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Tumors/Pathology Lists > Goldstein List > Flashcards

Goldstein List Flashcards

1
Q
  1. Tumour incidence in orthopaedic surgery (highest → lowest) (5)
A
  • Metastatic disease
  • Benign soft tissue
  • Benign bone
  • Malignant soft tissue
  • Malignant bone
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2
Q
  1. Bone tumour presenting complaints (4)
A
  • Soft tissue mass
  • Incidental finding
  • Painless bony mass
  • Painful bone lesion
  • Pathologic fracture
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3
Q
  1. Enneking classification of malignant bone tumors (5)
A
  • IA: low grade, intracompartmental
  • IB: low grade, extracompartmental
  • IIA: high grade, intracompartmental
  • IIB: high grade, extracompartmental
  • III: metastatic
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4
Q
  1. Enneking classification of benign bone tumors (3)
A
  • 1: latent
  • 2: active
  • 3: aggressive
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5
Q
  1. AJCC staging of bone sarcomas (4)
A
  • Stage I: low grade
    o A: < 8 cm
    o B: > 8 cm
  • Stage II: high grade
    o A: < 8 cm
    o B: > 8 cm
  • Stage III: “skip metastases” in the same bone
  • Stage IV: distant metastases
    o A: pulmonary
    o B: non-pulmonary (including other bones
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6
Q
  1. AJCC soft tissue sarcoma staging (4)
A
  • Stage I: low grade
  • Stage II: high grade
  • Stage III: high grade, deep, large (T2b)
  • Stage IV: metastatic
    o T:
     1 - ≤ 5 cm
     2 - > 5 cm
     a – superficial
     b – deep
    o N: nodal involvement
    o M: distant metastasis
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7
Q
  1. Most common metastatic tumors to bone (5)
A
  • Breast
  • Lung
  • Thyroid
  • Prostate
  • Renal cell
  • (B.L.T. with Pickle on Rye)
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8
Q
  1. Principles of biopsy (9)
A
  • Longitudinal incision
  • in line with definitive resection
  • Approach soft tissue mass or weakened bone
  • Avoid N/V structures
  • Don’t raise flaps
  • Through muscle
  • Avoid joints, growth plates and neurovascular structures
  • Frozen section to confirm lesional tissue
  • Meticulous hemostasis
  • Drain as needed distal and in-line with wound
    Bonus: oval window in bone if needed.
    Send tissue for culture if infection is on the differential

Never biopsy a fracture (pathology mimics osteosarcoma)

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9
Q
  1. Tumour suppressor syndromes (6)
A
  • Familial melanoma (p161NK4a – melanoma, osteosarcoma and chondrosarcoma)
  • Familial adenomatous polyposis (APC – colonic adenomas and desmoids tumours)
  • Hereditary retinoblastoma (RB – retinoblastoma and osteosarcoma)
  • Li-Fraumeni syndrome (p53 – osteosarcomas and breast cancer)
  • Multiple hereditary exostosis (EXT1/2 – osteochondromas and chondrosarcomas)
  • Neurofibromatosis (neurofibromin – neurofibromas and sarcomas)
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10
Q
  1. Findings of McCune Albright syndrome (4)
A
  • Polyostotic fibrous dysplasia
  • Cafe-au-lait spots (“Coast of Maine”)
  • Precocious puberty
  • Endocrine abnormalities
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11
Q
  1. Diagnostic criteria for Neurofibromatosis Type 1 (Von Recklinghausen’s disease) – requires 2 of 7 cardinal features (7)
A
  • > 6 cafe-au-lait spots (“Coast of California” 15 mm in adults/5 mm in kids)
  • ≥ 2 Lisch nodules (#2)
  • Axillary freckling (Crowe’s sign)
  • ≥ 2 neurofibromas or 1 plexiform neurofibroma
  • Optic glioma
  • a distinctive osseous lesion such as sphenoid dysplasia or thinning of long bone cortex with or without pseudarthrosis.
  • First degree relative with NF-1 as per these criteria
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12
Q
  1. Steps involved in the metastatic cascade (7)
A
  • Proliferation
  • Angiogenesis
  • Detachment
  • Dissemination
  • Adherence
  • Extravasation
  • Proliferation
  • (P.A.D.D.A.E.P.)
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13
Q
  1. Signs of hypercalcemia (10)
A
  • Early (5)
    o Polyuria
    o Polydypsia
    o Anorexia
    o Weakness
    o Fatigue
  • Late (5)
    o Nausea/vomiting
    o Psychiatric problems
    o Vision problems
    o Cardiac abnormalities
    o Coma
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14
Q
  1. Multiple Bone lesion
A

Malignant
-Metastatic
-Multiple myeloma
Benign
-Familial osteochondromatosis
-Ollier’s (multiple enchondromas)
-Maffucci’s (enchondromas and hemangiomas)
-fibrous dysplasia (McCune-Albright)
-EG
Non-Tumor
-multifocal osteomyelitis
-Paget’s

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15
Q
  1. Epiphyseal lesions (3 + others)
A
  • Chondroblastoma
  • GCT
  • Clear cell chondrosarcoma (MALIGNANT)– NEED TO RULE THIS OUT IN AN ADULT!
  • Telangiectatic osteosarcoma
  • Infection (Brodie’s abscess)
  • EG
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16
Q
  1. Metaphyseal lesions (8)
A
  • Malignant (4)
    o Malignant fibrous histiocytoma
    o Osteosarcoma
    o Chondrosarcoma
    o Metastases
  • Benign (4)
    o Osteochondroma
    o NOF
    o ABC
    o UBC
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17
Q
  1. Diaphyseal lesions
A
  • Adamantinoma
  • Eosinophilic granuloma
  • Infection/Fracture/Callus
  • Osteoid osteoma/Osteoblastoma
  • Ewing’s sarcoma
  • Myeloma/lymphoma/fibrous dysplasia
  • (A.E.I.O.U. and sometimes Y.)
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18
Q
  1. Lesions with circumferential bone involvement (3)
A
  • Infection
  • Lymphoma
  • Ewing’s sarcoma
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19
Q
  1. Surface bone lesions (5)
A
  • Parosteal osteosarcoma
  • Periosteal osteosarcoma
  • Periosteal chondroma
  • Myositis ossificans
  • Sessile osteochondroma
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20
Q
  1. Cortically-based lesions (3)
A
  • Adamantinoma
  • Chondromyxoid fibroma
  • Non-ossifying fibroma
  • Osteofibrous dysplasia
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21
Q
  1. Flat bone tumours (5)
A
  • Hemangioma
  • Fibrous dysplasia
  • Chondrosarcoma
  • Ewing’s sarcoma
  • Metastases
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22
Q
  1. Lesions of the vertebral body (9)
A
  • Infection
  • GCT
  • Hemangioma
  • Metastases
  • Multiple myeloma/plasmacytoma
  • Lymphoma
  • Chondrosarcoma
  • Osteosarcoma
  • Ewing’s
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23
Q
  1. Lesions of the posterior elements of the vertebra (3)
A
  • Aneurismal bone cyst
  • Osteoid osteoma
  • Osteoblastoma

Note: Anterior spine = mets, myeloma, neurofibroma, hemangioma, GCT, EG, TB infection

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24
Q
  1. Benign latent lesions (6)
A
  • Enchondroma
  • Eosinophilic granuloma
  • Infection
  • Non-ossifying fibroma
  • Osteochondroma
  • Unicameral bone cyst
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25
Q
  1. Benign aggressive lesions (5/6)
A
  • Osteoblastoma
  • Chondroblastoma
  • Aneurysmal bone cyst*
  • Giant cell tumour
  • Chondromyxoid fibroma
    *think about telangiectatic osteosarcoma
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26
Q
  1. “Bubbly” lesions in the pediatric tibia
A
  • Adamantinoma
  • Fibrous dysplasia
  • Osteofibrous dysplasia
  • NOF
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27
Q
  1. Malignant-looking lesions in peds:
A
  • Osteosarcoma
  • Ewing’s
  • Infection
  • EG
  • Leukemia
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28
Q
  1. Sacral tumours (5)
A
  • Metastases
  • Aneurysmal bone cyst
  • Chordoma
  • Giant cell tumour
  • Ewing’s
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29
Q
  1. Lesions on both sides of a joint (8)
A
  • Hemophilia
  • Infection
  • Pannus (inflammatory arthropathy – RA)
  • PVNS
  • CPPD (pseudogout)
  • Arthritis
  • Tuberculosis
  • Synovial chondromatosis
  • (H.I.P.P. C.A.T.S.)
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30
Q
  1. Tibial lesions in kids with a benign osteoblastic periosteal response (3)
A
  • Stress fracture
  • Osteoid osteoma
  • Infection
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31
Q
  1. Pediatric malignant-looking lesions (6)
A
  • Osteosarcoma
  • Ewing’s sarcoma
  • Hematologic malignancy (leukemia/lymphoma)
  • Metastases (rhabdomyosarcoma/Wilm’s tumor/neuroblastoma/retinoblastoma)
  • Infection
  • Eosinophilic granuloma
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32
Q
  1. Bone-forming tumours (4)
A
  • Osteoid osteoma
  • Osteoblastoma
  • Osteoma
  • Osteosarcoma
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33
Q
  1. Cartilage-forming tumours (6)
A
  • Enchondroma
  • Osteochondroma
  • Chondroblastoma
  • Chondromyxoid fibroma
  • Periosteal chondroma
  • Chondrosarcoma
34
Q
  1. Fibrous tumors of bone (5)
A
  • Non-ossifying fibroma
  • Fibrous dysplasia
  • Osteofibrous dysplasia
  • Fibrosarcoma
  • Malignant fibrous histiocytoma of bone
35
Q
  1. Vascular lesions of bone (3)
A
  • Hemangioma
  • Hemangioendothelioma
  • Angiosarcoma of bone
36
Q
  1. Lytic lesions with coarse trabeculae (5)
A
  • Aneurysmal bone cyst
  • Hemangioma
  • Sarcoidosis
  • Paget’s disease
  • Fibrous dysplasia
37
Q
  1. Small round blue cell tumours (8)
A
  • Ewing’s sarcoma/PNET
  • Leukemia
  • Lymphoma
  • Metastatic neuroblastoma/retinoblastoma/Wilm’s
  • Multiple myeloma
  • Rhabdomyosarcoma
  • Hepatoblastoma
  • Desmoplastic round cell tumour
38
Q
  1. Small round blue cell tumours by age
A

By age:
<5: leukemia, neuroblastoma
5-10: EG
5-30: Ewing’s
>50: Multiple myeloma

39
Q
  1. Lytic lesions of bone in patients > 40 years old (7)
A
  • Metastatic disease
  • Myeloma
  • Lymphoma
  • Infection
  • GCT
  • Hyperparathyroidism
  • Primary bone tumors
40
Q
  1. Lesions associated with secondary ABC (6)
A
  • Chondroblastoma (30%)
  • Osteoblastoma (25%)
  • Non-ossifying fibroma
  • Fibrous dysplasia
  • GCT
  • CMF
41
Q
  1. Lesions causing mineralization of soft tissue (9)
A
  • Benign
    o Lipoma
    o Hemangioma
    o Myositis ossificans
    o Synovial chondromatosis
    o Pseudogout (CPPD)
    o Calcific tendonitis
  • Malignant
    o Synovial sarcoma
    o Liposarcoma
    o Angiosarcoma
42
Q
  1. Diseases that can present with multiple soft tissue masses (5)
A
  • Neurofibromatosis
  • Hemangiomas (Mafucci’s)
  • Myxomas (Mazabraud’s)
  • Lymphoma
  • Liposarcoma
43
Q
  1. Deep soft tissue tumors (7)
A
  • Benign (4)
    o Lipoma
    o Hemangioma
    o Myxoma
    o Peripheral nerve sheath tumour
  • Benign aggressive (2)
    o Fibromatosis
    o Hemangiopericytoma
  • Malignant (1)
    o Soft tissue sarcoma
  • (4,2,1)
44
Q
  1. Soft tissue sarcomas that metastasize to lymph nodes (5)
A
  • Synovial sarcoma
  • Clear cell sarcoma (melanoma of soft parts)
  • Angiosarcoma
  • Rhabdomyosarcoma
  • Epithelioid sarcoma
  • (S.C.A.R.E.)
45
Q
  1. Soft tissue tumors that are bright on STIR
A
  • Schwannoma
  • Cysts
  • Myxoid liposarcoma
46
Q
  1. Types of oncologic surgical margins (4)
A
  • Intralesional
  • Marginal
  • Wide
  • Radical
47
Q
  1. Tumour reconstruction options (4)
A
  • Endoprosthesis
  • Osteoarticular/intercalary allografts
  • Allograft-prosthetic composites
  • Vascularized fibular autograft
48
Q
  1. Indications for excision of an osteochondroma (6)
A
  • Soft tissue inflammation
  • Frequent traumatic injury
  • Cosmetic abnormality
  • Causing deformity
  • Nerve/vascular irritation
  • Concern for malignant transformation
49
Q
  1. Risk factors for malignant transformation of an osteochondroma (6)
A
  • Multiple lesions
  • Proximal lesions
  • Recurrent lesions
  • Growth after skeletal maturity
  • Painful lesions
  • Cartilage cap > 2 cm thick
50
Q
  1. Principles of osteochondroma excision (4)
A
  • Extensile incision to visualize entire base
  • Do not disturb the cartilage cap
  • Amputate lesion at base of stalk
  • Don’t take too much cortical bone to prevent fracture
51
Q
  1. Indications for amputation in musculoskeletal oncology (5)
A
  • Negative margins cannot be achieved with limb salvage
  • Morbidity of limb salvage too high
  • Limb salvage will not give adequate function
  • Tumor unresponsive to neoadjuvant chemo/radiation
  • Involvement of a major neurovascular bundle
52
Q
  1. Osteosarcoma chemotherapy (4)
A
  • Doxorubicin
  • Methotrexate
  • Adriamycin
  • Cis-platinum
  • Ifosfamide
  • (M.A.C.I.)
53
Q
  1. Ewing’s sarcoma chemotherapy (4)
A
  • Cyclophosphamide
  • Adriamycin
  • Vincristine
  • Dactinomycin
  • (C.A.Ve.D)
54
Q
  1. Soft tissue sarcomas that respond to chemotherapy (5)
A
  • Synovial sarcoma
  • Ewing’s/PNET
  • Angiosarcoma
  • Rhabdomyosarcoma
  • Extraskeletal Osteosarcoma
  • (S.E.A.R.O.)
55
Q
  1. Complications of radiation therapy (7)
A
  • Growth arrest
  • Joint contractures
  • Fibrosis
  • Fracture (osteopenia)
  • Radiation dermatitis
  • Wound healing problems
  • Secondary malignancy
56
Q
  1. Principles of surgical treatment of metastatic disease (7)
A
  • Careful patient selection
  • Address all areas of weakened bone
  • Immediate stability of constructs
  • Adequate durability of constructs
  • Preoperative embolization for vascular tumours
  • Cement for bone defects
  • Cemented arthroplasty components
57
Q
  1. Advantages of prophylactic stabilization of metastatic lesions (6)
A
  • Decreased morbidity
  • Decreased Perioperative pain
  • Shorter OR
  • Faster recovery
  • Shorter hospital stay
  • Ability to co-ordinate care with oncology team
58
Q
  1. Components of Mirel’s Criteria for prophylactic stabilization of long-bone metastases (4)
A
  • Pain (mild, moderate, mechanical)
  • Appearance (blastic, mixed, lytic)
  • Shaft involvement (< 1/3, 1/3-2/3, > 2/3)
  • Site (UE, LE, peritrochanteric)
  • (P.A.S.S.)
59
Q
  1. Indications for resection and megaprosthetic replacement for subtrochanteric metastases (5)
A
  • Periarticular destruction precluding internal fixation
  • Displaced pathologic fracture
  • Radio-resistant lesion
  • Solitary lesion
  • Salvage of failed internal fixation
60
Q
  1. Poor prognostic factors for Ewing’s sarcoma (6)
A
  • Location (spine/pelvis)
  • Elevated LDH
  • Size > 100 cm3
  • < 90% necrosis with neoadjuvant chemotherapy
  • Metastatic disease at presentation
  • Non-pulmonary metastases
61
Q
  1. Poor prognostic factors for osteosarcoma (6)
A
  • Higher stage (#1)
  • Elevated LDH
  • Elevated alkaline phosphatase
  • < 90% necrosis with neoadjuvant chemotherapy
  • Pelvic location
  • Secondary tumour (radiation, Paget’s)
62
Q
  1. Prognostic factors for soft tissue sarcoma (6)
A
  • Grade (#1)
  • Metastases
  • Size of tumor (> 5 cm)
  • Depth of tumor (subfascial)
  • Location of tumor (axial)
  • Histopathologic subtype (“bad actors” – same ones that go to lymph nodes and Ewing’s)
63
Q
  1. Risk factors for malignant transformation of enchondroma (5)
A
  • Large
  • Lytic with bone expansion
  • Cortical thinning
  • Painful
  • Soft tissue mass
64
Q
  1. Signs predictive of chondrosarcoma vs. enchondroma (7)
A
  • Large size
  • Axial location (pelvis)
  • Older patient
  • Multiple lesions
  • Hot on bone scan
  • Pain (especially at night)
  • Local recurrence
65
Q
  1. Indications for biopsy of an enchondroma (4)
A
  • Change in size
  • Pain
  • Permeative lysis
  • Endosteal erosion
66
Q
  1. Risk factors for local recurrence of ABC after surgical treatment (5)
A
  • Young age
  • Open physes
  • Stage (Campanacci staging system I-V)
  • Type of surgical removal
  • Resulting margin
67
Q
  1. Campanacci staging of aneurysmal bone cysts (5)
A
  • Type I: central cyst with intact bone profile
  • Type II: central cyst with enlarged bone
  • Type III: eccentric cyst with minimal bone expansion
  • Type IV: subperiosteal cyst with superficial cortical erosion
  • Type V: cortical destruction with cyst expansion into the soft tissues
68
Q
  1. Campanacci staging of giant cell tumors (3)
A
  • Stage I: benign latent lesion with normal bone morphology
  • Stage II: benign active lesion with cortical expansion
  • Stage III: benign aggressive lesion with cortical disruption
69
Q
  1. XR findings of Telangiectatic osteosarcoma (6)
A
  • Expansile lesion
  • Metaphysis/epiphysis (epicentre is the metaphysis)
  • Geographic lysis
  • Wide zone of transition
  • Osteoid matrix
  • Internal septations and fluid-fluid levels
70
Q
  1. Glomus triad:
A

a. Pain
b. Cold intolerance
c. Purple
d. Xray shows dorsal shelled out lesion

71
Q
  1. Rad Sensitive Tumours:
A

a. Myeloma
b. Lymphoma
c. Leukemia
d. Breast
e. Prostate
f. Lung

72
Q
  1. Rad Resistant:
A

a. Thyroid
b. Renal
c. GI
d. Melonoma

73
Q
  1. Synovial Tumors (3):
A

a. PVNS
b. lipoma arborescens
c. synovial chondromatosis
d. also need to consider synovial sarcoma

74
Q
  1. Common translocations:
A

a. 11:22 – Ewing’s
b. 9:22 – Chondrosarcoma
c. X:18 – Synovial sarcoma
d. 12:22 – clear cell sarcoma
e. 12:16 – myxoid liposarcoma

75
Q
  1. Surface lesions:
A

a. parosteal osteosarcoma
b. myositis ossificans
c. ?periosteal sarcoma

76
Q
  1. Metastatic pattern with lymph nodes spread: “SCARE”
A

a. Synovial sarcoma
b. Clear cell sarcoma
c. Angiosarcoma
d. Rhabdomyosarcoma
e. Epithelial sarcoma

77
Q
  1. “Classic locations”
A

a. Chordoma – sacrum
b. Enchondroma – phalanges
c. Chondrosarcoma – pelvis

78
Q
  1. Standard chemotherapy regimen for bone sarcoma (4 – MACI):
A

a. Methotrexate
b. Adriamycin/doxorubicin
c. Cisplastin
d. Iphopsphamide

79
Q
  1. Standard chemotherapy regimen for soft tissue sarcomas (2):
A

a. Adriamycin/doxorubicin
b. Iphosphamide

80
Q

Epiphyseal lesions:

A

clear cell chondrosarcoma, GCT, chondroblastoma

Tumors/Pathology Lists (1 decks)

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