Exam 3 Tumors Flashcards
What tumor crosses the physis?
giant cell tumor
What tumor is in the epiphysis?
chondroblastoma
Age of occurrence for Ewing’s Sarcoma?
10-25
Age of occurrence for osteosarcoma?
10-25
Age of occurrence for Giant Cell Tumor?
20-40
Age of occurrence for chondrosarcoma?
55-70
Age of occurrence for myeloma?
50-70
75% of all malignancies?
metastatic disease
MC primary malignant tumor in in adults?
multiple myeloma
MC primary malignant tumor in kids?
osteosarcoma
MC benign osseous tumor?
osteochondroma
MC benign spinal tumor?
hemangioma
More aggressive tumors have ________ zone of transition.
longer
Most aggressive forms of periosteal reaction?
Codman’s Triangle
Tumors with cartilage matrix 5:
- enchondroma
- osteochondroma
- chondroblastoma
- chondromyxoid fibroma
- chondrosarcoma
Tumors with osseous matrix 5:
- osteoma
- osteoblastoma
- osteochondroma
- osteoid osteoma
- osteosarcoma
Tumors with fibrous matrix 6:
- fibrous dysplasia
- desmoplastic fibroma
- non-ossifying fibroma
- fibrous cortical defect
- ossifying fibroma
- fibrosarcoma
bone expansion typically primary, >6cm, numbers of lesions, periosteal reaction, presence of ST
primary neoplasia
MC sites of metastatic bone disease:
breast, lung, prostate, kidney, thyroid, and bowel
Types of metastatic bone disease:
blastic, lytic, mixed, or expansile
MC primary site for mets in females:
breast (70%) 80% is lytic and 10% is blastic
MC primary site for metastasis in males:
prostate (60%) 80% blastic
MC pathway of metastasis?
hematogenous dissemination (blood)
MC secondary sites of metastasis:
Spine 40% Ribs and sternum 28% Pelvis and sacrum 12% Proximal extremities 10% Skull 10%
Where is metastasis rare?
distal to knees and elbows
Radiographic features of vertebral metastasis:
ivory vertebra, pedicle destruction, pathologic collapse, focal osteoporosis of a body, and malignant schmorl’s node formation
Solitary ivory vertebra most likely indicates:
- Paget’s
- Hodgkin’s lymphoma
- Osteoblastic metastasis
What lab is helpful when checking for lymphoma?
CBC, BCP, and ESR
What lab is helpful when checking for Paget’s?
BCP for alkaline phosphatase
What lab is helpful when checking for blastic mets?
BCP to include alkaline and acid phosphatase and PSA
MRI characteristics of metastasis:
T1 sensitive: low
T2 variable: high
Primary malignant neoplasia accounts for ______ of all malignancies:
30%
Age for multiple myeloma:
50-70
Round cell tumors:
- Ewing’s
- Non-Hodgkin’s lymphoma
- Multiple myeloma
Clinical features of multiple myeloma:
pain, unexplained wt loss, cachexia, bacterial respiratory infections, anemia, renal disease, respiratory disease, deossification of bone, abnormal serum and urine proteins
Lab findings for multiple myeloma:
elevated ESR, thrombocytopenia, rouleaux formation, increased serum Ca, normal to increased serum phosphorus, M Spike on protein electrophoresis
Skeletal locations for multiple myeloma:
vertebrae: thoracic and lumbar, pelvis, skull, ribs, clavicle, scapula, femur, and humerus
What is solitary plasmacytoma?
localized form of plasma cell proliferation
What areas does solitary plasmacytoma prefer?
vertebra>pelvis>skull>sternum>ribs
Soap bubbly, highly expansile lesion:
solitary plasmacytoma
Bone scan on multiple myeloma:
may be normal
Rain drop skull:
multiple myeloma
Multiple myeloma may spare the _________ more than lytic mets:
pedicles
5 yr survival multiple myeloma:
20%
Primary malignant tumor of undifferentiated CT which forms neoplastic osteoid:
osteosarcoma
2nd MC primary malignant bone tumor:
osteosarcoma
MC primary malignant bone tumor in children and young adults:
osteosarcoma
Age for osteosarcoma:
10-25 and 60+
Clinical presentation for osteosarcoma:
painful swelling 85% of the time
Skeletal location of osteosarcoma:
distal femur: 40%
proximal tibia: 16%
proximal humerus: 15%
(75% in metaphysis next to growth plate)
(cylindrical bones under 30 and flat bones over 50)
Mets from osteosarcoma to:
lungs
Rad findings for osteosarcoma:
- ill defined, dense sclerotic lesion >5cm fills medullary space
- moth eaten medullary and cortical destruction less C
- sunburst/Codmans
- large ST mass w tumor
Cumulus cloud, cannonball:
osteosarcoma
What films are needed with osteosarcoma:
chest films/CT
Secondary osteosarcoma:
Paget’s, Ollier’s, Ionizing radiation, Polystotic fibrous dysplasia, Hereditary multiple exostosis
Third most common primary malignant bone tumor:
chondrosarcoma
Secondary chondrosarcoma:
complication of preexisting skeletal abnormality such as osteochondroma or enchondroma
Age for chondrosarcoma:
40-60
Common locations for chondrosarcoma:
proximal humerus, neck of femur, ribs, sternum, pelvis
Popcorn matrix calcification:
chondrosarcoma (also fluffy, stippled, cotton wool, etc)
4th most common primary malignant bone tumor:
Ewing’s Sarcoma
2nd most common primary malignant bone tumor in children:
Ewing’s Sarcoma
Age for Ewing’s Sarcoma:
10-25, peak at 15
Clinical Ewing’s:
severe localized pain, palpable soft tissue mass, fever, infection
Only primary malignant tumor that stimulates infection:
Ewing’s
Skeletal location for Ewing’s:
long tubular bones: 60% (femur, tibia, humerus, fibula, especially under 20)
onion skin
Ewing’s Sarcoma
Saucerization:
Ewing’s
Most common primary malignancy to metastasize to bone:
Ewing’s
Ewing’s metastasis:
lung, bone, regional lymph nodes (11-30% at diagnosis, 40-45% within 2 years)
Ewing’s 5 year survival:
60-75%
Giant Cell Tumor: Benign or Malignant?
quasi-malignant malignant 20% of time
Age for Giant Cell tumors:
20-40
Osseous location of GCT:
85% in long bones (distal femur, proximal tibia(50-60%), distal radius, and proximal humerus)
GCT tumors are more malignant in:
distal radius
GCT clinical:
local aching pain, malignant more in males
bony exostosis on external bone with a hyaline cartilage cap:
solitary osteochondroma
Most common benign osseous tumor:
solitary osteochondroma
50% of all benign tumors:
solitary osteochondroma
age for solitary osteochondroma:
under 20
Clinical solitary osteochondroma:
asymptomatic unless disturbing vessels or nerves. Painless hard mass. Pain or new growth may mean malignant
Osseous location solitary osteochondroma:
metaphysis of long bones: femur, tibia (50%), humerus, proximal radius
Growth of solitary osteochondroma stops when:
growth plate closes
Exostosis on solitary osteochondroma grows:
away from joint
Widespread solitary osteochondroma:
hereditary multiple exostosis
mushroom shaped peduculated bony excresence:
sessile osteochondroma
Hereditary multiple exostosis AKA:
diaphyseal achalasia
HME age:
2-10
Average exostosis in HME:
10
HME clinical:
painless hard masses, cord compression possible, malignant 5-20%(chondrosarcomas)
SBC age:
3-14
SBC location:
60-75% in proximal humerus and femur
Fallen fragment sign:
SBC
Age of aneurysmal bone cyst:
10-30 (75% below 20)
Clinical ABC:
acute onset of pain increasing over 6-12 weeks, may have trauma
Locations aneursymal bone cyst:
spine 30% (posterior anatomy)
long bones and flat bones
ABC cortex:
invisible thin
ABCs are not:
subarticular
GCTs are:
subarticular
Age osteoblastoma:
10-20 peak
Osteoblastoma resembles:
osteoid osteoma
Clinical osteoblastoma:
dull pain of insidious onset: 84%
Osteoblastoma locations:
spine in 40%
long bone: 30%
small bones of hands and feet: 25%
Osteoid osteoma represents ______ of benign tumors
12%
Age osteoid osteoma:
10-25
Clinical findings osteoid osteoma
tender to touch, local pain in 98%, worse at night, salicylates relieve pain in most
Location osteoid osteoma
meta/diaphysis of long bones (73%)
Age enchondroma:
10-30
MC benign tumor of the hand
enchondroma
Location endochondroma:
small bones of wrist and hands: 40% (phalanges>metacarpals), long bones, usually central
enchondromatosis, early childhood, hand and foot deformity, multiple enchondromas
Ollier’s disease
Age hemangiomas:
40-60
Signs/symptoms of hemangiomas:
asymptomatic unless spinal lesions cause stenosis and compression
Locations of hemangiomas:
lower thoracic and upper lumbars, calvarium (frontal)
Accordion, corduroy, honeycomb:
hemangioma
