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Clinical Medicine > Lumps and Bumps > Flashcards

Lumps and Bumps Flashcards

1
Q

Name the benign bone forming tumors

A

osteoid osteoma, osteoblastoma, osteoma

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2
Q

Name the benign cartilage forming tumors

A

chondroma, osteochondroma, chondroblastoma

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3
Q

name the benign fibrous bone lesions

A

fibrous dysplasia, nonossifying fibroma

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4
Q

name the benign radiolucent bone lesions

A

giant cell tumor, unicameral bone cyst, aneurysmal bone cyst

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5
Q

what’s the most common benign osteoid forming tumor?

A

osteoid osteoma

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6
Q

peak incidence of osteoid osteoma

A

2nd decade of life (10-30 yrs)

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7
Q

gender more affected by osteoid osteoma

A

men

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8
Q

location of osteoid osteoma

A

anywhere, but most common in long bones– proximal femur

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9
Q

CM of osteoid osteoma

A

pain; NIGHT PAIN; pain relieved with NSAIDs

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10
Q

pathophysiology of osteoid osteoma

A

neoplastic changes vs inflammatory osteoblasts

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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

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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

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13
Q

Prognosis of osteoid osteoma

A

excellent, local recurrence is rare

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14
Q

what’s an osteoblastoma?

A

large osteoid osteoma, >2 cm, more aggressive

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15
Q

how common is an osteoblastoma?

A

are, 1% of benign bone tumors

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16
Q

Age for osteoblastoma

A

1st to 3rd decade

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17
Q

males or females for osteoblastoma?

A

males

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18
Q

Location of osteoblastoma

A

posterior spine, long bones (femur, tibia)

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19
Q

presentation of osteoblastoma

A

pain, unresponsive to NSAIDs

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20
Q

radiographic appearance of osteoblastoma

A

variable, lucent, slightly expansible, no sclerotic rim, >2 cm, no nidus

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21
Q

Tx of osteoblastoma

A

biopsy, curettage and bone grafting, tumor excision with bone reconstruction vs. internal fixation

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22
Q

prognosis of osteoblastoma

A

excellent, low recurrence rate

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23
Q

what’s an osteoma?

A

deposition of reactive periosteal new bone

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24
Q

age for osteoma?

A

2nd to 4th decade

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25
Q

location of osteoma?

A

skull, tibia, femur

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26
Q

presentation of osteoma

A

firm mass with little to no pain

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27
Q

Osteoma is associated with what syndrome?

A

Gardner’s syndrome

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28
Q

Gardner’s syndrome

A

osteoma, colonic polyps, desmoid tumors

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29
Q

radiographic findings of osteoma

A

dense cortical bone, not contiguous with intramedullary canal

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30
Q

treatment of osteoma

A

observation vs. marginal resection

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31
Q

prognosis of osteoma

A

excellent, self-limiting

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32
Q

what’s a chondroma?

A

tumors contain mature hyaline cartilage

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33
Q

What’s an enchondroma?

A

within the medullary canal

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34
Q

enchondroma sex

A

no predilection

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35
Q

enchondroma age

A

3rd-4th peaks

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36
Q

Size of enchondroma

A

<5 cm

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37
Q

Periosteal chondroma location

A

surface of bone

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38
Q

sex periosteal chondroma

A

males

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39
Q

Which is more common enchondroma or periosteal chondroma?

A

enchondroma

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40
Q

enchondroma location

A

usually metaphyseal: proximal humerus, distal femur, mostly phalanges in hands and feet

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41
Q

presentation of enchondroma

A

asymptomatic, incidental finding, pain associated with pathologic fracture

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42
Q

Syndromes associated with enchondromas

A

Ollier’s disease; Maffucci’s syndrome

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43
Q

Ollier’s disease

A

multiple enchondromas

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44
Q

Maffucci’s syndrome

A

multiple enchondromas + multiple hemangiomas

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45
Q

enchondroma on plain film

A

varying presentation; stippled calcification; no cortical disruption, can be scalloped or thinned

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46
Q

periosteal chondroma location

A

usually metaphyseal: proximal humerus, distal femur, small bones in hands and feet; near tendon/ligament attachments

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47
Q

periosteal chondroma presentation

A

painful; sometimes palpable mass

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48
Q

periosteal chondroma on plain film

A

saucerization with sclerosis

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49
Q

Enchondroma treatment

A

don’t require treatment of asymptomatic; if symptomatic biopsy and curettage with bone grafting

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50
Q

Periosteal chondroma treatment

A

excision; need to r/o chondrosarcoma

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51
Q

What do you need to remember about a patient who comes in with pain and an enchondroma?

A

the enchondroma is not the source of their pain, you still need to find it

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52
Q

osteochondroma

A

cartilage-caped bony projection on the external surface of a bone; exostosis

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53
Q

exostosis

A

bone covered with cartilaginous cap

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54
Q

most common benign bone tumor?

A

osteochondroma

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55
Q

osteochondroma can be associated with what condition?

A

Multiple Hereditary Exostoses

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56
Q

Etiology of osteochondroma

A

unknown–displaced cartilage thru periosteal defect, bone grows at right angle to normal gorwth plate

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57
Q

osteochondroma location

A

femur (common at knee), tibia, humerus

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58
Q

sex osteochondroma

A

males

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59
Q

age osteochondroma

A

by 2nd decade

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60
Q

presentation osteochondroma

A

most common is asymptomatic, pain, painful mass

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61
Q

osteochondroma on plain film

A

pedunculated vs sessile stalk; will grow away from the growth plate

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62
Q

treatment osteochondroma

A

monitor if asymptomatic, surgical excision if symptomatic

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63
Q

prognosis osteochondroma

A

excellent, rarely re-occur after excision, very rarely develop into chondrosarcoma (<1%)

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64
Q

chondroblastoma

A

Cartilage forming tumor in the epiphysis due to immature cartilage cell proliferation

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65
Q

chondroblastoma location

A

prox and distal femur, prox tibia, prox humerus

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66
Q

chondroblastoma age

A

2nd decade; SKELETALLY IMMATURE

67
Q

sex chondroblastoma

A

males

68
Q

presentation chondroblastoma

A

pain, tenderness, swelling, limp if in LE

69
Q

chondroblastoma on plain film

A

well circumscribed, lytic lesion; surrounding sclerosis; possible stippled or flocculent (looks cystic) calcification

70
Q

treatment of chondroblastoma

A

curettage and bone graft

71
Q

prognosis chondroblastoma

A

recurrence rate <10% after excision; secondary osteosarcoma very rare; increased risk of OA when joint involved

72
Q

nonossifying fibroma

A

proliferation of fibrous tissue; fibrous cortical defect; small (<1cm) and only affects cortex; extends into the IM canal forming NOF

73
Q

nonossifying fibroma age

A

children/adolescents

74
Q

location nonossifying fibroma

A

anywhere, more common distal femur; proximal tibia

75
Q

presentation nonossifying fibroma

A

asymptomatic to painful

76
Q

sex nonossifying fibroma

A

males

77
Q

prognosis nonossifying fibroma

A

usually heal spontaneously by 20s

78
Q

Nonossifying fibromas can be associated with what syndrome

A

Jaffe-Campanacci Syndrome

79
Q

Jaffe-Campanacci Syndrome

A

multiple NOFs and café au lait spots

80
Q

nonossifying fibroma on plain film

A

geographic (within medullary canal), thick sclerotic rim, well circumscribed; fibrous cortical defect

81
Q

treatment of nonossifying fibroma

A

observation vs surgical management (curettage and bone graft)

82
Q

fibrous dysplasia

A

Abnormal tissue formation in place of lamellar bone

83
Q

two types of fibrous dysplasia

A

monostotic vs. polystotic

84
Q

which type of fibrous dysplasia is often associated with syndromes?

A

polystotic

85
Q

fibrous dysplasia location

A

anywhere but more common in femur

86
Q

presentation of fibrous dysplasia

A

pain

87
Q

fibrous dysplasia on plain film

A

ground glass apperance

88
Q

tx of fibrous dysplasia

A

surgical mangement–rigid fixation; bisphosphonates

89
Q

giant cell tumor

A

Aggressive, benign, proliferation of multinucleated giant cells

90
Q

giant cell tumor age

A

20-50; skeletally mature

91
Q

giant cell tumor sex

A

slightly higher females

92
Q

giant cell tumor location

A

distal femur, proximal tibia, distal radius, not as common in other bones

93
Q

giant cell tumor presentation

A

pain, swelling, deformity; soft tissue extension is common; pathologic fractures

94
Q

where can giant cell tumor metastasize to?

A

lung

95
Q

giant cell tumor presentation on plain film

A

lucent and eccentrically located; sometimes see local bony destruction and/or cortical destruction

96
Q

tx giant cell tumor

A

surgery: curettage, ablation, bone grafting, fixation

97
Q

unicameral bone cyst

A

Fluid filled cystic tumor with fibrous lining; near the physis and grows distally

98
Q

unicameral bone cyst location

A

proximal humerus; proximal femur; calcaneus

99
Q

unicameral bone cyst age

A

younger 5-15 y/o

100
Q

unicameral bone cyst sex

A

males

101
Q

unicameral bone cyst presentation

A

incidental finding or mild pain, swelling, stiffness in joint; sudden pain due to pathologic fracture

102
Q

sign associated with unicameral bone cyst

A

fallen fragment sign

103
Q

tx for unicameral bone cyst

A

r/o sarcoma; intralesional aspiration and corticosteroid injection; curettage with bone grafting

104
Q

prognosis of unicameral bone cyst

A

good, can resolve spontaneously

105
Q

aneurysmal bone cyst

A

Aggressive vascular lesion with cystic blood filled cavities; similar to GCT but not as frequent; locally dstructive

106
Q

what causes aneurysmal bone cyst?

A

d/t secondary lesion: Chondroblastoma, NOF, GCT, fibrous dysplasia

107
Q

age aneurysmal bone cyst

A

children

108
Q

sex aneurysmal bone cyst

A

women

109
Q

location aneurysmal bone cyst

A

distal femur/proximal tibia

110
Q

imaging for aneurysmal bone cyst

A

plain film; MRI because of fluid

111
Q

mri finding for aneurysmal bone cyst

A

soap bubble appearance

112
Q

tx aneurysmal bone cyst

A

sx: curettage and bone grafting

113
Q

most common bone tumor

A

metastatic disease

114
Q

common mets that end up in bones

A

breast/prostate, lung, kidney, GI tract, thyroid

115
Q

multiple myeloma

A

Proliferation of interosseous plasma cells; found in bone marrow

116
Q

sex multiple myeloma

A

men

117
Q

race multiple myeloma

A

AA

118
Q

age multiple myeloma

A

50+

119
Q

s/s multiple myeloma

A

bone pain, pathologic fractures, weakness/malaise, spinal cord compression (neuro complaints)

120
Q

multiple myeloma plain film findings

A

punched out lytic lesions

121
Q

multiple myeloma prognosis

A

depends on stage and % of plasma cells in the bone

122
Q

tx multiple myeloma

A

surgical fixation of pathologic fractures; chemo; radiation

123
Q

most common malignant bone tumor

A

osteosarcoma

124
Q

origin of osteosarcoma

A

primitive mesenchymal bone forming cells; produces malignant osteoid

125
Q

location of osteosarcoma

A

distal femur, prox tibia, prox humerus

126
Q

sex osteosarcoma

A

men

127
Q

race osteosarcoma

A

B

128
Q

age osteosarcoma

A

any, but more common 12-25; second peak 50-60

129
Q

S/S osteosarcoma

A

pain, swelling, night pain, no history of trauma

130
Q

PE osteosarcoma

A

palpable mass, decreased ROM, lymphadenopathy, possible respiratory disease

131
Q

Name the variants of osteosarcoma

A

conventional types (osteoblastic, chondroblastic, fibroblastic), telangiectatic, multifocal, parosteal, periosteal

132
Q

Telangiectatic osteosarcoma

A

appearance = similar to ABC or GCT; similar age and location as primary osteosarcoma ; protrusion out of cortex

133
Q

Multifocal osteosarcoma

A

2 or more locations without lung involvement; more common in children

134
Q

Parosteal osteosarcoma

A

juxtacortical; patients <30; painless to aching; slow growing; mimics osteochondroma

135
Q

Periosteal osteosarcoma

A

arises from surface of diaphysis; cortical involvement; star burst appearance

136
Q

osteosarcoma labs

A

LDH, ALP, CBC with diff, CMP, urinalysis, open biopsy by experience surgeon

137
Q

imaging osteosarcoma

A

plain films (LUNGS), bone scan, CT (location/staging), MRI (soft tissue involvement and skip lesions)

138
Q

tx osteosarcoma

A

wide resection-limb sparing; rotationplasty; amputation; chem pre-operative and post-operative

139
Q

5 year survival rate osteosarcoma

A

65-75% without lung mets; 30-40% with lung mets

140
Q

chondrosarcoma

A

predominately cartilage; low grade with low mets potential to high grade aggressive tumors; many categories

141
Q

presentation of primary chondrosarcoma

A

pain over time with or without mass; pain at night; associated symptoms depending on tumor location

142
Q

primary chondrosarcoma age

A

4th to 65th decade

143
Q

primary chondrosarcoma sex

A

males

144
Q

primary chondrosarcoma location

A

pelvis and femur; ribs; proximal humerus; scapula, upper tibia; metaphysis more common than diaphysis

145
Q

plain film findings for primary chondrosarcoma

A

“ring and arc” like pattern; punctate calcifications, endosteal calloping

146
Q

imaging for primary chondrosarcoma

A

plain films, MRI (soft tissue involvement), CT (delineation of bony destruction, biopsy

147
Q

tx primary chondrosarcoma

A

surgical excision (wide resection vs limb sparing), NO CHEMO/RADIO

148
Q

primary chondrosarcoma prognosis

A

low grade >90% after 5 years; high grade <30% after 5 years

149
Q

secondary chondrosarcoma arises from?

A

benign cartilage lesion: enchondroma, osteochondroma

150
Q

secondary chondrosarcoma locations

A

pelvis, proximal femur, proximal humerus, ribs

151
Q

secondary chondrosarcoma findings on plain films

A

scattered, irregular calcification

152
Q

Ewing Sarcoma

A

Endothelioma of bone

153
Q

Ewing Sarcoma associated with what genetically

A 
Associated with chromosomal 
translocation t(11:22)
154
Q

Ewing Sarcoma age

A

birth to 20s, more common 10-20

155
Q

second most common primary malignant bone tumor in children

A

Ewing Sarcoma

156
Q

Ewing Sarcoma sex

A

male

157
Q

Ewing Sarcoma race

A

W

158
Q

Ewing Sarcoma location

A

femur, tib/fib, pelvis, ribs, shoulder girdle; metadiaphyseal>diaphyseal>metaphyseal

159
Q

Ewing Sarcoma presentation

A

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
Q

Ewing Sarcoma plain film finding

A

destructive lesion with poorly marginated border; periosteal bone formation; soft tissue mass sometimes present

161
Q

Ewing sarcoma imaging

A

plain films; MRI (soft tissue involvement), CT (staging)

162
Q

Tx Ewing sarcoma

A

depends; chemo (vincristine, cyclophosphamide, actinomycin-D, ifosfamide); radiation; surgical resection (limb sparing, rarely amputation)

163
Q

Ewing sarcoma prognosis: 5 year survival rate

A

localized: 54-75%; disseminated: 30%

Clinical Medicine (13 decks)

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