Musculoskeletal Neoplasms and Cysts Flashcards by Cami Goyette

Benign cysts and bone dz
(3 diseases)

Ganglion cysts
Paget dz of Bone
Fiibrous Dysplasia

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Paget Dz of bone

AKA osteoitis deformans

disorder of bone remodeling (excessive bone resorption -> increased bone formation)

structurally weak, deformed, vascular bone more susceptible to fx

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Progress Pagets dz of bone

osteoclastic -> lystic lesions -> osteoblastic -> disorganized bone formation -> weak, deformed, vascular bone

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Paget Dz risk factors

men > women

Europeans and European migration areas

2nd MC bone disorder in elderly

usually incidental finding on radiographs or elevated alkaline phophatase

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Paget Dz: Presentation

Asympt.

polyostoic (2/3) or monostotic (1/3)

as progress:
- pain
- arthritis
- bone deformity
- secondary manif related to specific body area involved

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Paget Dz MC in what bones?

skull
pelvis
vertebrae
long bones of LE

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Paget Dz presentation cont.

Spinal stenosis
Kyphosis
Vascular steal (surrounding tissue not perfusing)
Dilated scalp veins
CN neuropathy/ neurological symptoms
Bowed tibia or femur
Gait changes
Increased hat size

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Paget Dz: Labs

elevated serum alkaline phosphate

screen for Vit D def.

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Paget Dz : imaging

Plain film X-ray

osteolytic lesions initially, focal radiolucencies

progresses to sclerotic bone appearance (or mixed)

thickened, deformed bones

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Paget Dz : imaging

Bone scans

detect early changes

disease extent

monitor therapy

MRI/CT when malignancy suspected

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Paget Dz : complications

Increased risk osteosarcoma and giant cell tumor

Vertebral collapse/spinal cord compression/para

CN palsies

Hearing loss, vertigo, vision changes

Immobilization -> hypercalcemia and renal caliculi

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Paget Dz treatment

surveillance (asymp)

Tx symp pt, high risk, or extensive dz
- (IV Bisphosphonate - tx of choice)
- Calcitonin (2nd line)
- correct vit D def. b4 biphosphonate

long term alk phos monitoring required

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to remember things about Pagets Dz

PANICS

Pain
Arthalgia/ Alk phos elevated
Nerve compression/ Neural deafness
Increased bone density
Cardiac failure
Skull/ Sclerotic vertebrae

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Fibrous Dysplasia

fibrous CT develops in place of normal bone -> weakens bone

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Fibrous Dysplasia MC in..

can occur.. MC in the …

teens and 20s

can occur anywhere, MC in proximal femur

mono or polyostotic

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Fibrous Dysplasia Presentation

Asymp

can have pain, deformity, fx

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Fibrous Dysplasia - on XRAY

(buzzword)

ground glass appearance

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Fibrous Dysplasia associated endocrine problems (McCune- Albright syndrome)

cafe-au-lait
precocious puberty
polyostotic dz

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Fibrous Dysplasia - Tx

self resolve into adult hood

surgery to stabilize joints/ bones

biphosphonates

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Sarcomas - diseases include

soft tissue sarcomas
bone sarcomas : Benign or malig

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Intro to sarcomas (where and types)

benign and malign

soft tissue vs bone tissue

primary malignant rare

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sarcomas affect..

all age groups

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Soft tissue sarcomas locations

muscles, tendons, fat, fibrous tissue, synovial t, vessles, and nn.

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Soft tissue sarcomas MC in what places

60% extremities

30% trunk

10% head and neck

Soft tissue sarcomas - etiologic factors

scar tissue rad. therapy HHV and HIV - Kaposi's sarcoma immunodef. Genetics

Soft tissue sarcomas - MC presentation

painless, gradually enlarging mass

Soft tissue sarcomas - when to bx and metastasis facts

bx - all new and growing/persistent masses lung tissue MC site for metastasis lymph node metastasis

Soft tissue sarcomas - imaging

plain radiographs MRI - extremities, head/neck CT -chest, abd, retroperitoneal cavity

Soft tissue sarcomas - tx

depends on tumor staging stage 1 = excision stage 2 = " " w/ adjuvant rad. therapy stage 3 = " " w/ adjuvant chemotherapy stage 4 = chemo +/- other modalities generally curable unless mets present

Bone Sarcomas Malign potential from benign

Endochondroma and osteochondroma --> chondrosarcoma Fibrous dysplasia, Paget's dz, Bone infarcts --> Osteosarcoma, UPS (undiff pleomorphic sarcoma)

Osteosarcoma

MC primary bone malign metaphyses of LONG BONES rapid bone growth -> growth spurt

Osteosarcoma MC in

10-20 y/o males > females

Osteosarcoma - MC sites

distal femur proximal tibia proximal humerus

Osteosarcoma - presentation

localized pain (nocturnal, after injury, wax/wane) soft tissue mass, large and tender usually +/- decreased ROM, limp

Osteosarcoma - dx Imaging - XRAY (buzzowrds!)

Destructive lesion = "MOTH-EATEN APPEARANCE" Periosteal rxn = "SUNBURST APPEARANCE" and CODMANS's TRIANGLE

Osteosarcoma - dx Imaging -

CT = best bone destruction/pattern calcification MRI = best intramedullary and soft tissue extension CXR and CT lungs, bone scan or PET - mets

Osteosarcoma - dx bx

core needle or open to confirm dx

Osteosarcoma - tx

REFER - oncology NO role for radiation pre/postop chemo limb-sparing surgery (>80%)

Ewing sarcoma

Ewing sarcoma family of tumors (EFT) 10-15% of bone sarcomas (rare) Mets very common (20% have obvious mets at initial dx)

Ewing sarcoma affected individuals

child/adolescent males (10-15y/o) caucasians

Ewing sarcoma MC sites

pelvis, diaphysys of long bones aggressive

Ewing sarcoma Presentation

localized pain, stiffness Night pain (develops over wks-mos b4 eval) Swelling, soft tissue masses Tenderness +/- erythema Constitutional Symptoms

Ewing sarcoma Plain radiograph

"ONION PEEL" peristeal rxn w/ soft tissue mass

Ewing sarcoma - Treatment

REFER - oncology systemic chemo (mainstay tx) surgical resection radiation

Ewing sarcoma - mets common in

lungs bones bone marrow

Ewing sarcoma Prognosis

depends on mets 5 yr survival rate 70-80% localized dz " " 30% overt mets at dx axial skeleton worse prognosis

Chondrosarcoma

arises from cartilaginous tissue arise de novo (MC) or malig transformation from enchondroma or osteochondroma (rare) slow growing 20-25% bone sarcomas

Chondrosarcoma - affected individuals

adults and older age

Chondrosarcoma - what bones

FLAT BONES pelvic and shoulder girdles proximal femur and humerus

Chondrosarcoma - Presentation

local pain and swelling

Chondrosarcoma - imaging

plain xray initially CT, MRI bx chest imaging to check lung mets

Chondrosarcoma - tx

surgical resection RESISTANT to chemo

Metastatic bone tumors

met tumors MC than primary tumors

common site of mets for CA of

Prostate Breast Lung 80% all bone mets from these 3 sources

Metastatic bone tumors: Dx sites involved

vertebrae, sacrum, pelvis, prox femur, ribs, sternum, prox humerus, skull

Metastatic bone tumors: presentation

asymp or painful (PAIN MC SYMP) gradual onset localized pain, more severe at night nerve root or SC compression pathologic fx hyper or hypocalcemia elevated alk phos

Metastatic bone tumors: Treatment

depends on underlying malign and symp curable vs palliative care local rad for pain relief; surgery (fx or impeding fx) ; pain relief - NARCOTICS

consider.. (4 things) for review

all bone neoplasms in DDX age of pt if pt has symptoms appearance/location of tumor on imaging