MIDTERM TUMOR* Flashcards
What are common sites of neoplasms?
FEMUR, pelvis, humerus
(UNCOMMON in spine)
Osteosarcom neoplasm %
50-55%
Fibrosarcoma neoplasm %
20-25%
Chondrosarcoma neoplasm %
10%
What is a neoplasm?
Abnormal cellular growth that can be benign or malignant
- Malignant: Ability to metastasize/spread
- Benign: Does not metastasize, but this does not mean insignificant
Any cell found in bone can produce ______
a tumor
* Subdivided by what type of cell it comes from
If a tumor originates in bone it is called a _____
primary bone tumor
What is a secondary bone tumor basic definition?
Starts somewhere else and metastasizes to bone
What is a tumor like lesion?
Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency
Primary bone tumors, benign category:
- Osteoma - MOST COMMON, intramembranous bone tumor, dont hurt
- Osteoid Osteoma - not as common, HURT
- Osteoblastoma - RARE, but half occur in spine
Describe conventional osteosarcomas:
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)
What is multifocal Osteosarcomatosis?
Most often in children in first decade, nearly always fatal
Osteosarcoma can be from post therapeutic radiation, t/f
true
What type of malignant bone tumor is extremely vascular?
Telangiectatic
What type of tumor can become an ostoesarcoma?
Dedifferentiated chondrosarcoma
What osteosarcoma originates in the soft tissue attached to the bone?
Extraskeletal Osteosarcoma
What is a tumor of the cortical bone?
Chondroma, and it is a common benign
What is a benign bone tumor that is inside the bone?
Enchondroma
Is osteochondroma benign or malignant?
Benign
What is a fibromyxoid chondroma?
Tumor made of fibrous mucus cartilage
- Dominant content is cartilage
- Loves the TIBIA - rare to be anywhere else
BENIGN
What is a chondroblastoma?
High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone
BENIGN**
What are the 3 Malignant cartilage Tumors?
- Primary Chondrosarcoma
- Secondary Chondrosarcoma
- Clear cell chondrosarcoma
What is primary chondrosarcoma?
Didn’t require anything else for it to be there, it originates by itself
What is secondary chondrosarcoma?
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
Malignant bone tumr =
Osteosarcoma
Peripheral secondary chondrosarcoma comes from _____ ?
Osteochondroma
What is clear cell chondrosarcoma?
Usually near a joint, mistaken for chondroblastoma
What is one of the more common bone tumors?
Giant cell tumor of bone/osteoclastoma
What are the characteristics of Giant cell tumor?
- Classically expansile soap bubble lesion
- about 1 in 5 are malignant
- “Quasi - malignant” can go either way - 80% malignant
Where do giant cell tumors most likey occur?
At the knee (HURT)
Ewings Sarcoma is in what category?
Marrow tumor (round cell tumor)
- Classically gives laminated periosteal reaction
- moth eaten appearance
- big tubular bone in young children
What is the most common primary bone malignancy in first decade (peak in teenagers)?
EWINGS SARCOMA
- dont confuse Leukemia, which is the most common malignancy in the first decade
What category is Non-Hodgkin Lymphoma under? (NHL)
Marrow tumor (round cell tumor: malignant)
What is the most common primary bone malignancy?
_Multiple Myeloma**** TEST_
Where would you see true punched out lesions?
Multiple Myeloma
Explain Myelomatosis:
Form of multiple myeloma:
- Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
What will plasmacytoma have?
Geographic soap bubble lesion
What is “extra osseous” ?
Branch of multiple myeloma
- Mass in nasal pharynx (difficulty breathing), very uncommon
What is under the Benign Vascular and Connective Tissue tumor?
Hemangioma - produces localized coarsening of the trabecular pattern
What is the “Malignant vascular tumor?’
Fibrosarcoma
What is the notochord remnant tumor?
Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint
What are the key points of osteolytic mets?
- 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
What accelerates osteoblasts?
Osteoblastic mets
Pic of mixed mets
What are 2 of the most common benign bone tumors?
Chondroma and Solitary Osteochondroma - asymptomatic
How can tumors be classified?
- They can be classified by location of where they originate - most often from the metaphysis
What are the top “Malignant Tumors” ?
MOCEF - top 5 primary malignant
- Multiple Myeloma: Over 40
- Osteosarcoma: under 30
- Chondrosarcoma: 40 - 60
- Ewing’s: Under 40
- Fibrosarcoma: 30 - 60
Central secondary chondrosarcoma comes from _____
Enchondroma
Marrow tumors, aka:
round cell tumors
What is the common theme with marrow tumors (round cell tumors)?
_Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE ******_
What are secondary tumors?
Metastatic tumors in bone
Vast majority of secondary tumors are _____
Hematogenous
Osteolytic mets is a _____
secondary tumor
What has 75% occurence %, osteolytic mets or osteoblastic mets?
Osteolytic
What is in the “Tumor Like” category?
- Not exhaustive list
- Fibrous dysplasia - as common as Paget’s
If a tumor is most likely benign, what will it’s characteristics be?
- Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)
KNOW THIS***
Primary Bone Tumors:
- 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
What are the Bone forming primary bone tumors?
-
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%
- Conventional Osteosarcoma
What are the Benign Cartilage Forming Tumors?
- Benign
- Chodnroma/Enchondroma
- Solitary Osteochondroma
- Chondromyxoid Fibroma/Fibromyxoid Chondroma
- Chondroblastoma
What are the malignant Cartilage forming tumors?
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
What are the marrow tumors (round cell tumors?)
- Ewing’s Sarcoma
- NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
- Multiple Myeloma
What are the branches of multiple myeloma?
- Classical MM
- Myelomatosis
- Plasmacytoma
- Extra Osseous MM
Vascular and Connective Tissue tumors are in what category, what are their subcategories?
It is in the category of “primary bone tumor”
- Benign - Hemangioma
- Malignant - Fibrosarcoma
Metastatic Tumors in bone - most common skeletal malginancy
- Osteolytic Mets
- Osteoblastic Mets
- Mixed Mets
Tumor Like Conditions:
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
If it’s a benign tumor they overwhelmingly originate when?
Before the Age of 30