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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 ____

105
Q

When does Giant cell tumor usually occur?

A

20-40 this is an exception

106
Q

Metastisis happens how?

A

Through Vascular system

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%

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)
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

110
Q

Is Enostosis primary or secondary bone tumor?

A

Primary

AKA BONE ISLAND

111
Q

What is enostosis classified as?

A

Tumorlike, usually an incidental finding, and is asymptomatic

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)
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
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

115
Q

WHat is the differential diagnosis for Enostosis?

A

Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma

116
Q

Osteoblastic mets ____

117
Q

low grade osteosarcoma is ____

118
Q

When would you take a biopsy of Enostosis?

A

Increase in size of 25% in 6 months

119
Q

Bony pelivs is a common site to see ____

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

121
Q

What are the possible diseases related to Enostosis?

A
  • Osteopoikilosis
  • Osteopathia Striata
  • Melorheostosis
122
Q

Osteopoikilosis =

A

Periarticular bone islands

123
Q

Osteopathia Striata =

A

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

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
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

​

126
Q

Benign Bone forming:

A

OSTEOMA

OSTEOID OSTEOMA

OSTEOBLASTOMA

127
Q

Osteoma aka:

A

Ivory Exostosis

128
Q

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

129
Q

What is the defect in Osteoma?

A

One resorption or formation during skeletal maturation

130
Q

What does osteoma arises beneath?

A

Endosteum from inner surface of cortex

131
Q

What causes surrounding reactive bone formation in Osteomas?

A

Elevation of periosteum from underlying bone

132
Q

Osteoma is a bone of _____

A

Intramembranous origin

133
Q

Extracranial Osteoms -

A

.03% of bone biopsied primary bone lesions

134
Q

Paranasal sinus osteomas -

A

.4%

Most have a osteosclerotic lesion in a frontal or ethmoid lesion

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
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)
137
Q

In osteoma, most just have ____

A

single solitary osteoma

138
Q

What are the clinical issues associated with Osteoma?

A
  • Small lesions usually asymptomatic
  • Project away from cortical surface
  • Palpable enlarging osseous mass
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
140
Q

What can osteoma tumors near orbit cause?

A

Cause exopthalmosis, double vision, vision loss

141
Q

What about the Hx of Osteoma:

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

What looks identical to bone island but has different location?

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
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
145
Q

OSTEOID OSTEOMA: main characteristics

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

147
Q

What is elevated in Osteoid Osteoma?

A

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

148
Q

Describe the nidus in Osteoid osteoma:

A

Radiolucent and is the actual tumor

149
Q

Pain is worse at night with what tumor?

A

Osteoid Osteoma

150
Q

Whats the origin of Osteoid Osteoma?

A

Unknown, inflammatory, traumatic, vascular, viral

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)

152
Q

Osteoid Osteoma is more common in ______

A

males 2-3:1

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%
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
155
Q

What does osteoid osteoma look like on bone scan?

A

lights up

(will have a solid dense periosteal reaction)

156
Q

OSTEOBLASTOMA aka:

A

Giant osteoid osteoma, osteogenic fibroma

157
Q

What is Osteoblastoma characterized by?

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

What are the %’s associated with Osteoblastoma?

A

< 1% of primary bone tumors

3% benign bone tumor

159
Q

Describe Osteoblastoma:

A
  • Circumscribed mass, often surrounded by shell of cortical bone or periosteum
  • Sharp interphase between lesion and cancellous bone
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
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
162
Q

Osteoblastoma originates ____

163
Q

Osteoblastoma gender pref.

A

2-3:1 in males

164
Q

WHat can Ostoeblastoma have?

A

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

RECURRENCE AFTER resection = 10-25%

165
Q

In aggressive osteoblastoma, the recurrence is ____ %

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
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%
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

169
Q

MALIGNANT PRIMARY BONE TUMORS:

A

Osteosarcoma, aka Osteogenic Osteosarcoma

170
Q

What is the main definition of Osteosarcoma?

A

Malignant tumor with ability to produce osteoid directly from neoplastic cells

171
Q

Talk about the growth rate of Osteosarcoma:

A

Frequency of tumor occurence corresponds to greatest growth rate during adolescence

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

173
Q

Think of osteosarcoma as ____

A

osteoblastic malignant tumor

174
Q

Periosteal reaction of osteosarcoma =

A

Spiculated

175
Q

2nd primary bone tumor is ____

A

Osteosarcoma (MOCEF)

176
Q

When does osteosarcoma peak?

177
Q

Where is the most common location for osteosarcoma?

A

Distal femoral metaphysis

178
Q

Osteosarcomatosis survival:

A

Change low

179
Q

Where will osteosarcoma metastasize to?

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
181
Q

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

A

Osteosarcoma

182
Q

20% primary bone malignancies:

A

Osteosarcoma

183
Q

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

A

Osteosarcoma

184
Q

What are the symptoms of Osteosarcoma?

A
  • Progressive Pain
  • Soft tissue mass, swelling
  • Pathological fracture
  • Penetration of cortex with often large extraosseous tumor mass
185
Q

What is common with Osteosarcoma?

A

Pulmonary mets common - pneumothorax

186
Q

What is most common location of osteosarcoma?

A

Femur #1 big tubular bone - distal femoral metaphysis is most common

187
Q

What is increased in osteosarcoma?

A

Serum Alkaline Phosphatase

Alkaline phosphatase is produced by osteoblasts

188
Q

Age in Osteosarcoma:

A
  • Bimodal
    • First peak 2-3 decade
    • Second peak - 6th decade
      • Usually happens from paget disease undergoing malignant degeneration
189
Q

What is the Gender in Osteosarcoma?

A
  • Male:Female - 1.3-1.6: 1
  • More common in Black people
  • Very progressive
  • 5 year survival = 41%
  • 5 year with resectable tumor and no mets = 60-70%
190
Q

What are the first 3 “Radiology location” signs for Osteosarcoma?

A
  • Around knee - 55%
  • Metaphysis of long tubular bones - 80%
  • Extenison into epiphysis - 75%
    • Pushes itself across the growth plate into the epiphysis
    • no vascular connection
191
Q

What are the last few radiographic features of Osteosarcoma?

A
  • Flat bones, VB 20%
  • In older patient (>50) axial skeleton and flat bones 40%
  • size 5-10 cm
192
Q

What are the first few points of Conventional Osteosarcoma (2nd type)?

A
  • Poorly defined, intramedullary mass, extends through cortex
  • Moth eaten bone destruction
193
Q

What are the last points of Conventional Osteosarcoma (2nd type)?

A
  • Aggressive Periosteal Reaction
    • Codman triangle
    • Sunburst (speculated) pattern
  • Indistinct borders with WZOT wide zone
  • Soft tissue mass +/- tumor calcification
194
Q

What are the radiographic appearances of Telangiectatic Osteosarcoma?

A
  • Purely lytic lesion
  • Cystic cavities filled with blood, necrosis
  • Fluid levels
195
Q

What are the radiographic findings of Multicentric Osteosarcoma?

A

o Synchronous osteoblastic osteosarcoma at multiple sites
o Basically same as central sclerotic but happening at multiple locations
o Exclusively in children (5-10 years)
o Extremely poor prognosis

196
Q

Parosteal Osteosarcoma Radiographic features:

A

o Low grade osteosarcoma in older age group (20-50 years)
o Posterior distal femur
o Attached to underlying cortex at origin
o Originates from cortex and grows out into soft tissue
o Can look like a mushroom
o Dense bony look to them

197
Q

Radiographic features of Periosteal Osteosarcoma:

first 4

A

o Intermediate grade osteosarcoma

o Most common diaphyseal

o No medullary involvement

o Cortical thickening

198
Q

Last 4 radiographic features of Periosteal Osteosarcoma:

A

o Sandwiched between periosteum and the cortex
o Doesn’t usually invade the cortex
o May even cause cortical erosion
o Speckled appearance

199
Q

What are the radiographic features of Gnathic Osteosarcoma?

A

o Involvement of mandible, maxilla
o Sclerotic, lytic, mixed
o Periosteal reaction
o Soft tissue extension

200
Q

What are the key radiographic features of Secondary Osteosarcoma?

A

Arises in pre existing bone lesion

o About half of osteosarcoma over age 50 are secondary, 67^ over age 60
▪ Paget disease
▪ Prior radiation
▪ Bone infarction
▪ Fibrous dysplasia
▪ Prosthesis
▪ OI
▪ Chronic osteomyelitis
▪ Retinoblastoma

201
Q

Osteosarcoma does what on a bone scan?

202
Q

If osteosarcoma hasn’t metastisized, what can you do?

A

Amputate and this will have a good prognossis

203
Q

What is a bone generating bone tumor?

A

Osteosarcoma

6 SKEL B (5 decks)

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