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ICM Unit 4 MSK > Musculoskeletal Neoplasms and Cysts > Flashcards

Musculoskeletal Neoplasms and Cysts Flashcards

1
Q

Benign cysts and bone dz
(3 diseases)

A

Ganglion cysts
Paget dz of Bone
Fiibrous Dysplasia

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2
Q

Paget Dz of bone

A

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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3
Q

Progress Pagets dz of bone

A

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

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4
Q

Paget Dz risk factors

A

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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5
Q

Paget Dz: Presentation

A

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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6
Q

Paget Dz MC in what bones?

A

skull
pelvis
vertebrae
long bones of LE

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7
Q

Paget Dz presentation cont.

A

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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8
Q

Paget Dz: Labs

A

elevated serum alkaline phosphate

screen for Vit D def.

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9
Q

Paget Dz : imaging

Plain film X-ray

A

osteolytic lesions initially, focal radiolucencies

progresses to sclerotic bone appearance (or mixed)

thickened, deformed bones

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10
Q

Paget Dz : imaging

Bone scans

A

detect early changes

disease extent

monitor therapy

MRI/CT when malignancy suspected

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11
Q

Paget Dz : complications

A

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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12
Q

Paget Dz treatment

A

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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13
Q

to remember things about Pagets Dz

PANICS

A

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

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14
Q

Fibrous Dysplasia

A

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

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15
Q

Fibrous Dysplasia MC in..

can occur.. MC in the …

A

teens and 20s

can occur anywhere, MC in proximal femur

mono or polyostotic

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16
Q

Fibrous Dysplasia Presentation

A

Asymp

can have pain, deformity, fx

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17
Q

Fibrous Dysplasia - on XRAY

(buzzword)

A

ground glass appearance

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18
Q

Fibrous Dysplasia associated endocrine problems (McCune- Albright syndrome)

A

cafe-au-lait
precocious puberty
polyostotic dz

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19
Q

Fibrous Dysplasia - Tx

A

self resolve into adult hood

surgery to stabilize joints/ bones

biphosphonates

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20
Q

Sarcomas - diseases include

A

soft tissue sarcomas
bone sarcomas : Benign or malig

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21
Q

Intro to sarcomas (where and types)

A

benign and malign

soft tissue vs bone tissue

primary malignant rare

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22
Q

sarcomas affect..

A

all age groups

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23
Q

Soft tissue sarcomas locations

A

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

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24
Q

Soft tissue sarcomas MC in what places

A

60% extremities

30% trunk

10% head and neck

25
Q

Soft tissue sarcomas - etiologic factors

A

scar tissue

rad. therapy

HHV and HIV - Kaposi’s sarcoma

immunodef.

Genetics

26
Q

Soft tissue sarcomas - MC presentation

A

painless, gradually enlarging mass

27
Q

Soft tissue sarcomas - when to bx and metastasis facts

A

bx - all new and growing/persistent masses

lung tissue MC site for metastasis

lymph node metastasis

28
Q

Soft tissue sarcomas - imaging

A

plain radiographs

MRI - extremities, head/neck

CT -chest, abd, retroperitoneal cavity

29
Q

Soft tissue sarcomas - tx

A

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

30
Q

Bone Sarcomas

Malign potential from benign

A

Endochondroma and osteochondroma –> chondrosarcoma

Fibrous dysplasia, Paget’s dz, Bone infarcts –> Osteosarcoma, UPS (undiff pleomorphic sarcoma)

31
Q

Osteosarcoma

A

MC primary bone malign

metaphyses of LONG BONES

rapid bone growth -> growth spurt

32
Q

Osteosarcoma MC in

A

10-20 y/o

males > females

33
Q

Osteosarcoma - MC sites

A

distal femur
proximal tibia
proximal humerus

34
Q

Osteosarcoma - presentation

A

localized pain (nocturnal, after injury, wax/wane)

soft tissue mass, large and tender usually

+/- decreased ROM, limp

35
Q

Osteosarcoma - dx

Imaging - XRAY (buzzowrds!)

A

Destructive lesion = “MOTH-EATEN APPEARANCE”

Periosteal rxn = “SUNBURST APPEARANCE” and CODMANS’s TRIANGLE

36
Q

Osteosarcoma - dx

Imaging -

A

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

37
Q

Osteosarcoma - dx

bx

A

core needle or open to confirm dx

38
Q

Osteosarcoma - tx

A

REFER - oncology

NO role for radiation

pre/postop chemo
limb-sparing surgery (>80%)

39
Q

Ewing sarcoma

A

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

40
Q

Ewing sarcoma affected individuals

A

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

41
Q

Ewing sarcoma MC sites

A

pelvis, diaphysys of long bones

aggressive

42
Q

Ewing sarcoma Presentation

A

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

43
Q

Ewing sarcoma Plain radiograph

A

“ONION PEEL” peristeal rxn w/ soft tissue mass

44
Q

Ewing sarcoma - Treatment

A

REFER - oncology

systemic chemo (mainstay tx)
surgical resection
radiation

45
Q

Ewing sarcoma - mets common in

A

lungs
bones
bone marrow

46
Q

Ewing sarcoma Prognosis

A

depends on mets

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

47
Q

Chondrosarcoma

A

arises from cartilaginous tissue

arise de novo (MC) or malig transformation from enchondroma or osteochondroma (rare)

slow growing

20-25% bone sarcomas

48
Q

Chondrosarcoma - affected individuals

A

adults and older age

49
Q

Chondrosarcoma - what bones

A

FLAT BONES

pelvic and shoulder girdles
proximal femur and humerus

50
Q

Chondrosarcoma - Presentation

A

local pain and swelling

51
Q

Chondrosarcoma - imaging

A

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

52
Q

Chondrosarcoma - tx

A

surgical resection

RESISTANT to chemo

53
Q

Metastatic bone tumors

A

met tumors MC than primary tumors

54
Q

common site of mets for CA of

A

Prostate
Breast
Lung

80% all bone mets from these 3 sources

55
Q

Metastatic bone tumors: Dx

sites involved

A

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

56
Q

Metastatic bone tumors: presentation

A

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

57
Q

Metastatic bone tumors: Treatment

A

depends on underlying malign and symp

curable vs palliative care

local rad for pain relief; surgery (fx or impeding fx) ; pain relief - NARCOTICS

58
Q

consider..

(4 things) for review

A

all bone neoplasms in DDX

age of pt

if pt has symptoms

appearance/location of tumor on imaging

ICM Unit 4 MSK (5 decks)

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