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6 SKEL B > MIDTERM TUMOR > Flashcards

MIDTERM TUMOR Flashcards

1
Q

What are common sites of neoplasms?

A

FEMUR, pelvis, humerus

(UNCOMMON in spine)

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2
Q

Osteosarcom neoplasm %

A

50-55%

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3
Q

Fibrosarcoma neoplasm %

A

20-25%

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4
Q

Chondrosarcoma neoplasm %

A

10%

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5
Q

What is a neoplasm?

A

Abnormal cellular growth that can be benign or malignant

  • Malignant: Ability to metastasize/spread
  • Benign: Does not metastasize, but this does not mean insignificant
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6
Q

Any cell found in bone can produce ______

A

a tumor

* Subdivided by what type of cell it comes from

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7
Q

If a tumor originates in bone it is called a _____

A

primary bone tumor

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8
Q

What is a secondary bone tumor basic definition?

A

Starts somewhere else and metastasizes to bone

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9
Q

What is a tumor like lesion?

A

Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency

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10
Q

Primary bone tumors, benign category:

A
  1. Osteoma - MOST COMMON, intramembranous bone tumor, dont hurt
  2. Osteoid Osteoma - not as common, HURT
  3. Osteoblastoma - RARE, but half occur in spine
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12
Q

Describe conventional osteosarcomas:

A

Most of these are central sclerotic (about 75%) originate from inside the bone and loves the distal femoral metaphysis

  • 72% (over 2/3 of all osteosarcomas)
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13
Q

What is multifocal Osteosarcomatosis?

A

Most often in children in first decade, nearly always fatal

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14
Q

Osteosarcoma can be from post therapeutic radiation, t/f

A

true

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15
Q

What type of malignant bone tumor is extremely vascular?

A

Telangiectatic

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16
Q

What type of tumor can become an ostoesarcoma?

A

Dedifferentiated chondrosarcoma

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17
Q

What osteosarcoma originates in the soft tissue attached to the bone?

A

Extraskeletal Osteosarcoma

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19
Q

What is a tumor of the cortical bone?

A

Chondroma, and it is a common benign

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20
Q

What is a benign bone tumor that is inside the bone?

A

Enchondroma

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21
Q

Is osteochondroma benign or malignant?

A

Benign

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22
Q

What is a fibromyxoid chondroma?

A

Tumor made of fibrous mucus cartilage

  • Dominant content is cartilage
  • Loves the TIBIA - rare to be anywhere else

BENIGN

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23
Q

What is a chondroblastoma?

A

High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone

BENIGN**

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24
Q

What are the 3 Malignant cartilage Tumors?

A
  • Primary Chondrosarcoma
  • Secondary Chondrosarcoma
  • Clear cell chondrosarcoma
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25
Q

What is primary chondrosarcoma?

A

Didn’t require anything else for it to be there, it originates by itself

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26
Q

What is secondary chondrosarcoma?

A

From a preexisting benign tumor that malignantly degenerate - can be multiple

  • Central secondary chondrosarcoma - From ENCHONDROMA, central is inside the bone in medullary cavity or cortex
  • Peripheral - OSTEOCHONDROMA - located external to the bone, looks like a trunk/stalk of broccoli coming off
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27
Q

Malignant bone tumr =

A

Osteosarcoma

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28
Q

Peripheral secondary chondrosarcoma comes from _____ ?

A

Osteochondroma

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29
Q

What is clear cell chondrosarcoma?

A

Usually near a joint, mistaken for chondroblastoma

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30
Q

What is one of the more common bone tumors?

A

Giant cell tumor of bone/osteoclastoma

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31
Q

What are the characteristics of Giant cell tumor?

A
  • Classically expansile soap bubble lesion
  • about 1 in 5 are malignant
  • “Quasi - malignant” can go either way - 80% malignant
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32
Q

Where do giant cell tumors most likey occur?

A

At the knee (HURT)

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35
Q

Ewings Sarcoma is in what category?

A

Marrow tumor (round cell tumor)

  • Classically gives laminated periosteal reaction
  • moth eaten appearance
  • big tubular bone in young children
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36
Q

What is the most common primary bone malignancy in first decade (peak in teenagers)?

A

EWINGS SARCOMA

  • dont confuse Leukemia, which is the most common malignancy in the first decade
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37
Q

What category is Non-Hodgkin Lymphoma under? (NHL)

A

Marrow tumor (round cell tumor: malignant)

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38
Q

What is the most common primary bone malignancy?

A

_Multiple Myeloma**** TEST_

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39
Q

Where would you see true punched out lesions?

A

Multiple Myeloma

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40
Q

Explain Myelomatosis:

A

Form of multiple myeloma:

  • Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
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41
Q

What will plasmacytoma have?

A

Geographic soap bubble lesion

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42
Q

What is “extra osseous” ?

A

Branch of multiple myeloma

  • Mass in nasal pharynx (difficulty breathing), very uncommon
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43
Q

What is under the Benign Vascular and Connective Tissue tumor?

A

Hemangioma - produces localized coarsening of the trabecular pattern

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44
Q

What is the “Malignant vascular tumor?’

A

Fibrosarcoma

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45
Q

What is the notochord remnant tumor?

A

Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint

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50
Q

What are the key points of osteolytic mets?

A
  • Destroys by physical bulk and restricting osteoblasts
  • 80% of metastasis found in spine, ribs and pelvis with another 10% found in cranium
  • Rarely go beyond the elbow and knee
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51
Q

What accelerates osteoblasts?

A

Osteoblastic mets

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52
Q

Pic of mixed mets

A
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53
Q

What are 2 of the most common benign bone tumors?

A

Chondroma and Solitary Osteochondroma - asymptomatic

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54
Q

How can tumors be classified?

A
  • They can be classified by location of where they originate - most often from the metaphysis
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56
Q

What are the top “Malignant Tumors” ?

A

MOCEF - top 5 primary malignant

  1. Multiple Myeloma: Over 40
  2. Osteosarcoma: under 30
  3. Chondrosarcoma: 40 - 60
  4. Ewing’s: Under 40
  5. Fibrosarcoma: 30 - 60
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64
Q

Central secondary chondrosarcoma comes from _____

A

Enchondroma

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70
Q

Marrow tumors, aka:

A

round cell tumors

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71
Q

What is the common theme with marrow tumors (round cell tumors)?

A

_Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE ******_

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83
Q

What are secondary tumors?

A

Metastatic tumors in bone

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84
Q

Vast majority of secondary tumors are _____

A

Hematogenous

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85
Q

Osteolytic mets is a _____

A

secondary tumor

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86
Q

What has 75% occurence %, osteolytic mets or osteoblastic mets?

A

Osteolytic

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90
Q

What is in the “Tumor Like” category?

A
  • Not exhaustive list
  • Fibrous dysplasia - as common as Paget’s
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92
Q

If a tumor is most likely benign, what will it’s characteristics be?

A
  • Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)

KNOW THIS***

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94
Q

Primary Bone Tumors:

A
  • Bone Forming Tumors
  • Cartilage Forming Tumors
  • Giant Cell Tumor of Bone/Osteoclastoma
  • Marrow Tumors (Round Cell Tumors)
  • Vascular and Connective Tissue Tumors
  • Notochord Remnant Tumor
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95
Q

What are the Bone forming primary bone tumors?

A
  • Benign
    • Osteoma
    • Osteoid Osteoma
    • Osteoblastoma
  • Malignant - Osteosarcomas
    • Conventional Osteosarcoma
      • 72% central
      • 75% sclerotic
      • 25% lytic
    • Parosteal Os 4%
    • Periosteal Os 1%
    • Multifocal Os/osteosarcomatosis 1%
    • Osteosarcoma of Jaw - 6%
    • Post Radiation Os - 4%
    • Os in Paget’s disease - 3%
    • Os Degeneration from benign condition - 1%
    • Telangiectatic Os - 3%
    • Dedifferentiated Chondrosarcoma - 3%
    • Extraskeletal Os. < 1%
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96
Q

What are the Benign Cartilage Forming Tumors?

A
  • Benign
    • Chodnroma/Enchondroma
    • Solitary Osteochondroma
    • Chondromyxoid Fibroma/Fibromyxoid Chondroma
    • Chondroblastoma
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97
Q

What are the malignant Cartilage forming tumors?

A

Malignant

  • Primary Chondrosarcoma - arise de novo
  • Secondary Chondrosarcoma - from preexisting benign tumor
    • Central - From enchondroma
    • Peripheral - From Osteochondroma
  • Clear cell chondrosarcoma - mistaken form chondroblastoma, low grade
  • Extra Skeletal - Rare
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98
Q

What are the marrow tumors (round cell tumors?)

A
  • Ewing’s Sarcoma
  • NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
  • Multiple Myeloma
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99
Q

What are the branches of multiple myeloma?

A
  • Classical MM
  • Myelomatosis
  • Plasmacytoma
  • Extra Osseous MM
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100
Q

Vascular and Connective Tissue tumors are in what category, what are their subcategories?

A

It is in the category of “primary bone tumor”

  • Benign - Hemangioma
  • Malignant - Fibrosarcoma
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101
Q

Metastatic Tumors in bone - most common skeletal malginancy

A
  • Osteolytic Mets
  • Osteoblastic Mets
  • Mixed Mets
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102
Q

Tumor Like Conditions:

A

PRIMARY BONE TUMORS

  • Solitary bone cyst/Unicameral bone cyst
  • Aneurysmal bone cyst
  • Fibrous Cortical defect and nonossifying fibroma
  • Fibrous Dysplasia
  • Brown Tumor of hyperparathyroidism
  • Pseudotumors of Hemophilia
  • Large Arthritic Cysts/Geode
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103
Q

If it’s a benign tumor they overwhelmingly originate when?

A

Before the Age of 30

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104
Q

If a tumor is asymptomatic and benign, it may not show till ____

A

age 50

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105
Q

When does Giant cell tumor usually occur?

A

20-40 this is an exception

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106
Q

Metastisis happens how?

A

Through Vascular system

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107
Q

Big 6 strongest potential to spread?

A
  1. Breast - females 70%
  2. Lung - 25%
  3. Prostate - Males 60%
  4. Kidney
  5. Ewing’s
  6. Neuroblastoma

*** Breast, lung, prostate, and kidney account for 80%

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108
Q

Where does lytic Mets come from?

A

Physical bulk - pressure from the tumor taking up space which impedes the osteoblasts

  • More common (75% of metastasis destroys)
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109
Q

Approximately 80% of all osseous metastases will be found _____

A

In the axial skeleton

  • 28% ribs
  • 39% vertebra
  • 13% bony pelvis

10 % of skeletal metastasis will be found in the cranium

10% extremities

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110
Q

Is Enostosis primary or secondary bone tumor?

A

Primary

AKA BONE ISLAND

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111
Q

What is enostosis classified as?

A

Tumorlike, usually an incidental finding, and is asymptomatic

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112
Q

What are the characteristics of Enostosis?

A
  • Rare in children
  • Osteosclerotic bone lesion
  • Can be considered a hamartoma (benign tumor that is multicellular and has all the cells of the host tissue)
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113
Q

Where is the location of Enostosis?

A

Intramedullary Location - usually up against inner surface of cortex

  • Composed of normal appearing compact lamellar bone with haversian canals
  • Blends with surround trabecular bone creating irregular margin
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114
Q

What is the radiological appearance of Enostosis

A
  • Round to oval (.2 - 2 cm) osteoblastic area
  • Epiphyseal or metaphyseal
  • Bone scan NORMAL

95 % no need for further radiologic evaluation

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115
Q

WHat is the differential diagnosis for Enostosis?

A

Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma

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116
Q

Osteoblastic mets ____

A

HURTS

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117
Q

low grade osteosarcoma is ____

A

PAINFUL

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118
Q

When would you take a biopsy of Enostosis?

A

Increase in size of 25% in 6 months

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119
Q

Bony pelivs is a common site to see ____

A

enostosis

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120
Q

Giant bone island is a _____

A

Enostosis that is > 2-3 cm in size

More likely to have increased activity on bone scan

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121
Q

What are the possible diseases related to Enostosis?

A
  • Osteopoikilosis
  • Osteopathia Striata
  • Melorheostosis
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122
Q

Osteopoikilosis =

A

Periarticular bone islands

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123
Q

Osteopathia Striata =

A

Lesions are more elongated in periarticular pattern, Vooerheve disease, fan-like bands in flat bones

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124
Q

What are the 3 common characteristics of Melorheostosis?

A
  • Osteosclerotic bone disorder
  • Often symptomatic (pain, decreased ROM, contractures, limb swelling, bowing)
  • Scleroderma - like skin lesions over osseous changes
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125
Q

What is the radiology of Melorheostosis?

A

o Osseous excrescences often exuberant and lobulated along bone surface

o Single limb—more common lower extremity

o Also endosteal involvement may extend into marrow space

o Intense activity on bone scan

o Long drippy bone island

​

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126
Q

Benign Bone forming:

A

OSTEOMA

OSTEOID OSTEOMA

OSTEOBLASTOMA

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127
Q

Osteoma aka:

A

Ivory Exostosis

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128
Q

What is a benign, slow growing hamartomatous lesion composed of well differentiated mature bone?

A

Osteoma

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129
Q

What is the defect in Osteoma?

A

One resorption or formation during skeletal maturation

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130
Q

What does osteoma arises beneath?

A

Endosteum from inner surface of cortex

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131
Q

What causes surrounding reactive bone formation in Osteomas?

A

Elevation of periosteum from underlying bone

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132
Q

Osteoma is a bone of _____

A

Intramembranous origin

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133
Q

Extracranial Osteoms -

A

.03% of bone biopsied primary bone lesions

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134
Q

Paranasal sinus osteomas -

A

.4%

Most have a osteosclerotic lesion in a frontal or ethmoid lesion

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135
Q

What are the associated abnormailities with Osteoma?

A
  • Gardner’s Syndrome
  • Mutation of Adenmatous Polyposis Coli Gene (5q21)
  • Multiple osteomas, intestinal polypsos, soft tissue desmoid tumors
  • Bone lesions may precede intestinal polyposis
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136
Q

Describe Gardner’s Syndrome in Osteoma:

A
  • Autosomal Dominant
    • Syndrome of hamartomatous tumors in different locations
    • One of the key findings - osteomas
    • Will develop color cancer (precursor to colon cancer)
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137
Q

In osteoma, most just have ____

A

single solitary osteoma

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138
Q

What are the clinical issues associated with Osteoma?

A
  • Small lesions usually asymptomatic
  • Project away from cortical surface
  • Palpable enlarging osseous mass
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139
Q

What is the nasal issue with Osteoma?

A
  • Large oseomain paranasal sinus may obstruct nasal ducts
    • Can erode wall of cranial fossa and dura
    • Can cause mucocele, sinusitis, headache, pain
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140
Q

What can osteoma tumors near orbit cause?

A

Cause exopthalmosis, double vision, vision loss

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141
Q

What about the Hx of Osteoma:

A
  • Found before 30 but can be seen anytime
  • EQUAL GENDER
  • No malginant potential
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142
Q

What looks identical to bone island but has different location?

A

Osteoma

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143
Q

What does Osteoma look like radiographically?

(first 3)

A
  • Well defined round dense sclerotic lesion attach to underlying bone
  • Vast majority in frontal and ethmoid sinus
  • DENSE ivory like sclerotic mass
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144
Q

What does Osteoma look like radiographically?

(last 3)

A
  • No satellite lesions
  • Low signal on MRI
  • Plain film is good to see them
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145
Q

OSTEOID OSTEOMA: main characteristics

A
  • Painful!
  • Produce dense periosteal reaction
  • Can regress spontaneously - infarction
  • Local swelling and point tenderness
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146
Q

What is Osteoid Osteoma characterized by?

A

Nidus less than 1 cm of osteoid/woven bone is vascular tissue surrounded by zone of reactive sclerosis

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147
Q

What is elevated in Osteoid Osteoma?

A

Prostaglandin E2 elevated 100-1000 times within Nidus (pain and vasodilation)

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148
Q

Describe the nidus in Osteoid osteoma:

A

Radiolucent and is the actual tumor

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149
Q

Pain is worse at night with what tumor?

A

Osteoid Osteoma

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150
Q

Whats the origin of Osteoid Osteoma?

A

Unknown, inflammatory, traumatic, vascular, viral

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151
Q

What is a distinguishing characteristic of Osteoid Osteoma?

A

These can produce a painful scoliosis, and they happen in the spine (lean into a legion)

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152
Q

Osteoid Osteoma is more common in ______

A

males 2-3:1

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153
Q

What are the first 4 radiological features of Osteoid Osteoma?

A
  • Long bones are common
  • Metaphysis/Diaphysis
  • Phalanges of hands and feet
  • Spine (10%)
    • Posterior Elements 90% - posterior arch lamina
    • Vertebral body 10%
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154
Q

What are the last 5-6 radiological features of osteoid osteoma?

A
  • Cortical: 70-80%
    • Radiolucent Nidus < 1.5 cm with surrounding dense sclerosis
    • Periosteal reaction may be present
  • Medullary: 25%
  • CT - well defined, round oval nidus surrounded by sclerosis
  • MRI - T1 WI nidus isointense to muscle
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155
Q

What does osteoid osteoma look like on bone scan?

A

lights up

(will have a solid dense periosteal reaction)

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156
Q

OSTEOBLASTOMA aka:

A

Giant osteoid osteoma, osteogenic fibroma

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157
Q

What is Osteoblastoma characterized by?

A
  • Production of osteoid and woven bone
  • Lesion > 1.5 cm
  • Histology similar to osteoid osteoma
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158
Q

What are the %’s associated with Osteoblastoma?

A

< 1% of primary bone tumors

3% benign bone tumor

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159
Q

Describe Osteoblastoma:

A
  • Circumscribed mass, often surrounded by shell of cortical bone or periosteum
  • Sharp interphase between lesion and cancellous bone
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160
Q

What does the nidus look like in Osteoblastoma?

A
  • 2-10 cm, friable, deep red (highly vascular)
  • Very vascular connective tissue stroma with interconnecting trabecular bone
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161
Q

What are the symptoms of osteoblastoma?

A
  • Dull, localized pain of insidious onset
  • Pain rarely interferes with sleep
  • Localized swelling, tenderness, and decreased ROM
  • Doesnt respond well to aspirin
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162
Q

Osteoblastoma originates ____

A

under 30

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163
Q

Osteoblastoma gender pref.

A

2-3:1 in males

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164
Q

WHat can Ostoeblastoma have?

A

Foci of aggressive stage 3 lesion (prone to aneurysmal bone cysts formation)

RECURRENCE AFTER resection = 10-25%

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165
Q

In aggressive osteoblastoma, the recurrence is ____ %

A

50

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166
Q

First 4 things of Osteoblastoma (radiology):

A
  • 30-50% SPINAL
    • Posterior elements –> 60% spinous, transverse process, pedicle
    • Posterior elements with extension into vertebral body 25%
    • Vertebral body 15%
  • Long bones, 30% originate in metaphysis
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167
Q

What are the 5-8 radiographic features of Osteoblastoma?

A
  • Hands and feet 15%
  • Skull and Jaw 15%
  • Pelvis 5%
  • Expansile, lytic circumscribed lesion
  • Reactive sclerosis 60%
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168
Q

Last radiologic features of Osteoblastoma:

A
  • CAN rapidly increase in size
  • Secondary aneurysmal bone cyst (ABC): 16% can look exactly the same
  • NECT: Expansile, lytic lesion with or without matrix mineralization
    • Can be purely radiolucent inside, speckled (inside matrix), or sclerotic looking

KEY IS EXPANSION

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169
Q

MALIGNANT PRIMARY BONE TUMORS:

A

Osteosarcoma, aka Osteogenic Osteosarcoma

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170
Q

What is the main definition of Osteosarcoma?

A

Malignant tumor with ability to produce osteoid directly from neoplastic cells

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171
Q

Talk about the growth rate of Osteosarcoma:

A

Frequency of tumor occurence corresponds to greatest growth rate during adolescence

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172
Q

What is chemically happening in osteosarcoma?

A

Overexpression of P-glycogen in OGS cells with propensity for metastasis and rx failure

alteration in Rb genes in OGS

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173
Q

Think of osteosarcoma as ____

A

osteoblastic malignant tumor

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174
Q

Periosteal reaction of osteosarcoma =

A

Spiculated

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175
Q

2nd primary bone tumor is ____

A

Osteosarcoma (MOCEF)

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176
Q

When does osteosarcoma peak?

A

teens

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177
Q

Where is the most common location for osteosarcoma?

A

Distal femoral metaphysis

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178
Q

Osteosarcomatosis survival:

A

Change low

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179
Q

Where will osteosarcoma metastasize to?

A

LUNG

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180
Q

Osteosarcoma has a majority of unknown origin, primary, but secondary to predisposing factors are:

A
  • Paget’s Disease (4th stage)
  • Bone infarction
  • Radiation
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181
Q

What is the most common malignant primary bone tumor in young adults and children?

A

Osteosarcoma

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182
Q

What are common sites of neoplasms?

A

FEMUR, pelvis, humerus

(UNCOMMON in spine)

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183
Q

Osteosarcom neoplasm %

A

50-55%

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184
Q

Fibrosarcoma neoplasm %

A

20-25%

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185
Q

Chondrosarcoma neoplasm %

A

10%

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186
Q

What is a neoplasm?

A

Abnormal cellular growth that can be benign or malignant

  • Malignant: Ability to metastasize/spread
  • Benign: Does not metastasize, but this does not mean insignificant
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187
Q

Any cell found in bone can produce ______

A

a tumor

* Subdivided by what type of cell it comes from

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188
Q

If a tumor originates in bone it is called a _____

A

primary bone tumor

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189
Q

What is a secondary bone tumor basic definition?

A

Starts somewhere else and metastasizes to bone

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190
Q

What is a tumor like lesion?

A

Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency

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191
Q

Primary bone tumors, benign category:

A
  1. Osteoma - MOST COMMON, intramembranous bone tumor, dont hurt
  2. Osteoid Osteoma - not as common, HURT
  3. Osteoblastoma - RARE, but half occur in spine
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193
Q

Describe conventional osteosarcomas:

A

Most of these are central sclerotic (about 75%) originate from inside the bone and loves the distal femoral metaphysis

  • 72% (over 2/3 of all osteosarcomas)
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194
Q

What is multifocal Osteosarcomatosis?

A

Most often in children in first decade, nearly always fatal

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195
Q

Osteosarcoma can be from post therapeutic radiation, t/f

A

true

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196
Q

What type of malignant bone tumor is extremely vascular?

A

Telangiectatic

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197
Q

What type of tumor can become an ostoesarcoma?

A

Dedifferentiated chondrosarcoma

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198
Q

What osteosarcoma originates in the soft tissue attached to the bone?

A

Extraskeletal Osteosarcoma

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200
Q

What is a tumor of the cortical bone?

A

Chondroma, and it is a common benign

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201
Q

What is a benign bone tumor that is inside the bone?

A

Enchondroma

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202
Q

Is osteochondroma benign or malignant?

A

Benign

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203
Q

What is a fibromyxoid chondroma?

A

Tumor made of fibrous mucus cartilage

  • Dominant content is cartilage
  • Loves the TIBIA - rare to be anywhere else

BENIGN

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204
Q

What is a chondroblastoma?

A

High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone

BENIGN**

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205
Q

What are the 3 Malignant cartilage Tumors?

A
  • Primary Chondrosarcoma
  • Secondary Chondrosarcoma
  • Clear cell chondrosarcoma
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206
Q

What is primary chondrosarcoma?

A

Didn’t require anything else for it to be there, it originates by itself

207
Q

What is secondary chondrosarcoma?

A

From a preexisting benign tumor that malignantly degenerate - can be multiple

  • Central secondary chondrosarcoma - From ENCHONDROMA, central is inside the bone in medullary cavity or cortex
  • Peripheral - OSTEOCHONDROMA - located external to the bone, looks like a trunk/stalk of broccoli coming off
208
Q

Malignant bone tumr =

A

Osteosarcoma

209
Q

Peripheral secondary chondrosarcoma comes from _____ ?

A

Osteochondroma

210
Q

What is clear cell chondrosarcoma?

A

Usually near a joint, mistaken for chondroblastoma

211
Q

What is one of the more common bone tumors?

A

Giant cell tumor of bone/osteoclastoma

212
Q

What are the characteristics of Giant cell tumor?

A
  • Classically expansile soap bubble lesion
  • about 1 in 5 are malignant
  • “Quasi - malignant” can go either way - 80% malignant
213
Q

Where do giant cell tumors most likey occur?

A

At the knee (HURT)

216
Q

Ewings Sarcoma is in what category?

A

Marrow tumor (round cell tumor)

  • Classically gives laminated periosteal reaction
  • moth eaten appearance
  • big tubular bone in young children
217
Q

What is the most common primary bone malignancy in first decade (peak in teenagers)?

A

EWINGS SARCOMA

  • dont confuse Leukemia, which is the most common malignancy in the first decade
218
Q

What category is Non-Hodgkin Lymphoma under? (NHL)

A

Marrow tumor (round cell tumor: malignant)

219
Q

What is the most common primary bone malignancy?

A

_Multiple Myeloma**** TEST_

220
Q

Where would you see true punched out lesions?

A

Multiple Myeloma

221
Q

Explain Myelomatosis:

A

Form of multiple myeloma:

  • Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
222
Q

What will plasmacytoma have?

A

Geographic soap bubble lesion

223
Q

What is “extra osseous” ?

A

Branch of multiple myeloma

  • Mass in nasal pharynx (difficulty breathing), very uncommon
224
Q

What is under the Benign Vascular and Connective Tissue tumor?

A

Hemangioma - produces localized coarsening of the trabecular pattern

225
Q

What is the “Malignant vascular tumor?’

A

Fibrosarcoma

226
Q

What is the notochord remnant tumor?

A

Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint

231
Q

What are the key points of osteolytic mets?

A
  • Destroys by physical bulk and restricting osteoblasts
  • 80% of metastasis found in spine, ribs and pelvis with another 10% found in cranium
  • Rarely go beyond the elbow and knee
232
Q

What accelerates osteoblasts?

A

Osteoblastic mets

233
Q

Pic of mixed mets

234
Q

What are 2 of the most common benign bone tumors?

A

Chondroma and Solitary Osteochondroma - asymptomatic

235
Q

How can tumors be classified?

A
  • They can be classified by location of where they originate - most often from the metaphysis
237
Q

What are the top “Malignant Tumors” ?

A

MOCEF - top 5 primary malignant

  1. Multiple Myeloma: Over 40
  2. Osteosarcoma: under 30
  3. Chondrosarcoma: 40 - 60
  4. Ewing’s: Under 40
  5. Fibrosarcoma: 30 - 60
245
Q

Central secondary chondrosarcoma comes from _____

A

Enchondroma

251
Q

Marrow tumors, aka:

A

round cell tumors

252
Q

What is the common theme with marrow tumors (round cell tumors)?

A

_Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE ******_

264
Q

What are secondary tumors?

A

Metastatic tumors in bone

265
Q

Vast majority of secondary tumors are _____

A

Hematogenous

266
Q

Osteolytic mets is a _____

A

secondary tumor

267
Q

What has 75% occurence %, osteolytic mets or osteoblastic mets?

A

Osteolytic

271
Q

What is in the “Tumor Like” category?

A
  • Not exhaustive list
  • Fibrous dysplasia - as common as Paget’s
273
Q

If a tumor is most likely benign, what will it’s characteristics be?

A
  • Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)

KNOW THIS***

275
Q

Primary Bone Tumors:

A
  • Bone Forming Tumors
  • Cartilage Forming Tumors
  • Giant Cell Tumor of Bone/Osteoclastoma
  • Marrow Tumors (Round Cell Tumors)
  • Vascular and Connective Tissue Tumors
  • Notochord Remnant Tumor
276
Q

What are the Bone forming primary bone tumors?

A
  • Benign
    • Osteoma
    • Osteoid Osteoma
    • Osteoblastoma
  • Malignant - Osteosarcomas
    • Conventional Osteosarcoma
      • 72% central
      • 75% sclerotic
      • 25% lytic
    • Parosteal Os 4%
    • Periosteal Os 1%
    • Multifocal Os/osteosarcomatosis 1%
    • Osteosarcoma of Jaw - 6%
    • Post Radiation Os - 4%
    • Os in Paget’s disease - 3%
    • Os Degeneration from benign condition - 1%
    • Telangiectatic Os - 3%
    • Dedifferentiated Chondrosarcoma - 3%
    • Extraskeletal Os. < 1%
277
Q

What are the Benign Cartilage Forming Tumors?

A
  • Benign
    • Chodnroma/Enchondroma
    • Solitary Osteochondroma
    • Chondromyxoid Fibroma/Fibromyxoid Chondroma
    • Chondroblastoma
278
Q

What are the malignant Cartilage forming tumors?

A

Malignant

  • Primary Chondrosarcoma - arise de novo
  • Secondary Chondrosarcoma - from preexisting benign tumor
    • Central - From enchondroma
    • Peripheral - From Osteochondroma
  • Clear cell chondrosarcoma - mistaken form chondroblastoma, low grade
  • Extra Skeletal - Rare
279
Q

What are the marrow tumors (round cell tumors?)

A
  • Ewing’s Sarcoma
  • NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
  • Multiple Myeloma
280
Q

What are the branches of multiple myeloma?

A
  • Classical MM
  • Myelomatosis
  • Plasmacytoma
  • Extra Osseous MM
281
Q

Vascular and Connective Tissue tumors are in what category, what are their subcategories?

A

It is in the category of “primary bone tumor”

  • Benign - Hemangioma
  • Malignant - Fibrosarcoma
282
Q

Metastatic Tumors in bone - most common skeletal malginancy

A
  • Osteolytic Mets
  • Osteoblastic Mets
  • Mixed Mets
283
Q

Tumor Like Conditions:

A

PRIMARY BONE TUMORS

  • Solitary bone cyst/Unicameral bone cyst
  • Aneurysmal bone cyst
  • Fibrous Cortical defect and nonossifying fibroma
  • Fibrous Dysplasia
  • Brown Tumor of hyperparathyroidism
  • Pseudotumors of Hemophilia
  • Large Arthritic Cysts/Geode
284
Q

If it’s a benign tumor they overwhelmingly originate when?

A

Before the Age of 30

285
Q

If a tumor is asymptomatic and benign, it may not show till ____

286
Q

When does Giant cell tumor usually occur?

A

20-40 this is an exception

287
Q

Metastisis happens how?

A

Through Vascular system

288
Q

Big 6 strongest potential to spread?

A
  1. Breast - females 70%
  2. Lung - 25%
  3. Prostate - Males 60%
  4. Kidney
  5. Ewing’s
  6. Neuroblastoma

*** Breast, lung, prostate, and kidney account for 80%

289
Q

Where does lytic Mets come from?

A

Physical bulk - pressure from the tumor taking up space which impedes the osteoblasts

  • More common (75% of metastasis destroys)
290
Q

Approximately 80% of all osseous metastases will be found _____

A

In the axial skeleton

  • 28% ribs
  • 39% vertebra
  • 13% bony pelvis

10 % of skeletal metastasis will be found in the cranium

10% extremities

291
Q

Is Enostosis primary or secondary bone tumor?

A

Primary

AKA BONE ISLAND

292
Q

What is enostosis classified as?

A

Tumorlike, usually an incidental finding, and is asymptomatic

293
Q

What are the characteristics of Enostosis?

A
  • Rare in children
  • Osteosclerotic bone lesion
  • Can be considered a hamartoma (benign tumor that is multicellular and has all the cells of the host tissue)
294
Q

Where is the location of Enostosis?

A

Intramedullary Location - usually up against inner surface of cortex

  • Composed of normal appearing compact lamellar bone with haversian canals
  • Blends with surround trabecular bone creating irregular margin
295
Q

What is the radiological appearance of Enostosis

A
  • Round to oval (.2 - 2 cm) osteoblastic area
  • Epiphyseal or metaphyseal
  • Bone scan NORMAL

95 % no need for further radiologic evaluation

296
Q

WHat is the differential diagnosis for Enostosis?

A

Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma

297
Q

Osteoblastic mets ____

298
Q

low grade osteosarcoma is ____

299
Q

When would you take a biopsy of Enostosis?

A

Increase in size of 25% in 6 months

300
Q

Bony pelivs is a common site to see ____

301
Q

Giant bone island is a _____

A

Enostosis that is > 2-3 cm in size

More likely to have increased activity on bone scan

302
Q

What are the possible diseases related to Enostosis?

A
  • Osteopoikilosis
  • Osteopathia Striata
  • Melorheostosis
303
Q

Osteopoikilosis =

A

Periarticular bone islands

304
Q

Osteopathia Striata =

A

Lesions are more elongated in periarticular pattern, Vooerheve disease, fan-like bands in flat bones

305
Q

What are the 3 common characteristics of Melorheostosis?

A
  • Osteosclerotic bone disorder
  • Often symptomatic (pain, decreased ROM, contractures, limb swelling, bowing)
  • Scleroderma - like skin lesions over osseous changes
306
Q

What is the radiology of Melorheostosis?

A

o Osseous excrescences often exuberant and lobulated along bone surface

o Single limb—more common lower extremity

o Also endosteal involvement may extend into marrow space

o Intense activity on bone scan

o Long drippy bone island

​

307
Q

Benign Bone forming:

A

OSTEOMA

OSTEOID OSTEOMA

OSTEOBLASTOMA

308
Q

Osteoma aka:

A

Ivory Exostosis

309
Q

What is a benign, slow growing hamartomatous lesion composed of well differentiated mature bone?

310
Q

What is the defect in Osteoma?

A

One resorption or formation during skeletal maturation

311
Q

What does osteoma arises beneath?

A

Endosteum from inner surface of cortex

312
Q

What causes surrounding reactive bone formation in Osteomas?

A

Elevation of periosteum from underlying bone

313
Q

Osteoma is a bone of _____

A

Intramembranous origin

314
Q

Extracranial Osteoms -

A

.03% of bone biopsied primary bone lesions

315
Q

Paranasal sinus osteomas -

A

.4%

Most have a osteosclerotic lesion in a frontal or ethmoid lesion

316
Q

What are the associated abnormailities with Osteoma?

A
  • Gardner’s Syndrome
  • Mutation of Adenmatous Polyposis Coli Gene (5q21)
  • Multiple osteomas, intestinal polypsos, soft tissue desmoid tumors
  • Bone lesions may precede intestinal polyposis
317
Q

Describe Gardner’s Syndrome in Osteoma:

A
  • Autosomal Dominant
    • Syndrome of hamartomatous tumors in different locations
    • One of the key findings - osteomas
    • Will develop color cancer (precursor to colon cancer)
318
Q

In osteoma, most just have ____

A

single solitary osteoma

319
Q

What are the clinical issues associated with Osteoma?

A
  • Small lesions usually asymptomatic
  • Project away from cortical surface
  • Palpable enlarging osseous mass
320
Q

What is the nasal issue with Osteoma?

A
  • Large oseomain paranasal sinus may obstruct nasal ducts
    • Can erode wall of cranial fossa and dura
    • Can cause mucocele, sinusitis, headache, pain
321
Q

What can osteoma tumors near orbit cause?

A

Cause exopthalmosis, double vision, vision loss

322
Q

What about the Hx of Osteoma:

A
  • Found before 30 but can be seen anytime
  • EQUAL GENDER
  • No malginant potential
323
Q

What looks identical to bone island but has different location?

324
Q

What does Osteoma look like radiographically?

(first 3)

A
  • Well defined round dense sclerotic lesion attach to underlying bone
  • Vast majority in frontal and ethmoid sinus
  • DENSE ivory like sclerotic mass
325
Q

What does Osteoma look like radiographically?

(last 3)

A
  • No satellite lesions
  • Low signal on MRI
  • Plain film is good to see them
326
Q

OSTEOID OSTEOMA: main characteristics

A
  • Painful!
  • Produce dense periosteal reaction
  • Can regress spontaneously - infarction
  • Local swelling and point tenderness
327
Q

What is Osteoid Osteoma characterized by?

A

Nidus less than 1 cm of osteoid/woven bone is vascular tissue surrounded by zone of reactive sclerosis

328
Q

What is elevated in Osteoid Osteoma?

A

Prostaglandin E2 elevated 100-1000 times within Nidus (pain and vasodilation)

329
Q

Describe the nidus in Osteoid osteoma:

A

Radiolucent and is the actual tumor

330
Q

Pain is worse at night with what tumor?

A

Osteoid Osteoma

331
Q

Whats the origin of Osteoid Osteoma?

A

Unknown, inflammatory, traumatic, vascular, viral

332
Q

What is a distinguishing characteristic of Osteoid Osteoma?

A

These can produce a painful scoliosis, and they happen in the spine (lean into a legion)

333
Q

Osteoid Osteoma is more common in ______

A

males 2-3:1

334
Q

What are the first 4 radiological features of Osteoid Osteoma?

A
  • Long bones are common
  • Metaphysis/Diaphysis
  • Phalanges of hands and feet
  • Spine (10%)
    • Posterior Elements 90% - posterior arch lamina
    • Vertebral body 10%
335
Q

What are the last 5-6 radiological features of osteoid osteoma?

A
  • Cortical: 70-80%
    • Radiolucent Nidus < 1.5 cm with surrounding dense sclerosis
    • Periosteal reaction may be present
  • Medullary: 25%
  • CT - well defined, round oval nidus surrounded by sclerosis
  • MRI - T1 WI nidus isointense to muscle
336
Q

What does osteoid osteoma look like on bone scan?

A

lights up

(will have a solid dense periosteal reaction)

337
Q

OSTEOBLASTOMA aka:

A

Giant osteoid osteoma, osteogenic fibroma

338
Q

What is Osteoblastoma characterized by?

A
  • Production of osteoid and woven bone
  • Lesion > 1.5 cm
  • Histology similar to osteoid osteoma
339
Q

What are the %’s associated with Osteoblastoma?

A

< 1% of primary bone tumors

3% benign bone tumor

340
Q

Describe Osteoblastoma:

A
  • Circumscribed mass, often surrounded by shell of cortical bone or periosteum
  • Sharp interphase between lesion and cancellous bone
341
Q

What does the nidus look like in Osteoblastoma?

A
  • 2-10 cm, friable, deep red (highly vascular)
  • Very vascular connective tissue stroma with interconnecting trabecular bone
342
Q

What are the symptoms of osteoblastoma?

A
  • Dull, localized pain of insidious onset
  • Pain rarely interferes with sleep
  • Localized swelling, tenderness, and decreased ROM
  • Doesnt respond well to aspirin
343
Q

Osteoblastoma originates ____

344
Q

Osteoblastoma gender pref.

A

2-3:1 in males

345
Q

WHat can Ostoeblastoma have?

A

Foci of aggressive stage 3 lesion (prone to aneurysmal bone cysts formation)

RECURRENCE AFTER resection = 10-25%

346
Q

In aggressive osteoblastoma, the recurrence is ____ %

347
Q

First 4 things of Osteoblastoma (radiology):

A
  • 30-50% SPINAL
    • Posterior elements –> 60% spinous, transverse process, pedicle
    • Posterior elements with extension into vertebral body 25%
    • Vertebral body 15%
  • Long bones, 30% originate in metaphysis
348
Q

What are the 5-8 radiographic features of Osteoblastoma?

A
  • Hands and feet 15%
  • Skull and Jaw 15%
  • Pelvis 5%
  • Expansile, lytic circumscribed lesion
  • Reactive sclerosis 60%
349
Q

Last radiologic features of Osteoblastoma:

A
  • CAN rapidly increase in size
  • Secondary aneurysmal bone cyst (ABC): 16% can look exactly the same
  • NECT: Expansile, lytic lesion with or without matrix mineralization
    • Can be purely radiolucent inside, speckled (inside matrix), or sclerotic looking

KEY IS EXPANSION

350
Q

MALIGNANT PRIMARY BONE TUMORS:

A

Osteosarcoma, aka Osteogenic Osteosarcoma

351
Q

What is the main definition of Osteosarcoma?

A

Malignant tumor with ability to produce osteoid directly from neoplastic cells

352
Q

Talk about the growth rate of Osteosarcoma:

A

Frequency of tumor occurence corresponds to greatest growth rate during adolescence

353
Q

What is chemically happening in osteosarcoma?

A

Overexpression of P-glycogen in OGS cells with propensity for metastasis and rx failure

alteration in Rb genes in OGS

354
Q

Think of osteosarcoma as ____

A

osteoblastic malignant tumor

355
Q

Periosteal reaction of osteosarcoma =

A

Spiculated

356
Q

2nd primary bone tumor is ____

A

Osteosarcoma (MOCEF)

357
Q

When does osteosarcoma peak?

358
Q

Where is the most common location for osteosarcoma?

A

Distal femoral metaphysis

359
Q

Osteosarcomatosis survival:

A

Change low

360
Q

Where will osteosarcoma metastasize to?

361
Q

Osteosarcoma has a majority of unknown origin, primary, but secondary to predisposing factors are:

A
  • Paget’s Disease (4th stage)
  • Bone infarction
  • Radiation
362
Q

What is the most common malignant primary bone tumor in young adults and children?

A

Osteosarcoma

363
Q

20% of primary bone malignancies describes what?

A

Osteosarcoma

364
Q

What is a heterogenous mass with ossified and non ossified components?

A

Osteosarcoma

365
Q

What are the common symptoms of Osteosarcoma?

A

Progressive pain, soft tissue mass, swelling, pathological fracture

366
Q

What happens with the cortex during Osteosarcoma?

A

Penetration of the cortex with often large extraosseous tumor mass

367
Q

What is common with Osteosarcoma in regards to spreading?

A

Pulmonary mets is common

(like the lungs!) = Pneumothorax

368
Q

What are you going to have an increase with in Osteosarcoma?

A

Serum Alkaline Phosphatase

369
Q

Describe the age in Osteosarcoma:

A
  • Age = Bimodal
    • First peak: 2-3 decade
    • Second peak: > 6th decade
370
Q

What is the gender in Osteosarcoma?

A

Gender = M:F

1.3-1.6 : 1

371
Q

What is the 5 year survival for Osteosarcoma?

372
Q

What is the 5 yr with respectable tumor and “No mets”?

373
Q

Where are you most likely going to see Osteosarcoma? (location)

A
  • Knee = 55%
  • Metaphyses of long tubular bones = 80%
  • Extension into epiphysis: 75%
  • Flat Bones, VB: 20%
  • In older pt (> 50 yrs) axial skeleton and flat bones: 40%
374
Q

What is the size of Osteosarcoma?

375
Q

What are some main characteristics of Conventional Osteosarcoma?

A
  • Poorly defined, intramedullary mass, extends through cortex
  • Moth eaten bone destruction
  • Aggressive P rxn.: Codman’s triangle, sunburst pattern
  • Indistinct border with wide ZOT
  • Soft tissue mass +/- tumor calcification
376
Q

What is described as “Telangiectatic Osteosarcoma?”

A
  • Purely lytic lesion
  • Cystic cavities filled with blood, necrosis
  • Fluid Levels
377
Q

Describe Multicentric Osteosarcoma:

A
  • Synchronous Osteoblastic Osteosarcoma at multiple sites
  • ONLY IN CHILDREN
  • HORRIBLE PROGNOSIS
378
Q

Describe Parosteal Osteosarcoma:

A
  • Low grade osteosarcoma in older age group (20-50)
  • Posterior Distal Femur
  • Attached to underlying cortex at origin
379
Q

Describe Periosteal Osteosarcoma:

A
  • Intermediate grade Osteosarcoma
  • Most common diaphyseal
  • No medullary involvement
  • CORTICAL THICKENING
380
Q

Describe Gnathic Osteosarcoma:

A
  • Involvement of mandible, maxilla
  • Sclerotic, lytic, mixed
  • Peri rxn
  • Soft tissue extension (pictured below)
381
Q

Describe Secondary Osteosarcoma:

A

Arises in pre-existing lesion of bone such as Paget disease, prior radiation, bone infarction, fibrous dysplasia, prosthesis, OI, chronic osteomyelitis, retinoblastoma

  • About half of osteosarcoma over age 50 are secondary, 67% over age 60
382
Q

What is helpful in imaging surface of OGS (Chondroblastic Osteosarcoma)?

383
Q

CECT (Contrast Enhanced C T) helps further identify what disease?

A

Osteosarcoma

384
Q

What would you see with Osteosarcoma on NucMed?

A

Increased uptake (staging, skip lesions, metastasis)

385
Q

Osteochondroma is ______

A

asymptomatic, common, and is also called “exostosis”

386
Q

What is osteochondroma?

A

Developmental osseous anomaly resulting in exophytic outgrowth on surface of bone (individuals are born with these)

387
Q

What is osteochondroma the result of?

A

Ectopic epiphyseal tissue (tissue in wrong place)

388
Q

What is the SINGLE MOST COMMON BENIGN BONE TUMOR?

A

Osteochondroma

389
Q

Describe the bony part of osteochondroma:

A

Bony part is an integral part of host bone - cortex of host is continuous with cortex of lesion and medullary cavity of host is continuous with medullary part of lesion

390
Q

What is Sessile Osteochondroma associated with?

A

Undertubulation of long bones (erlenmeyer flask deformity)

391
Q

Describe the exostosis in osteochondroma:

A

Bony part is stalk/base, cartilage cap is over the top in the soft tissue (only visible to the extent it is calcified)

392
Q

Benign cartilage tumors (enchondroma and osteochondroma) have a strong tendency to ____

A

Calcify in the cartilage

393
Q

Why don’t Osteochondromas hurt?

A

Because they are space occupying, they can cause symptoms by pressure (compression) = SECONDARY symptoms

394
Q

When do osteochondromas stop growing?

A

When the individual matures and stops growing,

  • Surgical resection = do sometimes reoccur, and only resect them if they are casuing physical mass symptomatology (pushing against adjacent soft tissue)
395
Q

What are the 3 subforms of osteochondroma?

A

Solidary Osteochondroma

Multiple Osteochondroma

Hereditary (genetic) Multiple Exostosis (HME)

396
Q

Describe Solidary Osteochondroma:

A

SINGLE, MOST COMMON, big tubular bones (metaphyses)

  • tibia
  • humerus
  • femur
397
Q

Describe Hereditary (genetic) multiple exostosis (HME):

A
  • Many, dozens!
  • GENETIC
  • Can lead to bone deformity
  • KNEES!!!
  • Sessile more common
398
Q

What can Hereditary (genetic) multiple exostosis result in (HME)?

A

Pseudo-Madelung deformity (ulnar shortening, bowing of radius)

399
Q

What do you have to worry about with HME?

A

Increased risk of malignant transformation

400
Q

What is MAIN COMPLICATION associated with osteochondroma?

A

Malignant degeneration of the cartilage cap

401
Q

Chondrosarcoma can become:

A

Central or Peripheral

402
Q

Peripheral chondrosarcoma means:

A

External to medullary cavity in soft tissue

403
Q

If osteochondroma hurts, what should happen?

A

If it hurts where it didn’t hurt before this would be a red flag for malignant degeneration

404
Q

Enchondroma is symptomatic or Asymp.?

A

Asymptomatic

405
Q

What is the 2nd most common benign bone tumor?

A

Enchondroma

406
Q

Describe Enchondroma:

A
  • Well defined lytic lesion with chondroid matrix
  • Juxtacortical (next to cortex)
  • Most commonly in MEDULLARY CAVITY
407
Q

Where are you going to find enchondroma?

A

Short tubular bones of hand and feet (60%)

  • MOST COMMON TUMOR OF PHALANGES OF THE HAND**
408
Q

Snowflake calcification would be seen with what tumor?

A

Enchondroma

409
Q

What are enchondromas subject to?

A

Pathological fracture (thins cortex), and pain unexplained by fracture should make you think malignant degeneration

410
Q

If enchondroma becomes malignant, what does it become?

A

CENTRAL CHONDROSARCOMA

411
Q

What can enchondroma look similar to?

A

medullary infarct

412
Q

What is Ollier disease?

A

Enchondromatosis

413
Q

Explain Olliers disease:

A
  • Multiple enchondromas
  • expansile
  • predilection of appendicular skeleton
  • mostly unilateral monemelic distribution
414
Q

What can Ollier disease become?

A

Sarcomatous Transformation (25-30%)

415
Q

Maffuci Syndrome is associated with what benign bone tumor?

A

Enchondroma

416
Q

What exactly is Maffuci Syndrome?

A
  • Multiple enchondromas (ollier) and soft tissue hemangiomas
    • Commonly have phelbolits (small, rounded calcifications)
417
Q

Describe what you’d see with Maffuci Syndrome:

A

Very large enchondromas, projecting into soft tissues

  • MALIGNANT TRANSFORMATION into CHONDROSARCOMA (central) = 15-25%
418
Q

Chondroblastoma aka

A

Codman’s Tumor

419
Q

What is the best diagnostic clue for Chondroblastoma?

A

Well defined lytic lesion centered in epiphysis of skeletal immature patients

420
Q

Where are you most likely to find Chondroblastoma?

A

LONG BONES 80%

421
Q

What does chondroblastoma really like?

422
Q

Chondroblastoma causes pain, T/F?

A

TRUE, that’s why it is LESS LIKELY to become Malignant

423
Q

Chondromyxoid fibroma aka

A

Fibromyxoid Chondroma

424
Q

Where are you going to see chondromyxoid fibroma?

A

LOWER EXTREMITY (Loves the knee)

  • knee 55%
  • foot 20-25%
425
Q

What age group would you see chondromyxoid fibroma?

A

young adults (60%), < 30 y.o.

426
Q

What will you see radiographically with chondromyxoid fibroma?

A

Geographic 1A-1C lesion

  • Eccentric metaphyseal location, often cortical
427
Q

Chondromyxoid fibroma will usually turn malignant?

t/f

A

FALSE, they are PAINFUL!!

More likely to tell someone (Dr.) about it when they’re painful

428
Q

What are the 3 key features of Chondromyxoid Fibroma?

A
  1. Myxoid, fibrous and chondroid tissue in various proportions
  2. Expansile remodeling simulating cortical permeation
  3. Rare matrix mineralization
429
Q

Chondrosarcoma is the ____

A

3rd most common primary bone tumor

MOCEF

430
Q

Chondrosarcoma is the most common:

A

Malignant tumor of the hand, sternum

431
Q

What are the most common locations for chondrosarcoma?

A

Pelvis, Femur, humerus

432
Q

What symptoms are associated with Chondrosarcoma?

A

Slow growing tumor = Deep pain, constipation, bladder issues (affects sacrum)

433
Q

What will you see radiographically with Chondrosarcoma?

A

Expansile geographic lesion, calcification (ring like), Margination has variable growth rate.

_ENDOSTEAL SCALLOPING***_

434
Q

Chondrosarcoma can be ____ or ______

A

central or peripheral

  • central = inside bone
  • eccentric = outsie bone
435
Q

Will you have lab findings with Chondrosarcoma?

436
Q

Chondrosarcoma comes in 2 forms, what are they?

A
  • Primary: Denovo
  • Secondary: More common to come from something pre-existing like benign cartilage tumor
437
Q

What are the primary types of Chondrosarcoma?

A
  • Intramedullary
  • periosteal/juxtacortical
  • clear cell
  • mesenchymal
  • myxoid
  • extraskeletal
  • dedifferentiated
438
Q

What are the secondary types of chondrosarcoma?

A
  • enchondroma
  • osteochondroma
  • paget disease
  • radiation induced
439
Q

Describe Intramedullary Chondrosarcoma:

A
  • symptoms: pain (95-99%) and mass (82%)
  • Average age 40-45
  • Metaphysis
440
Q

Describe Intramedullary Chondrosarcoma:

A
  • Geographic 1A-1C to permeative (often predominantly sclerotic)
  • Deep Endosteal scalloping
  • Expansile remodeling
  • Soft tissue mass (20-76%)
  • Chondroid Matrix (78% by x-ray, 94% by CT)
441
Q

Describe Juxtacortical Chondrosarcoma:

A
  • 2nd - 4th decade (MALE predilection)
  • Metaphyseal particularly femur and humerus
  • Similar to juxtacortical chondroma
  • Periosteal lesion - cortical erosion
  • chondroid features with matrix calcification
  • Larger than juxtacortical chondroma ( > 3-4 cm)
442
Q

2nd part of Juxta cortical chondrosarcoma:

A
  • Similar appearance to periosteal OGS (but no hair onend p rxn)
  • Intramedullary canal usually spread
  • Most lesions are low grade
  • Good prognosis 83% 5 year survival rate
443
Q

Clear cell chondrosarcoma:

A
  • 2 % of chondrosarcoma
  • slightly younger age
  • 75-80% lesion prox femur or humerus
  • propensity for epiphysis
  • better prognosis
444
Q

Clear cell chondrosarcoma 2:

A
  • Geographic 1A-1C lytic
  • Totally lytic 50%; calcified chondroid matrix 33%
  • Rind of sclerosis simulate nonaggressive lesion 20%
  • Soft tissue mass less common (10%)
445
Q

Dedifferentiated Chondrosarcoma:

A
  • Older pt. ave 60 yrs
  • 10-20% of chondrosarcomas
  • Often associated with secondary chondrosarcoma
  • Location
    • femur 20%
    • humerus 15%
    • pelvis 30%
    • Ribs and scap 12%
  • Low grade Chondrosarcoma
  • Spindle cell component
446
Q

Dedifferentiated Chondrosarcoma 2:

A
  • Radiology emulates pathology: dual characteristics
  • one region chondrosarcoma, second area aggressive
  • bone destruction
  • Cortical permeation and soft tissue mass 70%
447
Q

Giant Cell Tumor:

A
  • Quasi - malignant (Yochum)
  • Can have an aggressive behavior and even metasysis to lungs (rare)
  • Multinucleated giant cells in the tumor
  • Peak age: 20-40
  • Location: knee and femur, sacrum
448
Q

What are the radiographic findings of Giant cell tumor?

A
  • Lytic, subarticular and eccentric
  • Often lack a sclerotic rim
  • No host reaction
449
Q

Hemangioma is a ____

A

congenital anomaly

450
Q

Where do hemangioma occur?

A

Bone skin and viscera

451
Q

Where in the body do Hemangiomas occur?

A
  • 50% osseous hemangiomas in spine
  • 20% in skull
  • remaining in ribs, patella, long bones, and short tubular bones of the hand and feet

USUALLY SOLITARY LESIONS

452
Q

What are the 2 broad categories of Hemangioma?

A
  1. Capillary
    1. Hap hazardly arranged capillary sized vessels
  2. Cavernous
    1. Dilated vessels, lined with attenuated endothelial cells
453
Q

Hemangiomas (gender)

A

Femal to male

3:2

454
Q

Where are hemangiomas seen?

A

Vertebral body lower thoracic spine and upper lumbar spine

455
Q

What are the appearances of hemangioma?

A
  • Exaggerated vertebral radiopaque striations, called “acordion,” or “corduroy cloth” or “jail bar pattern”
  • Cervical spine pattern often exhibit a “honeycomb” appearance
  • CT = “Polka dot”
456
Q

Glomus Tumor:

A
  • Pt 4-5th decade
  • Tumor of neuromyoarterial glomus
  • Almost all in terminal phalanx soft tissue
  • Bone erosion/invasion (15-65%)
457
Q

What is angiomatosis?

A

Multifocal or diffuse infiltration of bone by hemangiomatous or lymphangiomatous lesions with or without soft tissue involvment

458
Q

What are the characteristics of angiomatosis?

A
  • Young pt. (first 3 decades)
  • M>F = 2:1
  • No malignant potential
459
Q

Describe the involvment associated with angiomatosis:

A
  • Osseous Involvment: Benign Course
  • Visceral Involvment: Poor prognosis
460
Q

What are Angiomatous Syndromes?

A
  • Maffucci syndrome
  • Osler-Weber-Rendu
  • Klippel-Trenaunay-Weber
  • Massive Osteolysis of Gorham
461
Q

Massive osteolysis of Gorham aka:

A

Vanishing bone disease

462
Q

What are the key features of Massive Osteolysis of Gorham?

A
  • Pt >40
  • 50% with history of trauma
  • Upper ext. favored, may extend across joint
463
Q

2 characteristics of Massive Osteolysis of Gorham:

A

Progressive bone absorption and fragmentation (simulate neuropathy)

Proliferating vascular channels

464
Q

What is Histiocytosis X?

A
  • Langerhans cell histiocytosis
    • Eosinophilic granuloma (less severe) localized one lesion
    • Hand Schueller-Christian disease
    • Letterer-Siwe (most severe) die before 2
465
Q

Describe the bone lesions of Eosinophilic granuloma:

A

Rare beyond the age of 20

  • MC presentation: Solitary, painful bone lesions although they may be disseminated and polyostotic (HSC, LS)
  • Location: Skull (MC) & Vertebra

GREAT PROGNOSIS

466
Q

What do you see radiographically with bone lesions of Eosinophilic granuloma?

A
  • Lytic lesion, well defined, sharp demarcated
  • Beveled edges in the skull (crater like)
  • Associated sequestrum
  • (+) scintigraphy
  • Lab findings vary
467
Q

What is eosinophilic granuloma Ddx?

A
  • Leukemia
  • Lymphoma
  • Osteomyelitis (sequestrum)
  • Ewings
468
Q

What is the only tumor that crosses joints?

A

CHORDOMA

Behaves like an INFECTION

469
Q

What are the characteristics of chordoma?

A
  • age > 40
  • Originates in remnants of notochord
  • Location: Sacro-coccygeal, spheno-occipital region (clivus), cervical spine (C2)
470
Q

Destructive lesion in sacrum =

471
Q

What will the patient present with (w/ Chordoma)?

A

Bowel/bladder deficiency, increased intracranial pressure, cord encroachment

  • Very EXPANSILE LESION
  • GEOGRAPHIC, slow growing but aggressive
472
Q

What is “tumor of the nerves?”

A

Schwanoma / Neurofibroma

473
Q

Where is Schwanoma/neurofibroma found?

A

In cranial nerves, nerve roots, or in the periphery

474
Q

What will you see with Schwanoma / Neurofibroma?

A

Radiographically, none for the tumor, but the tumor can erode or reshpae bone

Example: ENLARGEMENT of IVF, erodes pedicles and VB

475
Q

What are the “Tumor Like Lesions?”

A
  • Fibrous Xanthoma
  • Fibrous Dysplasia
  • Aneurysmal Bone Cyst (ABC)
  • Simple Bone Cyst (SBC)
  • Fibrous Dysplasia
476
Q

What is fibrous xanthomas?

A
  • Fibrous cortical defect (4-8)
  • Non-ossifying fibroma (8-20)

NON PAINFUL INCIDENTAL FINDING

Location: around knee

477
Q

Radiographic Presentation of Fibrous Xanthoma:

A
  • Geographic, elongated lesion with a sclerotic border
  • Bubbly appearance, endosteal scalloping
  • Expansile, thin cortex
  • Pathological fracture if very large
478
Q

Simple Bone Cyst aka:

A

Unicameral or solitary bone cyst

Not a tumor: Fluid Filled Cyst

479
Q

What are the features of Simple Bone Cyst?

A
  • Age: Pediatrics
  • Locations:
    • MC: Proximal Humerus
    • Proximal Femur
  • Asymptomatic Presentation unless fractured
480
Q

Radiographically what will you see with simple bone cyst?

A
  • Large, expansile, geographic lesion
  • Centric, medullary of long bones
  • Well-defined, endosteal scalloping
  • Metaphyseal, slides down the diaphysis with growth
  • Truncated-cone appearance
  • Fallen fragment sign (bone cyst)
481
Q

What is aneurysmal bone cyst named for?

A

Its shape: Expansile, dilated-blood vessels are not involved

482
Q

Main features of aneurysmal bone cyst:

A
  • Age: 5-25
  • Location: Femur, tibia, posterior elements of the spine
  • Only benign tumor that can cross physis
  • Fairly aggressive
  • Has nothing to do with vasculature (Pseudotumor)
483
Q

Radiographic appearance of Aneurysmal bone cyst:

A
  • Large expansile, geographic lesion
  • Metaphyseal, diaphyseal
  • Cortical thinning
  • May cause neuro defect due to size
  • CAN CROSS JOINT SPACE

LOOKS LIKE OSTEOBLASTOMA

484
Q

Aneurysmal bone cyst does what to spine?

A

Common to affect posterior elements, pedicle destruction doesnt = malignancy, looks exactly like osteoblastoma. (COMMON IN PEDES)

485
Q

Fibrous Dysplasia features:

A
  • Bone disorder of unknown origin
  • May be associated with skin and endocrine processes (McCune - Albright) pigment problems and puberty problems
486
Q

2 forms of Fibrous Dysplasia:

A

Monostotic (70%) and Polyostotic

Endocrine harming vs non endocrine harming

487
Q

Polyostotic vs Monostotic

A
  • Monostotic: Can usually be an incidental finding
  • Polyostotic: Forms can manifest along with a precocious puberty around age 8
488
Q

Fibrous Dysplasia appearance:

A
  • Leonine appearance: Forehead/face, looks like a lion
  • Cherubism: Fibrous Dys. of the jaw
  • Can cause BONE DEFORMITY
489
Q

Ground glass appearnace thinking =

A

fibrous dysplasia

490
Q

Common sightings in Fibrous Dysplasia:

A

Pseudofractures, path fractures, geographic, elongated lucent lesion with ground glass matrix, thick sclerotic rim, cortical thinning and scalloping

6 SKEL B (5 decks)

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