Malignant Bone Tumors Flashcards
What is the most frequent primary bone malignancy, exclusive of hematopoietic malignancies?
Osteosarcoma
Osteosarcoma is particularly common in patients aged 10 to 25 years.
What age group is primarily affected by osteosarcoma?
Patients between 10 to 25 years of age, with another peak after 40
Osteosarcoma is exceptionally rare in preschool children.
What percentage of all osteosarcomas do osteosarcomas of the jaws represent?
6-8%
These are most often found in the 3rd to 4th decade of life.
What are common symptoms of jaw osteosarcoma?
Swelling and pain
Other features may include loosening of teeth, parasthesia, and nasal obstruction.
Which regions of long bones are most commonly affected by osteosarcoma?
Metaphyseal region, particularly the lower end of the femur, upper end of tibia, and upper end of humerus
Less commonly, they are found in flat bones such as craniofacial bones, pelvis, and scapula.
What are the predisposing factors for osteosarcoma?
- Paget’s disease
- Radiation exposure
- Chemotherapy
- Pre-existing benign bone lesions
- Foreign bodies
Examples include fibrous dysplasia and orthopedic implants.
What is the mean age for patients with osteosarcoma of the jaw?
About 33 years
This is 10 to 15 years older than the mean age for osteosarcomas of the long bones.
What radiographic feature is common in jaw osteosarcoma?
Classical sunburst or sunray appearance
This appearance is due to osteophytic bone production on the surface of the lesion.
What is a key histopathological feature for diagnosing osteosarcoma?
Detection of osteoid and calcified osteoid produced by tumor cells
Osteoid is recognized by its eosinophilic-staining quality and glassy appearance.
How are osteosarcomas subclassified?
- Osteoblastic
- Chondroblastic
- Fibroblastic
These subtypes do not have any prognostic significance.
What is the prognosis for osteosarcoma of the jaw compared to those in long bones?
Less aggressive and lower grade
Metastases are seen less frequently, with 30-50% survival rates.
What is a chondroma?
Benign tumors composed of mature hyaline cartilage
Commonly located in short tubular bones of the hands and feet.
What is the peak age for the diagnosis of chondromas?
3rd to 4th decade of life
They usually present as painless slow-growing lesions.
What is the treatment for a diagnosed chondroma in the jaw?
Radical resection
Chondromas in the jaw should be considered potential chondrosarcomas.
What is a chondrosarcoma?
A malignant tumor characterized by the formation of cartilage by tumor cells
Chondrosarcoma rarely involves the jaws.
What are the three grades of chondrosarcoma?
- Grade I
- Grade II
- Grade III
The grades correlate with tumor growth rate and prognosis.
What is Ewing’s Sarcoma traditionally regarded as?
An undifferentiated type of bone sarcoma of children, linked with primitive neuroectodermal tumor (PNET)
The current term used is Ewing’s Sarcoma/PNET.
What age group is primarily affected by Ewing’s Sarcoma?
Patients between 5 and 20 years
Jaw involvement is uncommon.
What are common symptoms of Ewing’s Sarcoma?
Pain with swelling
Fever, leukocytosis, and elevated ESR may also be present.
What is the treatment for Ewing’s Sarcoma?
High dose radiotherapy and multidrug chemotherapy
This approach has improved the 5-year survival rate to 75%.
What are the characteristics of malignant lymphoma in bone?
Can involve the skeletal system primarily or as a manifestation of systemic disease
Large cell lymphoma is more common in adults.
What is Burkitt’s Lymphoma associated with?
B-lymphocyte origin that has a predilection to jaws
It is related to Epstein-Barr virus (EBV).
What is the classic histopathological feature of Burkitt’s Lymphoma?
Starry sky pattern
This pattern is caused by the presence of histiocytes within the tumor tissue.
What is Multiple Myeloma?
A malignancy of plasma cell origin within bone
Accounts for nearly 50% of all malignancies that involve the bone.
What are common clinical features of Multiple Myeloma?
Bone pain, pathologic fractures, fatigue, fever, infection, and bleeding tendency
These symptoms are due to abnormal platelet function.
What radiographic feature is characteristic of Multiple Myeloma?
Multiple well-defined, punched out radiolucencies
The jaws may be involved in 30% of cases.
What is the median age at diagnosis for the disease described?
60-70 years
Rarely diagnosed before the age of 40.
List some clinical features of the disease.
- Bone pain
- Pathologic fractures
- Fatigue
- Fever
- Infection
- Bleeding tendency due to abnormal platelet function
What are the radiographic features of the disease?
- Multiple well-defined punched out radiolucencies
- Ragged radiolucencies
- May affect the skull and jaws in 30% of cases
What histopathological features are observed in this disease?
- Diffuse, monotonous sheets of neoplastic, variably differentiated, plasmacytoid cells
- Frequent mitoses
- Amyloid deposits may be seen
What are the four key diagnostic methods for this disease?
- Skeletal X-ray showing radiolucency
- Histopathology revealing neoplastic plasma cells
- Bone-marrow examination showing at least 10% atypical plasma cells
- Bence-Jones proteins in urine (30-50%)
What is the prognosis and survival rate for this disease?
Poor prognosis with a 5-year survival rate of 25%
Define Plasmacytoma.
A unifocal, monoclonal, neoplastic proliferation of plasma cells usually arising within bone.
What is the average age at diagnosis for Plasmacytoma?
55 years
What are the clinical and radiographic features of Plasmacytoma?
- Affects adult males
- Most lesions are central within a bone
- Pain and swelling, but some cases are asymptomatic
- X-ray shows well-defined unilocular radiolucency
How does Plasmacytoma differ from Multiple Myeloma?
All the findings in the diagnosis of Multiple Myeloma are negative in Plasmacytoma.
