Malignant (Ewing's and on) Flashcards
Primitive primary malignant tumor of bone derived from connective tissue framework of bone marrow
Ewing’s Sarcoma
Ewing’s Sarcoma age range
10-25 yo peak at 15 years
Localized pain with swelling usually palpable soft tissue mass
Ewing’s Sarcoma
Only primary malignant bone tumor that
simulates an infection
Ewing’s Sarcoma
Fever, Anemia, Leukocytosis, and Elevated ESR
Ewing’s Sarcoma
- Permeative
- Wide zone of transition
- Laminated periosteal reaction (or spiculated)
- Codman’s Triangles
- Cortical saucerization is early sign
- Usually mixed lytic and sclerotic patterns
Ewing’s Sarcoma
early sign of Ewing’s sarcoma
Cortical saucerization
Cortical saucerization is due to
subperiosteal extension of tumor through
Haversion systems of cortex
MC primary malignant bone tumor to metastasize to bone
Ewing’s Sarcoma
Laminated periosteal
reaction seen in
Ewing’s
Sarcoma
Produces varying amounts of collagen
in 30-50 yo and presents with Local pain and swelling that may refer pain to joint
Fibrosarcoma
1/3 of fibrosarcoma patients present with
pathologic fracture
Malignant Fibrous Histiocytoma (MFH)
aka
Undifferentiated Pleomorphic Osteosarcoma
UPS
Fibrosarcomas are purely _______, with no _______
radiolucent, calcification
- Highly destructive lesion
- Expansile
- Medullary in origin
- Permeative, metaphyseal
- Eccentric
- Endosteal scalloping
Fibrosarcoma
A secondary Fibrosarcoma
may be caused by
Paget’s disease
Fibrosarcoma
usually metastasize to
lung and liver
Rare primary malignant bone tumor arising from
vestigial remnants of notochord, which have
persisted in the nucleus pulposus of the IVD
chordoma
m/c location for chordoma
Sacrococcygeal chordoma (50%)
chordoma can cross the
disc
Sacrococcygeal Chordoma will present with
constipation
– Increased intracranial pressure, and encroachment on adjacent structures – chronic Headache – Blurred vision, diplopia – Nasal obstruction – Cerebellar involvement
Spheno-Occipital Chordoma
vertebral cordomas mc affect the __ vertebral body and spares the
C2, posterior elements
Presents as localized bone lesion with Dull aching pain, not relieved by rest
but Patient feels fairly good overall
Non-Hodgkin’s Lymphoma
aka Reticulum Cell Sarcoma
Non-Hodgkin’s Lymphoma Tumor begins in
medullary bone
Laminated periosteal reaction and Pathological fracture is common (initial complaint)
Non-Hodgkin’s Lymphoma
radiograph of 51-year-old man with left leg pain demonstrates a
lytic lesion with a moth-eaten appearance centered in the mid
diaphysis of the tibia
Non-Hodgkin’s Lymphoma
usually more symptomatic than blastic lesions
Lytic lesions
Primary site of skeletal involvement for Hodgkin’s Lymphoma of Bone
vertebral body
Hodgkin’s Lymphoma of Bone is also common in
lower thoracic and upper lumbar spine
10-20% of patients with Hodgkin’s lymphoma
develop
skeletal disease
75% Osteolytic
accounts for
approximately 3% of malignant bone neoplasms and comprises less than 5% of all extranodal
non-Hodgkin’s lymphomas
Primary lymphoma of the bone
initial involvement of a single bone (long) with no evidence of
disease elsewhere for at least 6 months
primary bone lymphoma
characterized as “mottled” or “moth-eaten” radiolucencies,
corresponding to regions of marrow and cortical replacement by lymphoma cells
primary lymphomas of bone
reported in about
60% of Primary Lymphoma of Bone cases
Periosteal reaction
Primary Lymphoma of Bone enhances with
gadolinium contrast
Primary Lymphoma of Bone patients generally present with
localized bone pain
and, less frequently, soft-tissue swelling
Pain of an intermittent, aching nature, with localized swelling and tenderness in a 20-40 yo
Giant Cell Tumor
begins in the metaphysis and extends to end of long bone to the subarticular region
Giant Cell Tumors
mc spinal site for a giant cell tumor
Sacrum
Quasimalignant tumor of bone
Giant Cell Tumors
- Eccentric
- Metaphyseal
- Purely lytic (60%)
- Extends to subarticular region of bone
- Thinned, expanded cortex
- Soap bubble
Giant Cell Tumor
definitive diagnosis of a Giant Cell Tumor must be correlated by three means:
Radiologic, Clinical and Histologic
