Lumps and Bumps Flashcards
1
Q
Name the benign bone forming tumors
A
osteoid osteoma, osteoblastoma, osteoma
2
Q
Name the benign cartilage forming tumors
A
chondroma, osteochondroma, chondroblastoma
3
Q
name the benign fibrous bone lesions
A
fibrous dysplasia, nonossifying fibroma
4
Q
name the benign radiolucent bone lesions
A
giant cell tumor, unicameral bone cyst, aneurysmal bone cyst
5
Q
what’s the most common benign osteoid forming tumor?
A
osteoid osteoma
6
Q
peak incidence of osteoid osteoma
A
2nd decade of life (10-30 yrs)
7
Q
gender more affected by osteoid osteoma
A
men
8
Q
location of osteoid osteoma
A
anywhere, but most common in long bones– proximal femur
9
Q
CM of osteoid osteoma
A
pain; NIGHT PAIN; pain relieved with NSAIDs
10
Q
pathophysiology of osteoid osteoma
A
neoplastic changes vs inflammatory osteoblasts
11
Q
radiographic findings of osteoid osteoma
A
small, <1 cm lytic nidus with surrounding sclerosis; “hot” on bone scan; use CT scan to localize the lesion
12
Q
Tx of osteoid osteoma
A
pain control/suppression with NSAIDs; if fail medical management curettage/burring to get rid of nidus, radiofrequency ablation
13
Q
Prognosis of osteoid osteoma
A
excellent, local recurrence is rare
14
Q
what’s an osteoblastoma?
A
large osteoid osteoma, >2 cm, more aggressive
15
Q
how common is an osteoblastoma?
A
are, 1% of benign bone tumors
16
Q
Age for osteoblastoma
A
1st to 3rd decade
17
Q
males or females for osteoblastoma?
A
males
18
Q
Location of osteoblastoma
A
posterior spine, long bones (femur, tibia)
19
Q
presentation of osteoblastoma
A
pain, unresponsive to NSAIDs
20
Q
radiographic appearance of osteoblastoma
A
variable, lucent, slightly expansible, no sclerotic rim, >2 cm, no nidus
21
Q
Tx of osteoblastoma
A
biopsy, curettage and bone grafting, tumor excision with bone reconstruction vs. internal fixation
22
Q
prognosis of osteoblastoma
A
excellent, low recurrence rate
23
Q
what’s an osteoma?
A
deposition of reactive periosteal new bone
24
Q
age for osteoma?
A
2nd to 4th decade
25
location of osteoma?
skull, tibia, femur
26
presentation of osteoma
firm mass with little to no pain
27
Osteoma is associated with what syndrome?
Gardner's syndrome
28
Gardner's syndrome
osteoma, colonic polyps, desmoid tumors
29
radiographic findings of osteoma
dense cortical bone, not contiguous with intramedullary canal
30
treatment of osteoma
observation vs. marginal resection
31
prognosis of osteoma
excellent, self-limiting
32
what's a chondroma?
tumors contain mature hyaline cartilage
33
What's an enchondroma?
within the medullary canal
34
enchondroma sex
no predilection
35
enchondroma age
3rd-4th peaks
36
Size of enchondroma
<5 cm
37
Periosteal chondroma location
surface of bone
38
sex periosteal chondroma
males
39
Which is more common enchondroma or periosteal chondroma?
enchondroma
40
enchondroma location
usually metaphyseal: proximal humerus, distal femur, mostly phalanges in hands and feet
41
presentation of enchondroma
asymptomatic, incidental finding, pain associated with pathologic fracture
42
Syndromes associated with enchondromas
Ollier's disease; Maffucci's syndrome
43
Ollier's disease
multiple enchondromas
44
Maffucci's syndrome
multiple enchondromas + multiple hemangiomas
45
enchondroma on plain film
varying presentation; stippled calcification; no cortical disruption, can be scalloped or thinned
46
periosteal chondroma location
usually metaphyseal: proximal humerus, distal femur, small bones in hands and feet; near tendon/ligament attachments
47
periosteal chondroma presentation
painful; sometimes palpable mass
48
periosteal chondroma on plain film
saucerization with sclerosis
49
Enchondroma treatment
don't require treatment of asymptomatic; if symptomatic biopsy and curettage with bone grafting
50
Periosteal chondroma treatment
excision; need to r/o chondrosarcoma
51
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
52
osteochondroma
cartilage-caped bony projection on the external surface of a bone; exostosis
53
exostosis
bone covered with cartilaginous cap
54
most common benign bone tumor?
osteochondroma
55
osteochondroma can be associated with what condition?
Multiple Hereditary Exostoses
56
Etiology of osteochondroma
unknown--displaced cartilage thru periosteal defect, bone grows at right angle to normal gorwth plate
57
osteochondroma location
femur (common at knee), tibia, humerus
58
sex osteochondroma
males
59
age osteochondroma
by 2nd decade
60
presentation osteochondroma
most common is asymptomatic, pain, painful mass
61
osteochondroma on plain film
pedunculated vs sessile stalk; will grow away from the growth plate
62
treatment osteochondroma
monitor if asymptomatic, surgical excision if symptomatic
63
prognosis osteochondroma
excellent, rarely re-occur after excision, very rarely develop into chondrosarcoma (<1%)
64
chondroblastoma
Cartilage forming tumor in the epiphysis due to immature cartilage cell proliferation
65
chondroblastoma location
prox and distal femur, prox tibia, prox humerus
66
chondroblastoma age
2nd decade; SKELETALLY IMMATURE
67
sex chondroblastoma
males
68
presentation chondroblastoma
pain, tenderness, swelling, limp if in LE
69
chondroblastoma on plain film
well circumscribed, lytic lesion; surrounding sclerosis; possible stippled or flocculent (looks cystic) calcification
70
treatment of chondroblastoma
curettage and bone graft
71
prognosis chondroblastoma
recurrence rate <10% after excision; secondary osteosarcoma very rare; increased risk of OA when joint involved
72
nonossifying fibroma
proliferation of fibrous tissue; fibrous cortical defect; small (<1cm) and only affects cortex; extends into the IM canal forming NOF
73
nonossifying fibroma age
children/adolescents
74
location nonossifying fibroma
anywhere, more common distal femur; proximal tibia
75
presentation nonossifying fibroma
asymptomatic to painful
76
sex nonossifying fibroma
males
77
prognosis nonossifying fibroma
usually heal spontaneously by 20s
78
Nonossifying fibromas can be associated with what syndrome
Jaffe-Campanacci Syndrome
79
Jaffe-Campanacci Syndrome
multiple NOFs and café au lait spots
80
nonossifying fibroma on plain film
geographic (within medullary canal), thick sclerotic rim, well circumscribed; fibrous cortical defect
81
treatment of nonossifying fibroma
observation vs surgical management (curettage and bone graft)
82
fibrous dysplasia
Abnormal tissue formation in place of lamellar bone
83
two types of fibrous dysplasia
monostotic vs. polystotic
84
which type of fibrous dysplasia is often associated with syndromes?
polystotic
85
fibrous dysplasia location
anywhere but more common in femur
86
presentation of fibrous dysplasia
pain
87
fibrous dysplasia on plain film
ground glass apperance
88
tx of fibrous dysplasia
surgical mangement--rigid fixation; bisphosphonates
89
giant cell tumor
Aggressive, benign, proliferation of multinucleated giant cells
90
giant cell tumor age
20-50; skeletally mature
91
giant cell tumor sex
slightly higher females
92
giant cell tumor location
distal femur, proximal tibia, distal radius, not as common in other bones
93
giant cell tumor presentation
pain, swelling, deformity; soft tissue extension is common; pathologic fractures
94
where can giant cell tumor metastasize to?
lung
95
giant cell tumor presentation on plain film
lucent and eccentrically located; sometimes see local bony destruction and/or cortical destruction
96
tx giant cell tumor
surgery: curettage, ablation, bone grafting, fixation
97
unicameral bone cyst
Fluid filled cystic tumor with fibrous lining; near the physis and grows distally
98
unicameral bone cyst location
proximal humerus; proximal femur; calcaneus
99
unicameral bone cyst age
younger 5-15 y/o
100
unicameral bone cyst sex
males
101
unicameral bone cyst presentation
incidental finding or mild pain, swelling, stiffness in joint; sudden pain due to pathologic fracture
102
sign associated with unicameral bone cyst
fallen fragment sign
103
tx for unicameral bone cyst
r/o sarcoma; intralesional aspiration and corticosteroid injection; curettage with bone grafting
104
prognosis of unicameral bone cyst
good, can resolve spontaneously
105
aneurysmal bone cyst
Aggressive vascular lesion with cystic blood filled cavities; similar to GCT but not as frequent; locally dstructive
106
what causes aneurysmal bone cyst?
d/t secondary lesion: Chondroblastoma, NOF, GCT, fibrous dysplasia
107
age aneurysmal bone cyst
children
108
sex aneurysmal bone cyst
women
109
location aneurysmal bone cyst
distal femur/proximal tibia
110
imaging for aneurysmal bone cyst
plain film; MRI because of fluid
111
mri finding for aneurysmal bone cyst
soap bubble appearance
112
tx aneurysmal bone cyst
sx: curettage and bone grafting
113
most common bone tumor
metastatic disease
114
common mets that end up in bones
breast/prostate, lung, kidney, GI tract, thyroid
115
multiple myeloma
Proliferation of interosseous plasma cells; found in bone marrow
116
sex multiple myeloma
men
117
race multiple myeloma
AA
118
age multiple myeloma
50+
119
s/s multiple myeloma
bone pain, pathologic fractures, weakness/malaise, spinal cord compression (neuro complaints)
120
multiple myeloma plain film findings
punched out lytic lesions
121
multiple myeloma prognosis
depends on stage and % of plasma cells in the bone
122
tx multiple myeloma
surgical fixation of pathologic fractures; chemo; radiation
123
most common malignant bone tumor
osteosarcoma
124
origin of osteosarcoma
primitive mesenchymal bone forming cells; produces malignant osteoid
125
location of osteosarcoma
distal femur, prox tibia, prox humerus
126
sex osteosarcoma
men
127
race osteosarcoma
B
128
age osteosarcoma
any, but more common 12-25; second peak 50-60
129
S/S osteosarcoma
pain, swelling, night pain, no history of trauma
130
PE osteosarcoma
palpable mass, decreased ROM, lymphadenopathy, possible respiratory disease
131
Name the variants of osteosarcoma
conventional types (osteoblastic, chondroblastic, fibroblastic), telangiectatic, multifocal, parosteal, periosteal
132
Telangiectatic osteosarcoma
appearance = similar to ABC or GCT; similar age and location as primary osteosarcoma ; protrusion out of cortex
133
Multifocal osteosarcoma
2 or more locations without lung involvement; more common in children
134
Parosteal osteosarcoma
juxtacortical; patients <30; painless to aching; slow growing; mimics osteochondroma
135
Periosteal osteosarcoma
arises from surface of diaphysis; cortical involvement; star burst appearance
136
osteosarcoma labs
LDH, ALP, CBC with diff, CMP, urinalysis, open biopsy by experience surgeon
137
imaging osteosarcoma
plain films (LUNGS), bone scan, CT (location/staging), MRI (soft tissue involvement and skip lesions)
138
tx osteosarcoma
wide resection-limb sparing; rotationplasty; amputation; chem pre-operative and post-operative
139
5 year survival rate osteosarcoma
65-75% without lung mets; 30-40% with lung mets
140
chondrosarcoma
predominately cartilage; low grade with low mets potential to high grade aggressive tumors; many categories
141
presentation of primary chondrosarcoma
pain over time with or without mass; pain at night; associated symptoms depending on tumor location
142
primary chondrosarcoma age
4th to 65th decade
143
primary chondrosarcoma sex
males
144
primary chondrosarcoma location
pelvis and femur; ribs; proximal humerus; scapula, upper tibia; metaphysis more common than diaphysis
145
plain film findings for primary chondrosarcoma
"ring and arc" like pattern; punctate calcifications, endosteal calloping
146
imaging for primary chondrosarcoma
plain films, MRI (soft tissue involvement), CT (delineation of bony destruction, biopsy
147
tx primary chondrosarcoma
surgical excision (wide resection vs limb sparing), NO CHEMO/RADIO
148
primary chondrosarcoma prognosis
low grade >90% after 5 years; high grade <30% after 5 years
149
secondary chondrosarcoma arises from?
benign cartilage lesion: enchondroma, osteochondroma
150
secondary chondrosarcoma locations
pelvis, proximal femur, proximal humerus, ribs
151
secondary chondrosarcoma findings on plain films
scattered, irregular calcification
152
Ewing Sarcoma
Endothelioma of bone
153
Ewing Sarcoma associated with what genetically
```
Associated with chromosomal
translocation t(11:22)
```
154
Ewing Sarcoma age
birth to 20s, more common 10-20
155
second most common primary malignant bone tumor in children
Ewing Sarcoma
156
Ewing Sarcoma sex
male
157
Ewing Sarcoma race
W
158
Ewing Sarcoma location
femur, tib/fib, pelvis, ribs, shoulder girdle; metadiaphyseal>diaphyseal>metaphyseal
159
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*
160
Ewing Sarcoma plain film finding
destructive lesion with poorly marginated border; periosteal bone formation; soft tissue mass sometimes present
161
Ewing sarcoma imaging
plain films; MRI (soft tissue involvement), CT (staging)
162
Tx Ewing sarcoma
depends; chemo (vincristine, cyclophosphamide, actinomycin-D, ifosfamide); radiation; surgical resection (limb sparing, rarely amputation)
163
Ewing sarcoma prognosis: 5 year survival rate
localized: 54-75%; disseminated: 30%
