MS - Path (Primary bone tumors)

Question 1

What are 2 types of benign bone tumors?

Answer 1

(1) Giant cell tumor (2) Osteochondroma (exostosis)

Question 2

What age of patients does giant cell tumor typically affect?

Answer 2

20-40 years old

Question 3

What kind of tumor is giant cell tumor? Where is it located?

Answer 3

Benign primary bone tumor; Epiphyseal end of long bones

Question 4

What are 3 key characteristics of Giant cell tumor? There is one characteristic for each of the following areas: macroscopic appearance, imaging, histology.

Answer 4

(1) Locally aggressive benign tumor often around knee (2) “Soap bubble” appearance on x-ray (3) Multinucleated giant cells

Question 5

What is the most common benign tumor? What is another name for it?

Answer 5

Osteochondroma (exostosis) = Most common benign tumor

Question 6

What age and gender of patients does osteochondroma (exostosis) typically affect?

Answer 6

Males < 25 years old

Question 7

How is Osteochondroma (exostosis) characterized in terms of (1) its make-up (2) its progression/aggression.

Answer 7

(1) Mature bone with cartilaginous cap (2) Rarely transforms to chondrosarcoma

Question 8

What are 3 examples of malignant bone tumors?

Answer 8

(1) Osteosarcoma (osteogenic sarcoma) (2) Ewing sarcoma (3) Chondrosarcoma

Question 9

What is the 2nd most common primary malignant bone tumor? What is the first?

Answer 9

Osteosarcoma (osteogenic sarcoma) = 2nd most common primary malignant bone tumor (after multiple myeloma)

Question 10

What is another name for Osteosarcoma? What age(s) are typically affected by it?

Answer 10

Osteosarcoma (Osteogenic sarcoma); Bimodal distribution: 10-20 years old (primary), > 65 (secondary)

Question 11

What are 5 predisposing factors for Osteosarcoma (osteogenic sarcoma)?

Answer 11

Predisposing factors: (1) Paget disease of bone (2) bone infarcts (3) radiation (4) familial retinoblastoma (5) Li-Fraumeni syndrome (germline P53 mutation)

Question 12

Where is Osteosarcoma (osteogenic sarcoma) located?

Answer 12

Metaphysis of long bones, often around knee

Question 13

What are 2 ways to describe what may be seen on x-ray with Osteosarcoma (osteogenic sarcoma)?

Answer 13

Codman triangle (from elevation of periosteum) or sunburst pattern on x-ray

Question 14

In general, how does Osteosarcoma act/progress? How is it treated?

Answer 14

Aggressive; Treat with surgical en bloc resection (with limb salvage) and chemotherapy

Question 15

What is the age and gender of patients typically affected by Ewing sarcoma?

Answer 15

Boys < 15 years old

Question 16

What are the 4 common sites for Ewing sarcoma?

Answer 16

Commonly appears in diaphysis of long bones, pelvis, scapula, and ribs

Question 17

What is seen on histology of Ewing sarcoma?

Answer 17

Anaplastic small blue cell malignant tumor

Question 18

How does Ewing sarcoma act/progress? How does it respond to treatment?

Answer 18

Extremely aggressive with early metastases, but responsive to chemotherapy

Question 19

What classic appearance in the bone characterizes Ewing sarcoma?

Answer 19

“Onion skin” appearance in bone

Question 20

With what translocation is Ewing sarcoma associated?

Answer 20

Associated with t(11;22) translocation; Think: “11+22 = 33 (Patrick Ewing’s jersey number)”

Question 21

What kind of tumor is Chrondrosarcoma? Use 3 descriptors.

Answer 21

Rare, malignant, cartilaginous tumor

Question 22

What age and gender of patients are typically affected by Chrondrosarcoma?

Answer 22

Men 30-60 years old.

Question 23

Where is Chrondosarcoma usually found? Name 6 locations.

Answer 23

Usually located in pelvis, spine, scapula, humerus, tibia, or femur.

Question 24

What are the possible origins of Chrondrosarcoma?

Answer 24

May be of primary origin or from osteochondroma

Question 25

What is the characteristic appearance of Chondrosarcoma?

Answer 25

Expansible glistening mass within the medullary cavity.

Question 26

Draw a long bone, labeling its parts and drawing/labeling the primary bone tumors.

Answer 26

See p. 423 in First Aid 2014 for visual