Lab: Cysts & Neoplasia Flashcards
What type of bone response is common in the first stage of Paget disease?
How does this appear radiographically?
Osteoclastic/osteolytic response appears radiolucent
What type of bone response is common in the second stage of Paget disease?
How does this appear radiographically?
Osteoclastic and osteoblastic bone response (mixed) appears radiolucent and radiopaque
What type of bone response is common in the third stage of Paget disease?
How does this appear radiographically?
“Burn out”; won’t see much activity, everything that has already happened is still radiographically visible
What are the signs/symptoms of a simple bone cyst vs an aneurysmal bone cyst?
Simple bone cyst: asymptomatic, incidental finding, fracture possible
Aneurysmal bone cyst: pain, swelling, fracture, palpable
What is the radiographic appearance of a simple bone cyst?
- Radiolucent
- Sclerotic border
- Eucentric
- Non-expansile
- Unilocular
What is the radiographic appearance of an aneurysmal bone cyst?
- Radiolucent
- Sclerotic border
- Eccentric
- Expansile
- Multilocular (soap bubble)
What is found histologically in biopsy of a simple bone cyst vs an aneurysmal bone cyst?
Simple bone cyst: serous fluid
Aneurysmal bone cyst: blood
What are the signs/symptoms of a benign bone tumor?
- No pain
- Slow growing
- Palpable/swelling possible
osteoid osteomas are benign but very painful
What are signs/symptoms of a malignant bone tumor?
- Cardinal signs of inflammation
- Abnormal blood work
- Fast growing/changing
- Unexpected weight loss
- Hypercalcemia
What is the radiographic appearance of a benign bone tumor?
- Short zone of transition (defined border)
- No cortical/periosteal disruption
- No soft tissue effects
What is the radiographic appearance of a malignant bone tumor?
- Long zone of transition
- Cortical/periosteal disruption
- Soft tissue effects
What are some benign bone forming tumors found in bone?
- Osteoma
- Osteoid osteoma
- Osteoblastoma
What are some benign cartilage forming tumors found in bone?
- Osteochondroma
- Chondroma
What is a benign tumor of unknown origin found in bone?
Giant cell tumor
What is a malignant primary bone forming tumor found in bone?
Osteosarcoma (primary)
What is a malignant cartilage forming tumor found in bone?
Chondrosarcoma
What are some malignant primary tumors of unknown origin found in bone?
- Ewing sarcoma
- Multiple myeloma
This condition may be mistaken for a tumor-like condition.
What pathology is present?
Paget disease
What is an important lab result found in this patient?
Increased alkaline phosphatase
Paget disease
What are some manifestations of this pathology?
- Osteoporosis circumscripta
- Bone enlargement
- Localized pain
- Pagetic steal (ischemia from vascular compression in spinal arteries)
- Hearing impairment
Paget disease
What is the name for this deformity?
What is seen at the green arrow?
Sabre shin
Banana fracture/insuffiency pathological fracture
Paget disease
Is this bone tumor likely benign or malignant?
Benign
Notice the radiolucent radiopaque mixed appearance in this enlarged bone with cortical thickening.
What pathology is present?
Paget disease
sabre shin
What is the appearance of this lesion?
What pathology is present?
Unicameral/unilocular osteolytic
Simple bone cyst with fracture
fibrous lining filled with serous fluid
What is the typical location of this lesion?
How large will it grow?
Typically in eucentric metaphysis
Grows no larger than width of bone (non-expansile)
simple bone cyst
What is the typical age and sex of a patient with this presentation?
<20-year-old male
simple bone cyst
This lesion has led to what consequence shown in this radiograph?
Complete humeral fracture (pathological)
simple bone cyst
What is the appearance of this lesion?
What pathology is present?
Appears multilocular with visible fibrous septa, widening cortex (expansile)
Aneurysmal bone cyst
What is the typical age of those with monostotic fibrous dysplasia vs those with polyostotic fibrous dysplasia?
Monostotic: 10-30 years
Polyostotic: early childhood
What is the distribution of sex amongst those with monostotic fibrous dysplasia vs those with polyostotic fibrous dysplasia?
Monostotic: Males = Females
Polyostotic: Females > Males
What is the nature of lesions in monostotic fibrous dysplasia vs those in polyostotic fibrous dysplasia?
Monostotic: focal expanding lesion
Polyostotic: lesions in multiple bones
What are the locations of monostotic fibrous dysplasia vs polyostotic fibrous dysplasia?
Monostotic: (proximal) femur, ribs, tibia, facial bones
Polyostotic: more than 50% of skeleton affected
What are the effects of monostotic fibrous dysplasia on bone?
- Enlargement or deformation
- Pathologic fracture
What are the effects of polyostotic fibrous dysplasia on bone?
- Enlargement or deformation
- Limb length discrepancies
- Spine alignment issues
- Pathologic fracture
What are the syndromes associated with polyostotic fibrous dysplasia?
- Mazabraud syndrome
- Mcune-Albright syndrome
With fibrous dysplasia, failure to form ___ bone leads to ___ lesions
mature lamellar bone leads to osteolytic/radiolucent lesions
What is within the well defined lesions of fibrous dysplasia?
- Fibroblasts
- Collagen
- Irregular trabeculae
- Cystic degeneration
- Slight hemorrhage
A well defined lesion is biopsied and finds the following contents:
- Fibroblasts
- Collagen
- Irregular trabeculae
- Cystic degeneration
- Slight hemorrhage
What bone pathology is present?
Fibrous dysplasia
How does soft tissue involvement differ between benign and malignant neoplasia of bone?
Benign: no soft tissue involved
Malignant: soft tissue may be involved
How does cortex and periosteum involvement differ between benign and malignant neoplasia of bone?
Benign: cortex remains intact, periosteum unaffected
Malignant: cortex can be disrupted, periosteum can be perforated or lifted
How does the zone of transition differ between benign and malignant neoplasia of bone?
Benign: short (well-defined)
Malignant: long (poorly defined or irregular)
Is this bone neoplasia likely benign or malignant?
Malignant
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor’s visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
How would you describe the location of the lesion indicated by the green arrow?
How does it affect the cortex and periosteum?
Metaphysis medullary cavity location
Cortex and periosteum unaffected
osteoid osteoma
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor’s visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Does soft tissue appear to be affected by the lesion?
Is the zone of transition short or long?
Soft tissues unaffected
Short zone of transition
osteoid osteoma
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor’s visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Is this lesion consistent with a non-aggressive or aggressive lesion?
Non-aggressive (likely benign)
osteoid osteoma
What pathologies have we discussed that share a similar radiographic presentation of a radiolucency with a sclerotic border?
- Brodie abscess
- Osteoid osteoma
- Simple bone cysts
- Benign cartilaginous tumor
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor’s visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Which condition most closely aligns with this case?
Osteoid osteoma
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor’s visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Why would aspirin relieve this patient’s pain?
Aspirin is a vasoconstrictor
osteoid osteoma
Is this lesion osteolytic or osteoblastic?
How would it appear on a radiograph?
Osteolytic
Would appear radiolucent likely with sclerotic border
simple bone cyst
Is this lesion eucentric or eccentric?
Is it singular or multilocular?
Eucentric
Unilocular
simple bone cyst
Note the appearance of this lesion.
What is the likely diagnosis?
Simple bone cyst
benign
What is the appearance of this pathology?
Eucentric, unilocular, radiolucent lesion with sclerotic border
simple bone cyst
Is this lesion likely expansile?
Non-expansile
simple bone cyst
typically in metaphysis, but has a tendency to diaphysis as maturity continues
What type of fluid would be found in this patient’s lesion in a tissue biopsy?
Serous fluid
simple bone cyst
How might this patient present clinically?
Asymptomatic, or a fracture leads to incidental finding
simple bone cyst
Is this lesion eccentric or eucentric?
Unilocular or multilocular?
Expansile or non-expansile?
Eccentric
Multilocular
Expansile
aneurysmal bone cyst
What type of fluid would fill this lesion?
Blood
aneurysmal bone cyst
How will this bone cyst appear on a radiograph?
- Multilocular
- Radiolucent
- Sclerotic border
- Expansile
- Eccentric
aneurysmal bone cyst
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
What is the location of this lesion?
Has the cortex been disrupted?
Located in epiphysis, metaphysis, and metadiaphysis medullary cavity
Cortex has not been disrupted
giant cell tumor
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
Is this lesion singular or multiloculated?
Is it aggressive?
Is it benign or malignant?
Multiloculated
Non-aggressive
Benign
giant cell tumor
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
Note this radiolucent lesion with a sclerotic border. It is multiloculated with a short zone of transition, not disrupting the cortex.
What pathologies share a similar radiographic presentation?
- Giant cell tumor
- Aneurysmal bone cyst
benign
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
What is the location of the lesion?
Metaphysis extending from the cortex
Pointing away from joint
osteochondroma
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
Does the lesion have a short or long zone of transition?
Is it likely aggressive?
Short zone of transition
Likely non-aggressive
osteochondroma
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
This lesion is extending from the cortex without disrupting it. Is the periosteum intact? Is soft tissue affected?
Periosteum is not lifted
Lesion is not invading soft tissues
osteochondroma
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
What specific term could you use to describe the shape of this lesion?
Pedunculated
osteochondroma
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
What would you expect this patient’s lab results to be?
ESR:
Alkaline phosphatase:
ESR: normal
Alkaline phosphate: increased
osteochondroma
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says “a while” and says it might have gotten bigger recently. He doesn’t feel pain. This is his radiograph.
What is the most likely diagnosis for this individual?
Pedunculated osteochondroma
points away from joint
Label the image shown.
Green arrows:
Purple arrows:
Red arrows:
Green arrows: perichondrium (fibrous tissue lining)
Purple arrows: hyaline cartilage
Red arrows: bone
osteochondroma
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
What is the location of this lesion?
Is it disrupting the cortex? The periosteum?
Metaphysis, diaphysis, medullary cavity
Disrupting the cortex and affecting the periosteum
osteosarcoma
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
Does this lesion have a short or long zone of transition?
Is it likely aggressive?
Long zone of transition
Likely aggressive
osteosarcoma
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
Is this primarily an osteoblastic or osteolytic pathology?
Osteoblastic; sunburst appearance (Sharpey’s fibers) of spiculated periosteum
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
Is soft tissue likely to be affected by this neoplasia?
Is it benign or malignant?
Soft tissue likely affected because of cortex and periosteal involvement
Malignant
osteosarcoma
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
What would be this patient’s lab results?
ESR:
CRP:
Alkaline phosphatase:
ESR: elevated
CRP: elevated
Alkaline phosphatase: increased
osteosarcoma
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn’t recall any injuries. This is his radiograph.
What is the most likely diagnosis for this patient?
Osteosarcoma
spiculated radiopaque mass, deep bone pain keeping patient up at night
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
What pathologies have we discussed that could cause tibial bowing?
Which of these cause bowing unilaterally vs bilaterally?
Unilateral bowing: Pagets disease
Bilateral bowing: Syphilis, Rickets
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
What observations can you make about the changes in this bone? Are these changes osteoblastic, osteolytic, or mixed?
Coarse trabecular expansion (highly vascular); bone enlargement with cortical thickening
Mixed blastic and lytic response
Pagets disease
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
Based on the number of bones affected in this clinical presentation and the radiograph, what term could you use to describe this condition?
Monostotic
Pagets disease
What could increased alkaline phosphatase indicate about bone metabolism?
Increased osteoblastic activity
What do increased type I collagen byproducts (P1NP and b-CTX) indicate about bone metabolism?
Increased bone turnover (decreased bone quality, increased fracture risk)
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
What pathology do you think this patient is most likely experiencing?
Pagets disease
What term describes the anterior bowing of the tibia in this patient’s case?
Sabre shin
Pagets disease
How is the pathogenesis of this anterior bowing different from that seen in syphilis?
Pagets disease: physical tibial bowing with coarse trabecular expansion
Syphilis: periosteal reaction creates appearance of tibial bowing without actual bowing
