Lecture 13 - Bone Tumors

Question 1

Bone tumors have to be between ____-____% destructive to be visible on plain films.

Osteomas are benign tumors of the bone, and people with multiple osteomas should be suspected of having ______ syndrome (aka Familial Colorectal Polyposis).

Answer 1

40-50%

Gardner’s syndrome

Question 2

_____ ______ are most often identified in young male patients between 5 and 25 years old who complain of waking in the middle of the night with intense pain. Imaging will show a painful lesion (“nidus”) that can be relieved by aspirin. These are common in _____ bones. If they are larger than 2cm and occur in the axial spine, they are considered _______, and these are not relieved by aspirin.

Answer 2

Osteoid Osteomas

Long

Osteoblastomas

Question 3

_______ is the most common primary malignant tumor of bone (REMEBER that 95% of malignant bone tumors are secondary tumors that have metastasized from other tumors). It demonstrates a bimodal age distribution, occurring most frequently in the Second and ______ decades of life. The ____ plates surrounding the distal femur and proximal tibia are the most common sites for this tumor. If “Skip” lesions are present, there is a poor prognosis. Why?

Answer 3

Osteosarcoma

Second and Fifth decades

Growth plates

Skip lesions suggest metastases and thus the cancer has traveled through the blood.

Question 4

What is the most common site of metastasis for Osteosarcoma?

Answer 4

Lung

Question 5

__________ (think bone + cartilage) is the most common primary benign bone tumor. In the hereditary version, there is inactivation of _____1 and ______2. This disease develops only in bones that undergo ________ ossification (so basically long bones.)

Answer 5

Osteochondroma

EXT1 and EXT2

Endochondral ossification

Question 6

Endochondroma’s are neoplasms consisting of hyaline cartilage. If a patient has multiple endochondromas, this is characteristic of ______’s disease. If a patient has multiple endochondromas with concurrent ________ and hemangiomas, this is considered ______ syndrome.

Answer 6

Ollier’s disease

Lymphangiomas

Mafucci’s Syndrome

Question 7

_________ is the second most common primary bone tumor. It is a malignant tumor of cartilage that occurs most often in adults aged ____ and older, and it occurs more commonly in _____ (males or females?). It presents similar to Osteoid Osteomas (with pain waking the patient in the middle of the night, so look out for the age of the patient. This tumor does NOT respond to ______.

Answer 7

Chondrosarcoma

40 and older

Males

Chemo

Question 8

Fibrous dysplasia (FD) comes in two flavors: 1. ______ (single bone involvement) 2. ______ (multiple bone involvement) _____ _____ syndrome describes the second variety with accompanying precocious puberty and cafe-au-lait spots, and this syndrome most commonly occurs in _____ (males or females?). FD is caused by a somatic mutation of a G protein encoded by the ______ gene. Only very RARELY does it transform into an _______. Histology will show osteoid and _____ bone that looks like random squiggles and “C” shapes.

Answer 8

1. Monostotic
2. Polyostotic

McCune-Albright syndrome

Females

GNAS

Osteosarcoma

Woven bone

Question 9

Giant cell bone tumors are mostly benign and occur in skeletally ______ (mature or immature?) patients (so closed physes). Look for giant cells containing upward of 100 nuclei. For patients that can not undergo surgery for these tumors, ______ is prescribed.

Answer 9

Mature

denosumab

Question 10

_______ Sarcoma is the 3rd most common malignancy of bone and most often occurs in with a peak incidence in the 2nd decade of life. It is characterized by a common translocation between chromosomes ____ and ____. Radiology will show hallmark “______-_____” appearance of the periostum. Histology will show _____ (uniform or variable?) sheets of small ____ (what color?) cells (very little cytoplasm, so they stain rich in color) with basically no bony matrix.

Answer 10

Ewing’s Sarcoma

11 and 22

“Onion-skin”

Uniform

Blue