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
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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
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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)
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What is multifocal Osteosarcomatosis?
Most often in children in first decade, nearly always fatal
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Osteosarcoma can be from post therapeutic radiation, t/f
true
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What type of malignant bone tumor is extremely vascular?
Telangiectatic
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What type of tumor can become an ostoesarcoma?
Dedifferentiated chondrosarcoma
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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
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What is a benign bone tumor that is inside the bone?
Enchondroma
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Is osteochondroma benign or malignant?
Benign
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What is a fibromyxoid chondroma?
Tumor made of fibrous mucus cartilage
- Dominant content is cartilage
- Loves the TIBIA - rare to be anywhere else
BENIGN
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What is a chondroblastoma?
High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone
BENIGN**
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What are the 3 Malignant cartilage Tumors?
- Primary Chondrosarcoma
- Secondary Chondrosarcoma
- Clear cell chondrosarcoma
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What is primary chondrosarcoma?
Didn’t require anything else for it to be there, it originates by itself
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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
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Malignant bone tumr =
Osteosarcoma
Peripheral secondary chondrosarcoma comes from _____ ?
Osteochondroma
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What is clear cell chondrosarcoma?
Usually near a joint, mistaken for chondroblastoma
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What is one of the more common bone tumors?
Giant cell tumor of bone/osteoclastoma
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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
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Where do giant cell tumors most likey occur?
At the knee (HURT)
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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
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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
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What category is Non-Hodgkin Lymphoma under? (NHL)
Marrow tumor (round cell tumor: malignant)
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What is the most common primary bone malignancy?
_Multiple Myeloma**** TEST_
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Where would you see true punched out lesions?
Multiple Myeloma
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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
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What will plasmacytoma have?
Geographic soap bubble lesion
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What is “extra osseous” ?
Branch of multiple myeloma
- Mass in nasal pharynx (difficulty breathing), very uncommon
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What is under the Benign Vascular and Connective Tissue tumor?
Hemangioma - produces localized coarsening of the trabecular pattern
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What is the “Malignant vascular tumor?’
Fibrosarcoma
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What is the notochord remnant tumor?
Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint
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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
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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
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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
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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