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YEAR 4 SEMESTER 1 CDM > LECTURE 9 - finished > Flashcards

LECTURE 9 - finished Flashcards

1
Q

Define osteosarcoma

A

A highly malignant osteoid producing tumour comprised of primitive osteoblasts.

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2
Q

What are some risk factors associated with the development of osteosarcoma

A

OverSeas Ricky Fucks OG RAP

Osteogenesis imperfecta

Genetic factors:

  • germ-line mutations the p53 gene
  • Patients with retinoblastoma defects

Radiation

Areas of rapid bone growth

Paget’s disease

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3
Q

What do osteosarcoma cells look like histologically?

A

OG RAP 90’s high intensity tunes on the SpinDial (spindle)

The cells are spindle shaped with variable cytologic atypia (e.g. pleomorphism & ↑ed mitotic activity)

90% of all osteosarcomas are high grade intramedullary types

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4
Q

In terms of histology, how is osteosarcoma diagnosed?

A

Need to see presence of:
• Osteoid
• New bone

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5
Q

Where does osteosarcoma common metastasise to?

A

OverSeas spread via the Down Low

Distant bone
Lung

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6
Q

What is the most common primary bone malignancy? What % of primary bone malignancies does it account for

A

Osteosarcoma

22%

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7
Q

Osteosarcoma age of onset?

A

1st peak = 10-30

2nd peak = > 60 and usually arises from a benign or low grade bone lesion

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8
Q

Gender distribution of osteosarcoma

A

M:F = 1.5:1

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9
Q

Describe the pathology of osteosarcoma

A

OverSeas Playas Alternate Demoing and Recording, spreading to the people and the softies, may even cross the plates. Their extra spread can have new beats involved too. (lame as fuck but helps)

Osteosarcoma destroys & replaces bone and we can observe alternating areas of:
• bone loss
• abnormal new bone production (esp. at periosteal margins secondary to periosteal lifting)

It quickly spreads outwards to the periosteum & surrounding soft tissues.

Commonly the extraosseous part of the lesion has new bone extending into it.

It may cross the epiphysial plate.

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10
Q

What is the distribution of osteosarcoma?

A

Any bone may be affected, but usually occur in:
- Long bone metaphyses
• Knee
• Proximal humerus

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11
Q

What is the clinical picture of osteosarcoma?

A

The most common presentation is pain and a mass occurring near a joint.

• Pain

  • Usually the presenting symptom
  • Constant
  • Worse at night
  • Gradual increase in severity
  • Lump/swelling (increasing in size)
  • Swelling & erythema of overlying tissue due to ↑ed tumour vascularity
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12
Q

How are osteosarcomas diagnosed?

A

The diagnosis is suspected from the clinical presentation, and confirmed by imaging, and other diagnostic procedures.

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13
Q

Important lab findings in osteosarcoma

A
  • ↑ ESR

* ± ↑ serum alk. phosphatase

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14
Q

What are some radiological features of osteosarcoma

A

OverSeas Rad Fucks TRI P PE D down a BREACHed HOLe.
• codman’s TRIangle (reactive periosteal bone formation)
• Pulmonary metastases
• Poor definition of Endosteal margin
• Dense osteoblastic areas
• cortical Breaching (sunray/sunburst sign)
• Hazy OsteoLytic areas

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15
Q

Some ddx for osteosarcoma?

A

OverSeas dicks drink SCOBE:

  • Stress fracture (pathology may look similar)
  • cost traumatic Callus or myositis ossificans
  • Osteomyelitis
  • Benign bone tumour
  • Ewing’s sarcoma
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16
Q

Prognosis for osteosarcoma

A

Localised osteosarcoma is now associated with a 5 year survival rate of ≈ 60%

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17
Q

Define chondrosarcoma

A

A collective term for a group of malignant mesenchymal tumours mainly made up cartilage cells that produce cartilage matrix

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18
Q

What is the second most common primary malignant tumour of bone?

A

Chondrosarcoma

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19
Q

Which age group does Chondrosarcoma usually affect

A

30-50

20
Q

Gender distribution of Chondrosarcoma?

A

M:F = 1.5:1

21
Q

What are the classifications for Chondrosarcoma?

A

Primary chondrosarcoma
• uncommon
• appear centrally or peripherally in the bone
• metaphyses of chondral bones are usually affected
• found in children

Secondary chondrosarcoma
- Arise from benign cartilage defects e.g.
• Osteochondroma (=peripheral)
• Enchondroma (=central)

22
Q

What is the pathology of chondrosarcoma

A
  • Slow growing tumour
  • Can become very large
  • Derived from cartilage
  • Produces cartilage
  • Late metastasis
23
Q

What is the most common distribution of chondrosarcoma?

A

Most common in the femur, humerus, ribs and on the surface of the pelvis

24
Q

What is the clinical picture of chondrosarcoma

A

Cholas can fuck T-Pains Pelvic ROM PS

2 pains:
• local PAIN (deep, dull ache)
• PAIN at night

• PELVIC tumour ssx:

  • urinary frequency or obstruction
  • may present as “groin muscle pulls”
  • nerve dysfunction: esp. lumbosacral plexus, sciatic or femoral nerves)
  • ↓ed ROM when tumour is near a joint
  • Pathological fracture
  • Swelling
25
Q

How are chondrosarcomas diagnosed

A

The diagnosis is suspected from the clinical presentation, and confirmed primarily by imaging, and biopsy

26
Q

What are the radiological features of chondrosarcoma?

A
  • Large lesion (> 5 cm)
  • Radiolucent area
  • Endosteal scalloping
  • Stippled calcification
  • Globular mass on surface of bone
  • Periosteal new bone formation
27
Q

DDx for chondrosarcoma

A
  • Chondroma
  • Fibrosarcoma
  • Fibrous dysplasia
  • Osteosarcoma
28
Q

Prognosis chondrosarcoma

A

The overall 5-year survival rate is 48-60%

29
Q

Define fibrosarcoma

A

A tumour of mesenchymal cell origin.

Composed of malignant fibroblasts in a collagen matrix

30
Q

Epidemiology of fibrosarcoma

A
  • Rare in bone
  • <5% of all primary tumours of bone
  • Most common in adults 30-60 yrs
  • M:F ≈1:1
31
Q

Classifications of fibrosarcoma

A

Primary:
- Arise from bone
- Arise from connective tissue
May originate in bone or invade bone from nearby connective tissue

Secondary: 
- Arise at the site of pre-existing bone pathology
e.g:
• Paget's disease
• fibrous dysplasia
• irradiated giant cell tumour
• bone infarct
• chronic osteomyelitis
32
Q

Outline the pathology of fibrosarcoma

A

Fibrosarcoma is a fibroblastic connective tissue tumour i.e.. composed of large fibroblasts.

Fibrosarcoma cells produce a collagen matrix but do not produce osteoid or chondroid

33
Q

Distribution of fibrosarcomas

A

Occurs in the metaphysis or metadiaphysis of long bones.
Usually occur in the lower limbs, esp. femur & tibia

Most common sites: Distal femur and proximal tibia followed by the pelvis

34
Q

What is the clinical picture of fibrosarcoma usually due to?

A
  • Localised painful mass

* Pathological fracture

35
Q

Radiological features of fibrosarcoma

A

Rad Fucks fib POEMS

  • Periosteal reaction is seen with cortical destruction
  • Osteolytic lesion
  • Extension into soft tissue (common)
  • Margins: well-defined or ragged
36
Q

Prognosis of fibrosarcoma

A

5-year survival rate: ≈65%

37
Q

Ewings sarcoma definition

A

Ewings sarcoma is a primary malignant tumour of bone. The small, round tumour cells resemble those of lymphoma or neuroblastoma.

38
Q

Epidemiology of Ewing’s Sarcoma

A
  • ≈10-15% of all bone sarcomas
  • Median age is 15 years
  • Peak incidence in the second decade of life
39
Q

Where does ewings sarcoma usually metastasise to?

A

Ewing’s sarcoma is a malignant neoplasm which commonly metastasises to:
• Lungs
• Other bones
• Bone marrow

40
Q

What are the 2 main affected regions in ewings sarcoma?

A
  • Lower extremity

* Pelvis

41
Q

What is the clinical picture of ewings sarcoma?

A 
Ewan, dont PALP peoples BACK PAIN
• Palpable mass
• Asymmetrical neurological ssx
• Localised pain
• Pathologic fracture

• Back pain may indicate a paraspinal, retroperitoneal, or deep pelvic tumour

42
Q

What manifestations can indicate metastatic disease?

A
  • Systemic symptoms (fever &weight loss)
  • Petechiae/purpura
  • Pulmonary ssx indicating lung metastases
43
Q

How is ewings sarcoma diagnosed?

A

The diagnosis is suspected from the clinical presentation, & confirmed primarily by imaging, biopsy & blood tests

44
Q

Typical lab tests seen in ewings sarcoma?

A
  • ↑ed Serum ALP

* Hypercalcaemia (=>widespread disease)

45
Q

What are some radiological manifestations of ewings sarcoma?

A
  • large
  • poorly marginated
  • > 80% extend into adjacent soft tissues
46
Q

What are 3 common radiological findings in ewings sarcoma?

A

Ewans rad? PLS

Common findings include:
• permeative: 76%
• laminated (onion skin) periosteal reaction: 57%
• sclerosis: 40%

47
Q

DDx for ewings sarcoma

A
  • Osteomyelitis
  • Lymphoma (Reticulum cell sarcoma)
  • Small cell osteosarcoma
  • Metastatic Ca

YEAR 4 SEMESTER 1 CDM (12 decks)

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