Lumps and Bumps Flashcards
Name the benign bone forming tumors
osteoid osteoma, osteoblastoma, osteoma
Name the benign cartilage forming tumors
chondroma, osteochondroma, chondroblastoma
name the benign fibrous bone lesions
fibrous dysplasia, nonossifying fibroma
name the benign radiolucent bone lesions
giant cell tumor, unicameral bone cyst, aneurysmal bone cyst
what’s the most common benign osteoid forming tumor?
osteoid osteoma
peak incidence of osteoid osteoma
2nd decade of life (10-30 yrs)
gender more affected by osteoid osteoma
men
location of osteoid osteoma
anywhere, but most common in long bones– proximal femur
CM of osteoid osteoma
pain; NIGHT PAIN; pain relieved with NSAIDs
pathophysiology of osteoid osteoma
neoplastic changes vs inflammatory osteoblasts
radiographic findings of osteoid osteoma
small, <1 cm lytic nidus with surrounding sclerosis; “hot” on bone scan; use CT scan to localize the lesion
Tx of osteoid osteoma
pain control/suppression with NSAIDs; if fail medical management curettage/burring to get rid of nidus, radiofrequency ablation
Prognosis of osteoid osteoma
excellent, local recurrence is rare
what’s an osteoblastoma?
large osteoid osteoma, >2 cm, more aggressive
how common is an osteoblastoma?
are, 1% of benign bone tumors
Age for osteoblastoma
1st to 3rd decade
males or females for osteoblastoma?
males
Location of osteoblastoma
posterior spine, long bones (femur, tibia)
presentation of osteoblastoma
pain, unresponsive to NSAIDs
radiographic appearance of osteoblastoma
variable, lucent, slightly expansible, no sclerotic rim, >2 cm, no nidus
Tx of osteoblastoma
biopsy, curettage and bone grafting, tumor excision with bone reconstruction vs. internal fixation
prognosis of osteoblastoma
excellent, low recurrence rate
what’s an osteoma?
deposition of reactive periosteal new bone
age for osteoma?
2nd to 4th decade
location of osteoma?
skull, tibia, femur
presentation of osteoma
firm mass with little to no pain
Osteoma is associated with what syndrome?
Gardner’s syndrome
Gardner’s syndrome
osteoma, colonic polyps, desmoid tumors
radiographic findings of osteoma
dense cortical bone, not contiguous with intramedullary canal
treatment of osteoma
observation vs. marginal resection
prognosis of osteoma
excellent, self-limiting
what’s a chondroma?
tumors contain mature hyaline cartilage
What’s an enchondroma?
within the medullary canal
enchondroma sex
no predilection
enchondroma age
3rd-4th peaks
Size of enchondroma
<5 cm
Periosteal chondroma location
surface of bone
sex periosteal chondroma
males
Which is more common enchondroma or periosteal chondroma?
enchondroma
enchondroma location
usually metaphyseal: proximal humerus, distal femur, mostly phalanges in hands and feet
presentation of enchondroma
asymptomatic, incidental finding, pain associated with pathologic fracture
Syndromes associated with enchondromas
Ollier’s disease; Maffucci’s syndrome
Ollier’s disease
multiple enchondromas
Maffucci’s syndrome
multiple enchondromas + multiple hemangiomas
enchondroma on plain film
varying presentation; stippled calcification; no cortical disruption, can be scalloped or thinned
periosteal chondroma location
usually metaphyseal: proximal humerus, distal femur, small bones in hands and feet; near tendon/ligament attachments
periosteal chondroma presentation
painful; sometimes palpable mass
periosteal chondroma on plain film
saucerization with sclerosis
Enchondroma treatment
don’t require treatment of asymptomatic; if symptomatic biopsy and curettage with bone grafting
Periosteal chondroma treatment
excision; need to r/o chondrosarcoma
What do you need to remember about a patient who comes in with pain and an enchondroma?
the enchondroma is not the source of their pain, you still need to find it
osteochondroma
cartilage-caped bony projection on the external surface of a bone; exostosis
exostosis
bone covered with cartilaginous cap
most common benign bone tumor?
osteochondroma
osteochondroma can be associated with what condition?
Multiple Hereditary Exostoses
Etiology of osteochondroma
unknown–displaced cartilage thru periosteal defect, bone grows at right angle to normal gorwth plate
osteochondroma location
femur (common at knee), tibia, humerus
sex osteochondroma
males
age osteochondroma
by 2nd decade
presentation osteochondroma
most common is asymptomatic, pain, painful mass
osteochondroma on plain film
pedunculated vs sessile stalk; will grow away from the growth plate
treatment osteochondroma
monitor if asymptomatic, surgical excision if symptomatic
prognosis osteochondroma
excellent, rarely re-occur after excision, very rarely develop into chondrosarcoma (<1%)
chondroblastoma
Cartilage forming tumor in the epiphysis due to immature cartilage cell proliferation
chondroblastoma location
prox and distal femur, prox tibia, prox humerus
chondroblastoma age
2nd decade; SKELETALLY IMMATURE
sex chondroblastoma
males
presentation chondroblastoma
pain, tenderness, swelling, limp if in LE
chondroblastoma on plain film
well circumscribed, lytic lesion; surrounding sclerosis; possible stippled or flocculent (looks cystic) calcification
treatment of chondroblastoma
curettage and bone graft
prognosis chondroblastoma
recurrence rate <10% after excision; secondary osteosarcoma very rare; increased risk of OA when joint involved
nonossifying fibroma
proliferation of fibrous tissue; fibrous cortical defect; small (<1cm) and only affects cortex; extends into the IM canal forming NOF
nonossifying fibroma age
children/adolescents
location nonossifying fibroma
anywhere, more common distal femur; proximal tibia
presentation nonossifying fibroma
asymptomatic to painful
sex nonossifying fibroma
males
prognosis nonossifying fibroma
usually heal spontaneously by 20s
Nonossifying fibromas can be associated with what syndrome
Jaffe-Campanacci Syndrome
Jaffe-Campanacci Syndrome
multiple NOFs and café au lait spots
nonossifying fibroma on plain film
geographic (within medullary canal), thick sclerotic rim, well circumscribed; fibrous cortical defect
treatment of nonossifying fibroma
observation vs surgical management (curettage and bone graft)
fibrous dysplasia
Abnormal tissue formation in place of lamellar bone
two types of fibrous dysplasia
monostotic vs. polystotic
which type of fibrous dysplasia is often associated with syndromes?
polystotic
fibrous dysplasia location
anywhere but more common in femur
presentation of fibrous dysplasia
pain
fibrous dysplasia on plain film
ground glass apperance
tx of fibrous dysplasia
surgical mangement–rigid fixation; bisphosphonates
giant cell tumor
Aggressive, benign, proliferation of multinucleated giant cells
giant cell tumor age
20-50; skeletally mature
giant cell tumor sex
slightly higher females
giant cell tumor location
distal femur, proximal tibia, distal radius, not as common in other bones
giant cell tumor presentation
pain, swelling, deformity; soft tissue extension is common; pathologic fractures
where can giant cell tumor metastasize to?
lung
giant cell tumor presentation on plain film
lucent and eccentrically located; sometimes see local bony destruction and/or cortical destruction
tx giant cell tumor
surgery: curettage, ablation, bone grafting, fixation
unicameral bone cyst
Fluid filled cystic tumor with fibrous lining; near the physis and grows distally
unicameral bone cyst location
proximal humerus; proximal femur; calcaneus
unicameral bone cyst age
younger 5-15 y/o
unicameral bone cyst sex
males
unicameral bone cyst presentation
incidental finding or mild pain, swelling, stiffness in joint; sudden pain due to pathologic fracture
sign associated with unicameral bone cyst
fallen fragment sign
tx for unicameral bone cyst
r/o sarcoma; intralesional aspiration and corticosteroid injection; curettage with bone grafting
prognosis of unicameral bone cyst
good, can resolve spontaneously
aneurysmal bone cyst
Aggressive vascular lesion with cystic blood filled cavities; similar to GCT but not as frequent; locally dstructive
what causes aneurysmal bone cyst?
d/t secondary lesion: Chondroblastoma, NOF, GCT, fibrous dysplasia
age aneurysmal bone cyst
children
sex aneurysmal bone cyst
women
location aneurysmal bone cyst
distal femur/proximal tibia
imaging for aneurysmal bone cyst
plain film; MRI because of fluid
mri finding for aneurysmal bone cyst
soap bubble appearance
tx aneurysmal bone cyst
sx: curettage and bone grafting
most common bone tumor
metastatic disease
common mets that end up in bones
breast/prostate, lung, kidney, GI tract, thyroid
multiple myeloma
Proliferation of interosseous plasma cells; found in bone marrow
sex multiple myeloma
men
race multiple myeloma
AA
age multiple myeloma
50+
s/s multiple myeloma
bone pain, pathologic fractures, weakness/malaise, spinal cord compression (neuro complaints)
multiple myeloma plain film findings
punched out lytic lesions
multiple myeloma prognosis
depends on stage and % of plasma cells in the bone
tx multiple myeloma
surgical fixation of pathologic fractures; chemo; radiation
most common malignant bone tumor
osteosarcoma
origin of osteosarcoma
primitive mesenchymal bone forming cells; produces malignant osteoid
location of osteosarcoma
distal femur, prox tibia, prox humerus
sex osteosarcoma
men
race osteosarcoma
B
age osteosarcoma
any, but more common 12-25; second peak 50-60
S/S osteosarcoma
pain, swelling, night pain, no history of trauma
PE osteosarcoma
palpable mass, decreased ROM, lymphadenopathy, possible respiratory disease
Name the variants of osteosarcoma
conventional types (osteoblastic, chondroblastic, fibroblastic), telangiectatic, multifocal, parosteal, periosteal
Telangiectatic osteosarcoma
appearance = similar to ABC or GCT; similar age and location as primary osteosarcoma ; protrusion out of cortex
Multifocal osteosarcoma
2 or more locations without lung involvement; more common in children
Parosteal osteosarcoma
juxtacortical; patients <30; painless to aching; slow growing; mimics osteochondroma
Periosteal osteosarcoma
arises from surface of diaphysis; cortical involvement; star burst appearance
osteosarcoma labs
LDH, ALP, CBC with diff, CMP, urinalysis, open biopsy by experience surgeon
imaging osteosarcoma
plain films (LUNGS), bone scan, CT (location/staging), MRI (soft tissue involvement and skip lesions)
tx osteosarcoma
wide resection-limb sparing; rotationplasty; amputation; chem pre-operative and post-operative
5 year survival rate osteosarcoma
65-75% without lung mets; 30-40% with lung mets
chondrosarcoma
predominately cartilage; low grade with low mets potential to high grade aggressive tumors; many categories
presentation of primary chondrosarcoma
pain over time with or without mass; pain at night; associated symptoms depending on tumor location
primary chondrosarcoma age
4th to 65th decade
primary chondrosarcoma sex
males
primary chondrosarcoma location
pelvis and femur; ribs; proximal humerus; scapula, upper tibia; metaphysis more common than diaphysis
plain film findings for primary chondrosarcoma
“ring and arc” like pattern; punctate calcifications, endosteal calloping
imaging for primary chondrosarcoma
plain films, MRI (soft tissue involvement), CT (delineation of bony destruction, biopsy
tx primary chondrosarcoma
surgical excision (wide resection vs limb sparing), NO CHEMO/RADIO
primary chondrosarcoma prognosis
low grade >90% after 5 years; high grade <30% after 5 years
secondary chondrosarcoma arises from?
benign cartilage lesion: enchondroma, osteochondroma
secondary chondrosarcoma locations
pelvis, proximal femur, proximal humerus, ribs
secondary chondrosarcoma findings on plain films
scattered, irregular calcification
Ewing Sarcoma
Endothelioma of bone
Ewing Sarcoma associated with what genetically
Associated with chromosomal translocation t(11:22)
Ewing Sarcoma age
birth to 20s, more common 10-20
second most common primary malignant bone tumor in children
Ewing Sarcoma
Ewing Sarcoma sex
male
Ewing Sarcoma race
W
Ewing Sarcoma location
femur, tib/fib, pelvis, ribs, shoulder girdle; metadiaphyseal>diaphyseal>metaphyseal
Ewing Sarcoma presentation
progressively worsen pain and localized swelling/mass; increased warmth over the area; low grade fever; increased sed rate; increased WBCs; anemia; malaise mimics an infectious process
Ewing Sarcoma plain film finding
destructive lesion with poorly marginated border; periosteal bone formation; soft tissue mass sometimes present
Ewing sarcoma imaging
plain films; MRI (soft tissue involvement), CT (staging)
Tx Ewing sarcoma
depends; chemo (vincristine, cyclophosphamide, actinomycin-D, ifosfamide); radiation; surgical resection (limb sparing, rarely amputation)
Ewing sarcoma prognosis: 5 year survival rate
localized: 54-75%; disseminated: 30%
