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NMSP 2 > Joints, Bones, And Soft Tissue Pathology Dr. Martin > Flashcards

Joints, Bones, And Soft Tissue Pathology Dr. Martin Flashcards

1
Q

most common tumor is located where
and most common tumors
and survival

A
  1. long bones , (osteosarcoma is on knee and peaks at adolescents)
  2. osteosarcoma, chondrosarcoma, Ewing sarcoma
  3. 50% survival
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2
Q

Osteoid osteoma SX and due to what happening

A
  1. Worse at night pain , responding to NSAIDS And ASPIRIN

2. excess PGE2 made by osteoblasts

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3
Q

Osteoid Osteoma

  1. DX criteria
  2. histo
  3. TX
A
  1. Less then 2cm, if over 2cm = osteoblastoma
  2. Central nidus or translucent woven bone, surrounded by osteoblasts + thick rind or reactive cortical bone
  3. radiofrequency ablation
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4
Q

Osteoblastoma

  1. dx
  2. location
  3. sx
  4. tx
  5. B or M
A
  1. over 2cm , no bony reaction
  2. spine
  3. achy pain that does not respond to aspirin
  4. curetted or excised en bloc
  5. B
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5
Q

Osteosarcoma
1. what happens and sx
2. location
3 .AGE

A
  1. Malignant mesenchymal cells make bone matrix, (PAINFUL enlarging mass)
  2. knee 50%
  3. under 20yo, second peak in older males (PAGETS) from prior radiation = secondary osteosarcoma
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6
Q

Osteosarcoma

  1. DX
  2. histo
A
  1. X-ray, mixed lytic and blastic mass
    + CODMAN TRIANGLE (periosteum elevation after fractures = AGGRESSIVE TUMOR
  2. bizarre giant tumor cells , lace like , can make cartilage = CHONDROBLASTIC OSTEOSARCOMA
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7
Q

Osteosarcoma

1. risk with what genes

A
  1. RB ; sporatic
  2. TP53 : Li-Fraumani syndrome (breast cancer)
  3. CDKN2A (INK4a gene) : encoding p14 and p16
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8
Q

Osteosarcoma looks like what

A

bulky gritty gray-white with hemorrhage and cystic degeneration (spreading to medullary cavity)

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9
Q

Osteosarcoma what do you assume about all pts with this

A

that they have occult metastases when dx and start radio/chemo, surgery

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10
Q

Osteosarcoma spreads to

A

lungs, bones, brains

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11
Q

most common benign bone tumor

A

osteochondroma

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12
Q

Osteochondroma

  1. happen how and age
  2. associated with
  3. and prevalence
A
  1. sporadic around 10-20yo early adulthood
  2. Multiple hereditary EXOSTOSIS : AD 5%-20% progress to chondrosarcoma
  3. men
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13
Q

Osteochondroma gene

A

EXT1 and EXT2 = heparin sulfate glycosaminoglycans

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14
Q

Osteochondroma

  1. how is it formed
  2. SX
A
  1. bony stalk capped by cartilage + medullary cavity continuous with bone
  2. pain if nerve impingement
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15
Q

Chondroma / Enchondroma

  1. location of both
  2. imaging looks like
  3. associated with what 2 syndromes
  4. tx
A
  1. Medullary cavity (Enchondroma), Surface of subperiosteal or juxtacortical (Chondroma)
  2. Circumscribed lucency with central irregular calcifications, sclerotic rim (nodules well circumscribed in hyaline cartilage)
  3. Ollier Syndrome + Maffucci Syndrome
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16
Q

Ollier Syndrome

A

many enchondromas , not hereditary

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17
Q

Maffucci syndrome

A

many enchondromas + hemangiomas
= increases risk of chondrosarcoma + brain glioma
= not hereditary

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18
Q

Enchondroma gene

A

IDH1 and IDH2

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19
Q

Chondrosarcoma

  1. location
  2. usually come from what
  3. SX
A
  1. pelvis, shoulders
  2. enchondromas, osteochondromas
  3. Painful Enlarging mass (usually to lungs)
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20
Q

Chondrosarcoma imaging

A

calcified matrix (looks like flocculent dansities)

21
Q

Chondrosarcoma : 4 stages

A
  1. Conventional : glistening gray/white, translucent cartilage (cystic and ooze out)
  2. Dedifferentiated : low grade with a HIGH grade component (no cartilage)
  3. Clear Cell : large chondrocytes + osteoclast-type giant cells (malignant)
  4. Mesenchymal : well differentiated hyaline cartilage surrounded by sheets of small round cells
22
Q

Chondrosarcoma TX

A

surgical excision = conventional, excision + chemo = mesenchymal and dedifferentiated (more aggressive)

23
Q

Chondrosarcoma gene

A 
EXT gene (multiple osteochondroma syndromes)
IDH1 and IDH 2
24
Q

Ewing Sarcoma Family Tumors (ESFT)

  1. prevalence
  2. looks like what
  3. gene
A
  1. whites
  2. small blue round tumor cells, primitive round cells
  3. PNET, EWSR1 gene Ch22, FLI1 gene CHR11
25
Q

Ewing Sarcoma Family Tumors (ESFT) :

  1. SX
  2. imaging
  3. location
A
  1. PAINFUL, enlarging mass, tender, warm, swollen like an infection (fever, high WBCs, high sed rate)
  2. Periosteal reaction : onion skin on x-ray ( Moth eaten margins) + Sunbust / hair looking + Codman
  3. long bones FEMUR, pelvic
26
Q

Ewing Sarcoma Family Tumors (ESFT)

  1. location in bone it starts
  2. histo
  3. TX and how to see if its working and prognosis
A
  1. medullary cavity, invading cortex, periosteum, soft tissue
  2. homer wright rosettes
  3. Chemo induced necrosis, more necrosis means its working more, higher prognosis
27
Q 
Giant Cell Tumor of bone : 
other name 
1. looks like what other disease
2. B or M 
3. cell type and what they have 
4. location
A

OSTEOCLASTOMA

  1. looks like brown tumor of hyperparathyroidism
  2. 20yo-40yo, B, however usually locally destructive
  3. Osteoblasts with RANKL= osteoclasts
  4. Epiphyses (knee)
28
Q

Giant Cell Tumor of bone :

  1. histology
  2. TX
A
  1. thin shell of reactive bone (red brown many large giant cells, cystic degeneration)
  2. Curetting and usually comes back + RANKL inhibitor = DENOSUMAB
29
Q

Aneurysmal Bone Cyst (ABC) :

  1. B or M
  2. gene
  3. location
  4. age
A
  1. B , locally aggressive
  2. CRH17p13 = increase osteoblasts
  3. femur, tibia, vertebral body
  4. adolescence
30
Q

Aneurysmal Bone Cyst (ABC) :

  1. SX
  2. imaging
  3. histo finding
A
  1. pain + swelling , limp, nerve compression
  2. LYTIC lesion, central lysis = EGGSHELL, trabeculae = SOAP,
    BUBBLE
  3. multinucleated OSTEOCLAST-GIANT CELLS lined by osteoblasts, BLUE BONE
31
Q

Fibrous Cortical Defect :

  1. know as what
  2. who and age
  3. location
  4. DX criteria
A
  1. Metaphyseal Fibrous Defect (fibrous CT replace bone)
  2. over 2yo usually found in adolescents
  3. metaphysis around knee (usually bilateral)
  4. udner 0.5cm
32
Q

Non-ossifying Fibroma

A

Fibrous Cortical Defect that has progressed and is 5cm-6cm

33
Q

Fibrous Cortical Defect + Non-ossifying fibroma :

imaging

A

sharply demarcated radiolucent mass, rim of sclerosis

yellow/brown, fibroblasts in storiform pattern**

34
Q

Fibrous Cortical Defect + Nonossifying Fibroma : SX and TX

A
  1. Asymptomatic
  2. spontaneously resolution over time
    = Curettage needs bone grafting for proper healing
35
Q

Fibrous Dysplasia :

what is it

A

B with fibrous tissue and bone growing and not maturing

36
Q

Fibrous Dysplasia 4 patterns you see

A
  1. Monostatic ** : asymptmatic
  2. Polyostotic : many bones, crippling
  3. Craniofacial involvement
  4. shoulder and pelvic girdles (Crippling deformaties and fractures)
37
Q

Fibrous Dysplasia can become what rarely

A

Malignant to sarcoma

38
Q

Fibrous Dysplasia age and locations and SX and can grow more during what

A
  1. adolescence
  2. 1/3 craniofacial bones, 1/3 femur or tibia, 1/3 ribs
  3. pain , fractures, different length in limbs
  4. during pregnancy
39
Q

Fibrous Dysplasia histology and gene

A

ground glass and GNAS1

40
Q

Fibrous Dysplasia : McCune-Albright Disease

  1. what
  2. sx
  3. what is associated
  4. mutation
A
  1. unilateral bone lesions,
  2. Cafe a lait spots same side
  3. Precocious puberty in females
  4. GNAS mutation (early in embryo)
41
Q

Fibrous Dysplasia : Mazabraud Syndrome

  1. what
  2. adult vs child
A
  1. polyostotic fibrous dysplasia

2. many skeletal deformaties (childhood), soft tissue myxomas (Adult)

42
Q

Fibrous Dysplasia

  1. mutation happening after bone formation in embryo causes
  2. Histo
A
  1. monostotic
  2. Intramedullary lytic lesions , cause bowing and cortical thinning
    + hyaline nodules, disorganized growth plates , + curvilinear trabeculae with NO osteoblastic rimming
43
Q

Fibrous Dysplasia Curvinilnear trabeculae looks like

A

chinese characters

44
Q

most common metastatic cancers spreading to bone in ADULT and CHILDREN

A
  1. Prostate, breast, Kidney, Lung ** (PBL King)

2. Neuroblastoma, Wilms, Osteosarcoma, Ewing, Rhabdomyosarcoma

45
Q

Metastatic Bone cancer is usually presented like what and locations

A
  1. multifocal except (thyroid and kidney)

2. Axial skeleton, hands and feet (lung, kidney, colon)

46
Q

Metastiatic Bone Cancer LYTIC vs BLASTIC

A
  1. LYTIC : bone destroying = lung, kidney, GI, Melanoma

2. BLASTIC : bone forming = Prostatic adenocarcinoma

47
Q

Hyaline Cartilage serves for what purpose

A

CT for elastic shock absorber, wear resistance

48
Q

synovial fluid is composed of

A

hyaluronic acid rich plasma filtrate acting like a viscous lubricant + nutrition for hyaline cartilage

NMSP 2 (3 decks)

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