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MSK > Lecture 14: Bone Tumors > Flashcards

Lecture 14: Bone Tumors Flashcards

1
Q

All the bone tumors that are malignant end in…

A

-Sarcoma

Osteosarcoma, chondrosarcoma, ewing sarcoma

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2
Q

There are only two bone tumors that make more bone. They are…

A
  • Osteoid osteomas (weird sounding bone tumor)
  • Osteoblastoma (bone building tumor)
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3
Q

Primary bone malignant bone tumors come from (), whereas secondary come from ()

A
  • Primary: originated from the bone
  • Secondary: From outside the bone and metastasized in.
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4
Q

There are only two benign bone tumors that actually cause symptoms and increase the risk of fracture. They are…

A
  • Osteoid osteoma
  • Osteochondroma
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5
Q

One would expect a malignant bone tumor to cause () pain that progresses over time.

A

Dull, aching pain

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6
Q

The initial study of choice for a suspected bone tumor…

A

XRAY

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7
Q

A benign bone tumor is characterized by:
* () border
* () zone of transition
* () size or multiple lesions
* () by natural barriers
* Lack of cortical destruction or extension into soft tissue

A
  • Well-defined/sharp borders
  • Sharp zone of transition
  • Small size
  • Confined by natural barriers

Malignant is the opposite. Think spiculated for periosteal reactions.

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8
Q

After XR is obtained for a bone tumor, we would order a CT if we wanted to check for (), but MRI for checking tumor (). We can add on contrast for () planning.

A
  • CT for mets to the thorax
  • MRI for tumor size
  • Add on contrast for biopsy planning.
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9
Q

T/F: Are bone lesions tumors?

A

yes

dont tell the pt tho

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10
Q

You have a 15M with a benign bone tumor in his femur. The doctor says it originated from osteoblasts and is making more bone. You know this is most likely a…

A

Osteoid Osteoma

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11
Q

The characteristic description of osteoid osteoma is a () surrounded by () bone. This center secretes () which cause pain.

A
  • Nidus surrounded by sclerotic bone.
  • Secretes prostaglandins
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12
Q

Osteoid Osteomas cause () pain that is worse at (), and is relieved by () or ()

A
  • Dull, aching pain worse at night.
  • Relieved by NSAIDs or ASA
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13
Q

You have a 25M patient with a limp and referred pain to their knee. Their dull, aching, pain is worse at night, but it gets better if he takes an aspirin. The doctor says he has a benign bone tumor that builds bone. He forgot the name of it. Although this is an atypical presentation of it, the bone tumor you suspect is…

A

Osteoid Osteoma

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14
Q

A nidus typically is less than () cm on XR in osteoid osteoma. If it is calcified, the radiopauqe point it makes is called a ()

A
  • Less than 1.5 cm
  • Bell
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15
Q

Following XR, the preferred next step in evaluating an osteoid osteoma is..

A

CT w/ IV con

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16
Q

You have a patient you suspect has an osteoid osteoma. XR was normal and they can’t get a CT scan. You should order a… () and hopefully it will show a () sign.

A

Bone scan with double density sign (fried egg)

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17
Q

Last resort imaging for Osteoid Osteoma is…

A

MRI w/ gadolinium (only if can’t confirm via XR or CT)

Not as accurate as CT

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18
Q

Your 24M with an osteoid osteoma is doing well on OTC therapy like NSAIDs. The recommended management for him is ….

He starts limping. Your next step is to ()

A
  • Serial imaging Q4-6 months
  • Refer to ortho for surgical intervention
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19
Q

Osteoblastomas have a nidus that is greater than () cm and are MC found in the (). Most appear in ages 10-20 but are slow growing.

A
  • Nidus GREATER than 2 cm
  • MC found in the posterior column of the spine

blast out the back

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20
Q

The two main differences between osteoid osteomas and osteoblastomas are relief via () and () size

A
  • Osteoblastomas are not relieved with NSAIDs
  • Nidus is bigger in osteoblastoma

Bigger nidus = more prostaglandins = more pain

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21
Q

T/F: Spinal osteoblastomas are likely to extend into soft tissue

A

Yes :(

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22
Q

The characteristic finding of an osteoblastoma on XR is a () lesion/nidus that is () cm.

A

Well-circumscribed, radiolucent nidus > 2 cm.

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23
Q

T/F: All patients with suspect osteoblastomas MUST get a CT scan?

A

Yes

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24
Q

MRI in osteoblastoma is best for lesions that extend into surrounding (), (), and ()

A
  • Soft tissues
  • Bone marrow
  • Spine

They don’t make that surrounding reactive zone like osteoid osteomas.

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25
Q

To confirm an osteoblastoma, you must get a ()

A

Core needle bx via an oncologic orthopedic surgeon

Must check if its malignant

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26
Q

The recommended treatment for all osteoblastoma patients is…

A

Surgical resection

Curettage and burring + grafting usually. Marginal in aggressive.

Must do radiation afterwards IF full resection not possible.

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27
Q

Overall, the MC, solitary benign bone tumor is a

A

Osteochondroma

OneCommonOma(tumor)

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28
Q

This benign bone tumor is MC around the knee and proximal humerus, especially in your 2nd decade. It is a cartilage-capped, bony projection on the external surface of a bone. This describes a …

A

Osteochondroma

Osteo K(on) H(oma)

Knees and humerus

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29
Q

Osteochondromas do not continually grow. They stop when () happens.

A

Growth plate closure.

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30
Q

Usually, osteochondromas appear alone as a painless mass. However, sometimes you can have hereditary multiple osteochondromas (HMO), which is a genetic mutation in what 2 tumor suppressor genes?

A

EXT1 or EXT2

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31
Q

Bone spur extending away from a joint on XR is indicative of…

A

Osteochondroma

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32
Q

Althought CT helps with localization and surgical planning, MRI is preferred if you’re looking at () for an osteochondroma

A

Soft tissue.

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33
Q

In asymptomatic osteochondromas, the preferred management is..

A

Annual monitoring. MRI if any changes occur.

No intervention.

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34
Q

Generally, you would only suspect malignant transformation of an osteochondroma if..

() increases risk
new () of lesion
new ()
() growth of lesion

A
  • HMO
  • New onset growth
  • New onset pain
  • Rapid growth
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35
Q

() are benign cartilage forming tumors that develop in the bone marrow of long bones

A

Enchondroma

ENside the bone

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36
Q

Enchondromas typically involve the () or () and grow from metaphysis to diaphysis.

A

Hands and feet

En the Hands and Feet

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37
Q

Enchondromatosis is a non-hereditary () mutation resulting in multiple enchondromas with a () predominance prior to the age of 10.

A
  • Acquired genetic mutation
  • Unilateral predominance
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38
Q

Enchondromas usually hurt because there was a () fracture

A

Pathologic fracture

They are usually asymptomatic

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39
Q

Enchondromas typically show up as () located on XR and well-circumscribed.

A

Centrally located

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40
Q

In uncomplicated enchondromas, a bone scan will show ().

A

Nothing

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41
Q

The purpose of CT/MRI is to check if an enchondroma is…

A

A chondrosarcoma or bone infarct

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42
Q

Your patient with a suspected enchondroma has pain at the site of his tumor. There is no fracture present. Your next step is to…

A

Biopsy it to rule out chondrosarcoma

Enchondromas can Evolve into chondrosarcomas?

43
Q

Generally, the 3 risk factors for pathologic fracture due to enchondroma is:

  • () bone
  • Greater than () mm in diameter
  • Involving () of the diameter of the cortex
A
  • Wt bearing bone
  • > 25mm in diameter
  • Involves > 50% of the diameter of the cortex
44
Q

In a small, asymptomatic enchondroma with low pathologic fx risk, the preferred management is…

A

Monitoring with exams and imaging.

45
Q

In an enchondroma patient with symptoms or pathologic fracture risk, the preferred management is…

A

Curettage & bone grafting

Let fx heal first!

46
Q

The two locations for an enchondroma that are riskiest for malignant transformation to chondrosarcoma are () and ()

A
  • Long bones
  • Pelvis
47
Q

A chondroblastoma originates in the () or () of long bones

A

Epiphyses or Apophyses of long bones

Outermost portion of bone

48
Q

The MC site for a chondroblastoma to occur is…

A

Epiphysis of the proximal humerus

Distal femur, proximal tibia

49
Q

Chondroblastomas are (pain/not painful) and have ()

A
  • Mild, progressive, constant pain that is unrelated to activity
  • Joint stiffness and swelling
50
Q

If a chondroblastoma is located on a wt bearing bone, a () may occur

51
Q

Small, well-defined lesions with a sclerotic border than may cross the physis/growth plate is most indicative of what benign bone tumor?

A

Chondroblastoma

52
Q

A biopsy of a suspected chondroblastoma should be done () surgery if lesion was atypical on imaging

A

Prior to surgery

53
Q

The primary and definitive management of chondroblastoma is…

A

Curettage and bone grafting

54
Q

The main complication of a chondroblastoma is … monitored via …

A

Benign pulm mets, monitor with CXR or CT w/ con if very sus.

Resectable and curable.

55
Q

Abnormal fibrous tissue and trabecular bone replacing bone marrow/bone tissue describes what benign bone lesion?

A

Fibrous dysplasia

56
Q

What genetic condition is fibrous dysplasia associated with?

A

McCune-Albright Syndrome

57
Q

Varus deformity of the proximal femur, a shepherd’s crook, is seen in what benign bone lesion?

A

Fibrous dysplasia

They get a lot of bent looking limbs

58
Q

Spongy-like appearance on CT of of the orbits, jaw, and cranial base might suggest…

A

Fibrous dysplasia

59
Q
  • Lytic lesons with ground-glass appearance
  • Bowing
  • Thin cortical bone

Describe XR findings for what benign bone lesion?

A

Fibrous dysplasia

60
Q

You must do a bone scan after initial dx of fibrous dysplasia to rule out…

A

Polyostotic disease

61
Q

For asymptomatic fibrou dysplasia, management is…

A

Serial exams and imaging

62
Q

For symptomatic fibrous dysplasia patients, you can do () or ()

A
  • Curettage & bone grafting (if older pt)
  • IV bisphosphonates to prevent bone loss and with pain.
63
Q

In children, ossifying fibroma/osteofibrous dysplasia MC affects the () and () in children aged 1-5. In adults, it typically only affects the ()

A
  • In children: tib and fib
  • In adults: Mandible

Ossi-tying my Shoes Man!

64
Q

The MC clinical sign of ossifying fibroma is…

A

Localized, firm swelling in the affected area

Normally painless unless pathologic fx.

65
Q

In a child with ossifying fibroma, you might notice that their tibia is () anteriorly or anterolaterally

66
Q
  • Cortex thinned with multiple lytic lesions of lucency.
  • Well-circumscribed intracortial lesions

Describe XR findings for what benign bone condition?

A

Ossifying Fibroma

67
Q

Asymptomatic ossifying fibroma is managed via…

A

Repeat XR every 6 months

68
Q

Symptomatic ossifying fibroma with pain/deformity is managed via…

A

Resection, currettage, and bone grafting done AFTER skeletal maturity

Otherwise risk of recurrence.

69
Q

Overall, the MC benign bone lesion in CHILDREN

A

Nonossifying fibromas

70
Q
  • Small, well-defined, eccentric, lytic lesions
  • Distal diaphysis/metaphysis
  • Can have multiple

Describe XR findings for what benign bone lesion?

A

Nonossifying Fibromas (NOFs)

71
Q

NOFs only require surgical intervention if

  • Lesion is () of bone diameter
  • Lesion is located in a () area like the distal femur
A
  • > 50% of bone diameter
  • High stress areas
72
Q

Non-cancerous, fluid filled lesions with fibrous linings found in young children describe what cystic tumor?

A

Unicameral bone cyst

like a camel hump

73
Q
  • Well-defined, cystic lesions at metaphysis or metadiaphysis
  • Generally involves the entire diameter of the bone
  • Pathologic fx caused by these may have a fallen leaf or fallen fragment sign

These XR findings describe what bone condition?

A

Unicameral bone cyst

falling off the camel hump

74
Q

Asymptomatic unicameral bone cysts are managed via…

A
  • Observation with Q4m XR and activity restrictions.
  • Can aspirate cyst and inject methylprednisolone to speed it up.
75
Q

Surgery is only done in unicameral bone cysts that…

A

Compromise structural integrity of bone

76
Q

() will occur to unicameral bone cysts after skeletal maturity

A

Spontaneous resolution

77
Q

Aneurysmal bone cys are benign, rapidly growing but destructive cysts filled with… ()

78
Q

Aneurysmal bone cysts are the only bone lesion more common in ()

A

Females

I think, everything has been male from what ive seen

79
Q

The 2 MC sites for aneurysmal bone cysts to occur is the () and the ()

A
  1. Tibia
  2. Femur

from the ground up

TIBIA FEMUR VERTEBRAE PELVIS HUMERUS

80
Q

Aneurysmal bone cysts present with () pain, (), and ()

A
  • Localized pain
  • Tenderness
  • Swelling
81
Q
  • Aggressive, expansile, lytic metaphyseal lesion with sharp borders
  • Eggshell sclerotic rim
  • Soap bubble appearance

These describe XR findings of what?

A

Aneurysmal bone cyst

82
Q

Prior to surgery for an aneurysmal bone cyst, you want to…

A

Selective arterial embolization to prevent hemorrhage via angiography.

83
Q

The MC MALIGNANT bone tumor is…

A

Osteosarcoma

84
Q

Osteosarcomas are overgrowths of malignant (), MC found at the () of long bones.

A
  • Osteoblasts
  • Metaphysis of long bones
85
Q

Osteosarcomas peak in incidence twice:

  • () adolescence
  • Over the age of ()
A
  • Early adolescence
  • Seniors
86
Q

What disease is a RF for osteosarcoma?

A

Paget disease

87
Q

The first and 2 MC symptoms of osteosarcomas are…

A

Pain & swelling that worsen with activity

88
Q
  • Osteolytic and osteoblastic lesions can be seen.
  • moth eaten appearance
  • Starburst appearance
  • Codman’s triangle

All describe XR findings of…

A

Osteosarcomas

89
Q

You must do a () to look for multifocal/mets in osteosarcoma. If any new lesion is identified, you must then do…

A
  • Bone scans
  • CT/MRI for every lesion seen on bone scan.
90
Q

Osteosarcoma is confirmed via () and is treated with pre/post-op () and () sparing surgery

A
  • Confirmed via core needle/open biopsy
  • Pre and post-op chemo
  • Limb salvage surgery
91
Q

Chondrosarcomas typically appear after the age of () and appear in the () and () girdles.

A
  • After the age of 50
  • Pelvic and shoulder girdles
92
Q

Chondrosarcomas cause () pain that gradually progresses and is worse with ()

A
  • Dull, deep aching pain
  • Worse at night
93
Q
  • Bony contour is thinned and expanded
  • Endosteal scalloping
  • Lesion often > 5 cm

These XR findings are seen in what malignant bone tumor?

A

Chondrosarcoma

94
Q

Dx of a chondrosarcoma is confirmed via…

A

Core needle/open biopsy

95
Q
  • MRI w/ gad is done preop to check ().
  • CT () w/ con checks for mets to the ()

For chondrosarcoma

A
  • Check tumor extent
  • CT Chest w/ con to check for lung mets (MC)
96
Q

Primary tx of chondrosarcoma is via…

A

Surgical excision

97
Q

Ewing Sarcoma is due to a chromosomal translocation between () and (). It’s origin is from neuro()

A
  • 11 and 22
  • Neuroectodermal tumor

Ewing’s number is 33, so 11+22 = 33

98
Q

Ewing Sarcoma MC appears in the () and the ()

A
  1. Pelvis
  2. Femur
99
Q

Generally, Ewing’s sarcoma appears like most malignant bone lesions, such as pain worse with () or (). It is also palpable.

A
  • Worse at night
  • Worse with activity
100
Q
  • Poorly marginated destructive lesion
  • Onion skin appearance

These XR findings are suggestive of what malignant bone tumor?

A

Ewing Sarcoma

101
Q

Ewing Sarcoma is managed via…

A

Multi-drug chemo + surgery/radiation

102
Q

The top 3 cancers that metastasize to the bone are…

A
  1. Breast
  2. Lung
  3. Thyroid

BLT

103
Q

The most common approach to metastatic bone disease is () and ()

A
  • Radiation
  • Pain meds

Chemo, bisphosphonates

104
Q

Biopsy is used for metastatic bone disease to () and determine ()

A
  • Definitive dx
  • Determine primary site

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