Malignant Bone Tumors Flashcards
Osteosarcoma radiographic
Ill-defined, mixed sclerotic and lytic
Metaphysis
Periosteal reaction 9Codman’s triangle)
Extra-osseuous mass in soft tissue
Osteosarcoma
Ages
Second decade (rapid growth)
Over 60 (Paget’s dz)
Causes of ostesarcoma
Growth - metaphysis of taller children
Secondary from radiation
Genetic syndrome
Paget’s in older
Genetic syndrome and osteosarcoma
Retinoblastoma (RB)
Rothmund-Thomson (RecQL4)
Li-Fraumeni Syndrome (TP53)
Presentation of osteosarcoma
Pain at tumor site (typically steady)
Swelling and limp will develop
Fever, weight loss, etc. uncommon
Locations of osteosarcoma
Metaphysis of long bones
Distal femur (most common) or promximal tibia
Proximal ghumeorus 3rd most
Eval of osteosarcoma
Plain film of - ill-efined mixed, periosteal rxn, wide zone of transition
Then MRI of entire bone
Search for bone metastases with bone scan or PET
Search for lung with chest CT
Most important prognostic factor of osteosarcoma
Lung metastases
Diagnosiing osteosarcoma
Biopsy always required (core biopsy or surgery)
Hallmark osteosarcoma on a slide
Lamignant osteoid
Tx of osteosarcoma
Use chemo and surgery….oragnepeel strategy
Ewing sarcoma radiographic/in a slide
Moth eaten superoir pelvic ramus
Lots of small blue cells
Ewing sarcoma
Age, sx,
25% in soft tissues
Diagnosed in first 3 decases
Could have the fever, weight loss etc.
Persistnet pain
Ewing sarcoma areas affected
Axial and appendicular skeleton
Typically from diaphysis but also some from metaphysis
Single most common in plevis
Metastatic spread of Ewing
Most have micrometastatic
Lungs are common, followed by bone and bone marrow (no bone marrow in osteosarcoma)
Tx difference for Ewing
Radiation can be used
Chondrosarcoma
Pathology, age, sites
Production of cartialge matri
Develop within normal bone
Middle-age to older adults
Pelvis and proximal femur are common
Chondrosarcoma
Most common type, mutations, management
Most are primary arising in meduallry canal
IDH2 and IDH1
Managmeent surgical onlyy
Chondrosarcoma on a slide
CHondrocytes and matrix
Radiograph appearance of chondrosarcoma
Arcs and rings with ossification
OS
Age Sx Common primary site Location in bone X-ray Pathology Tx
Teenage, elderly Pain Femur, tibia, humerous Metaphysis Lytic/slerotic Malignant osteoid production Surg and chemo
ES Age Sx Common site Location in bone X-ray Partho tx
Teenage/young adults Pain, fever, WL Axial=appendicular Diaphysis Onion skin/moth eaten SMall round blue cells, EWS-FLI-1 translocation Surgery/RT and chemo
CS Age sx common site Location in bone X ray patho Tx
30-70 Pain Pelvis, femur Often central Arcs and rings Chondroid matrix...IDH 1 and IDH2 Surgery
