
Incidence: Excluding multiple myeloma, a tumor of__cells
= commonest primary malignant bone tumor
Age: 2 peaks → 1st : 10-25 years
2nd : 50 years (complicates Paget’s)
Sex: more in _________ (2:1)
Site: metaphysis of long bones, especially around the knee

Predisposing Factors:

1. Paget’s disease
2. Exposure to radiation and viral infection
3. Genetic: chromosome 13 mutation

Answer 5

B

males

Question 6

BONE FORMING TUMORS

3. Osteosarcoma—malignant mesenchymal cells. Sarcomas have very pleomorphic cells, often with a spindle shape. There are islands of reactive new bone. The periosteum has laid down a proximal triangular shell of reactive bone known as a __________ ____________

Depending on degree of differentiation, can be either:

Grade 1: (50%)

• formation of neoplastic bone tissue (____________)
• gray-white mass
• hard consistency
• bony spicules along stretched periosteal vessels (sunray appearance)

Grade 2:
- red, soft, hemorrhagic, no matrix (______________)

Answer 6

Codman triangle

Sclerotic

Osteolytic

Question 7

BONE FORMING TUMORS

3. Osteosarcoma

Clinically:
A--- Painful swelling
B--- Rapid rate of growth
C--- Pathological fracture
D--- Spread:
- local (direct spread)
- \_\_\_\_\_\_\_\_\_\_\_is major route (LUNG)
- lymphatic (rare)

Treatment:-
A— Current treatment is combination of surgery, radiation and chemotherapy leading to a 5 years survival rate of __%

Answer 7

blood

60%

Question 8

CARTILAGE FORMING TUMORS

1. ____________–A benign tumor consisting of mature HYALINE cartilage

Features:
Age: YOUNG adults
Sex: NO difference
Site: SMALL bones of hands and feet

Clinically:

• Pain
• Swelling
• Erosion → fracture

Treatment: removal if necessary

Answer 8

Enchondroma-

Question 9

CARTILAGE FORMING TUMORS

2. ________________ = A malignant tumor that originates from CARTILAGE cells

Answer 9

Chondrosarcoma

Question 10

TUMORS OF UNKNOWN ORIGIN

1. Ewing’s sarcoma = A rare but extremely ____________neoplasm of bone and soft tissue.

Features:
Age: children & young adults (10-30 years)
Sex: more in males (2:1)
Site: diaphysis of long bones ( femur, tibia,
humerus) & the pelvis

Pathology:
Extends into:
– medullary cavity
– cortex = several layers of subperiosteal bone formation (_______–________ pattern)
– surrounding soft tissue
–Fleshy mass with hemorrhage & necrosis

Answer 10

malignant

onion-skin

Question 11

TUMORS OF UNKNOWN ORIGIN

Ewing’s sarcoma—originates in the ________of long bones

Spread:

i. local
ii. blood to many organs (highly malignant)

Answer 11

diaphysis

Question 12

TUMORS OF UNKNOWN ORIGIN

2. ________ _________Tumor (osteoclastoma)
   - multinucleated giant cells (osteoclasts)
   - spindle-shaped mononuclear neoplastic
   cells

Features:
Age: 20-40 years
Sex: slight female predominance
Site: epiphysis of long bones especially around the knee, proximal humerus, & distal radius

Spread:

• potentially malignant
• 50% reoccur after removal
• 20% extension into soft tissue
• 10% metastasis (e.g. lung)

Answer 12

GIANT CELL