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Soft Tissue and Bone > Mostly bone stuff > Flashcards

Mostly bone stuff Flashcards

1
Q

Mesencymal Chondrosarcoma (histologic findings)?

IHC Stains (Positive and Negative)?

FISH Finding?

A

Biphasic tumor (Small blue cells round/spindle and cartilage); rare cartilage, cell around heangiopericytoma like vessels

M=F 20-30 yrs

CD99+, SOX9+, FLI-1 -

HEY1-NCOA2

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2
Q

Ewing sarcoma/Primative neuroectodermal tumor? (Morphology, population)

Prognosis, poor prognosis markers?

Translocation?

IHC findings?

A

High grade primative maligant small round sarcoma cells; geographic/cogaulative necrosis

Children and young adults (12 year median); good prognosis
Poor: high stage, >8cm, increased WBC, p53 alterations, no chemo response

t(11;22) EWSR-FLI1; CD99+, FLI-1 + and ERG +; PAS+ granules

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3
Q

NUT Midline (histology findings)?

IHC?

Gene rearrangement?

Prognosis?

A

Poorly defined SCC, monotonous small-medium, clear cytoplasm focal/abrupt sq differentaiton, significant mitotic activity

Found in the midline in ~20 year olds with rapid onset in head and neck

CD5/6, CK-pan, p40, p63+, C52+
BRD4-NUTM1 t(15;19)

Poor prognosis 10 months survival

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4
Q

What is a sign of benignity in bone on H and E (think Fracture Callus)?

Purple rhomboid crystals think?

Pale needle crystals think?

A

Osteoblast rimming even if cellular

Pseudogout; calcium pyrophosphate; survives formalin fixation

Gout; uric acid; disolved in formalin

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5
Q

Califlour lesion continuous with marrow?

H and E?

Where in bone?

A

Osteocondroma with cartlagenous cap; thicker is worse=chondrosarcoma!

Cart cap over chondrocytes

Epiphysis mostly

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6
Q

BPOP?

Location?

H and E?

A

Bizarre parosteal osteochondromatous proliferation; happens below nail or distal extremeties

Not continuous with marrow; hyper cellular cartilage and disorganized bone

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7
Q

Periosteal chondroma H and E?

Always has?

DDx?

A

Tubular bones; Cartilage may erode into cortex or buldge into marrow. Low grade cellularty;

Always intervening intact cortex

Periosteal (juxtacortical chonrosarcoma); larger higher grade cellularity

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8
Q

Lesion with broad base attached to cortex, think?

H and E?

Gene amplification?

A

Parosteal osteosarcoma; Fibroblastic; young adults on metaphysis

Strands of woven bone with spindled matrix?

MDM2

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9
Q

Fusiform mass on bone?

H and E?

MDM2 status?

A

Periosteal osteosarcoma; young; distal femur diaphysis>metaphysis

Low grade cart tumor

No MDM2

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10
Q

Most common cartlagenous lesion in bone?

Syndrome?

H and E?

Gene?

A

Enchondroma

Ollier’s, Marfucci’s, Metachondromatosis

Hyaline matrix with chondrocytes; binucleation ok; rim of bone on outside ok

50% IDH1/2

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11
Q

Intramedullary bone lesion with lobules?

H and E?

Genes?

A

Intramedullary chondrosarcoma!

Lobules of cartilage going through bone and encasing bone

IDH1/2

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12
Q

Clear cell chondrosarcoma age and location?

H and E?

A

Adults long bones epiphysis

Lobulated cartilage with clear cells invading bone; +/- osteoblastic rimming

Rare regular appearing chondrosarcoma areas can be present

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13
Q

Infiltrative lytic jaw lesion in teen/young adult?

H and E?

Gene?

A

Mesenchymal chondrosarcoma

Sheets of spindle cells and cartilage

HEY1-NCOA2; Poor prognosis

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14
Q

Chondroblastoma location/age?

H and E?

A

Epiphysis in long bone of skeletally immature people; Lucent with sclerotic rim

Chrondoblast with kidney bean nuclei, multinucleated giant cells, chicken wire matrix (possible calc)

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15
Q

Chondromyxoid fibroma location?

H and E?

A

Metaphysis (knees) young people in marrow

Lobules of myxoid cartilage with increased celluarity at edges and giant cells

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16
Q

Non-ossifying fibroma population/location?

H and E?

A

Teens around knee; Most common cause of fracture

Hypercellular spindle cells in storiform pattern with Giant cells

17
Q

Big intramedullary lesion with invasion and red brown friable on gross?

Benign or malignant?

H and E?

Genes to know/IHC?

A

Giant cell tumor of bone; skeletally mature (20-40) around knee

Benign but can have mets (to lung)

Giant cells and single cells with simiilar nuclei

RANKL expressed, and Histone H3.3; MDM2- (vs osteosarc)

18
Q

Expansive lytic lesion with rim reactive bone and MRI fluid levels?

H and E?

Genes/IHC?

A

ABC!; Blood lakes

Giant cells “jumping” into cysts or solid; spindle cells and giant cells; some osteoid and BLUE BONE

CDH11-USP6 t(16;17)

19
Q

USP6 lesions?

A

ABC, nodular fascitiis, and some tendon sheeth issues

20
Q

ABC ddx in kids?

H and E?

A

Telangectasia osteosarcoma in long bones kids

More infiltrative; Histologic malignant (large, mitosis, atypical mites); rare osteoid, some blood lakes

21
Q

Simple bone cyst population?

H and E?

Genes?

A

Young kids/teens with lucent bone with multiloculations

No fluid levels; thin strans of wall, pink material in wall (less cellular than ABC), blood or no filled spaces

USP6-

22
Q

What is Paget disease of bone?

Stages?

Tx?

A

Idiopathic bone deforming, >40 in pelvis and spine mostly

Mimics osteoclast in brown tumor

Ostoclastic, Mixed (Ostoclast and blasts), Sclerotic (reversal lines and fibrosis)

Bisphosphonates

23
Q

Craniofacial cortical nodule think?

H and E?

If multiple think?

A

Osteoma

Benign oval dense bone (woven and lamellar with canals)

Gardners

24
Q

Intracortical lesion with central nidus?

Classical clinical presentaiton?

H and E?

TX?

A

Osteoid osteoma

Night pain releaved with NSAID

Woven bone with osteoblastic rimming

RFA

25
Q

Who gets osteoblastoma/bone?

H and E?

Pain releived by NSAIDs?

A

Long bones or spine in kids (>2cm)

Woven bone with osteoblast rimming but more vascular; look out for atypical epithelioid osteoblastoma

No and RFA not as good

26
Q

Osteofibrous dysplasia, who gets it/location?

H and E?

Can progress to?

A

Anterior cortex tibia teenage male

Variably cellular fibrous tissue with bony trabecula; OSTEOBLASTIC RIMMING!

Adamantanoma

27
Q

Adamantanoma H and E?

Stain?

Can they have mets?

A

Like ameoloblastoma of jaw; Epithelium in background of osteofibrous dysplasia

Keratin +

Yes

28
Q

Fibrous dysplasia H and E?

Gene?

Radiology?

A

Fibrous bone and bland spindled stroma with “Asian” like characters; lacks osteoblastic rimming

GNAS1

Kind of ground glass in marrow

29
Q

Well differentiated intramedullary osteosarcoma H andE

Age of patients?

Gene?

A

Looks like fibrous dysplasia with cytologic atypia in spindle cells (large, hyperchromasia, mites)

Kids/Teens

MDM2/CDX4 positive

30
Q

Codman’s triangle, think?

H and E?

Gene?

Chemo response magic number?

A

Peristeum pushing up from osteosarcoma

Lacey osteoid, atypical osteoblasts

STATB2 (not as specific as thought)

90% death!

31
Q
A
32
Q

Langerhans Histocytosis H and E?

IHC?

Mutation?

Syndrome?

A

Histeocytes with folded nucleus; Eosinophils

Langrin +, S100+ , CD1a+

BRAF V600E

Han-Schiller-Christian (Multiple lesions)

33
Q

Ewing H and E, population?

Genes?

IHC?

A

Sheets of blue cells with some rossetts; Kids to teens, diaphysis long bone

t(11;22)(q21;q12) EWSR1-FLI1 85%
t(21;22)EWSR1-EGR 15%

CD99+ and FLI1+

34
Q

Ewing Like:
1. BCOR-CCNB3 location and H and E?

Stains?

  1. CIC-DUX4, location and H and E?
A

BCOR-CCNB3: Bone, blue cell with some myxoid stroma

usually CD99a +, BCOR+, CCNB3+

CIC-DUX4: soft tissue, round and spindle cells with mycoid stroma

usually CD99-, WT1+, ETV6+, CIC+

35
Q

What goes to Bone (mets mnemonic)?

A

BLT and Kosher Pickle

Breast, lung, thyroid, kidney, prostate!

36
Q

Multiple hemangioma’s in bone, syndrome?

A

Gordam-Stout: Hemangiomas causing mastic osteolysis

Cavernous cystic spaces with endothelial lined spaces

37
Q
A

Soft Tissue and Bone (2 decks)

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