Onc Flashcards
osteoid osteoma
age? what do nsaids inhibit?
what will you see in the spine? Metaphysis?
histology. whats the best imaging? treatment
Biopsy Principles
What type of incision?
Proximal Humerus biopsy, what compartment?
In general go for ____, and avoid ___
core needle biopsy higher risk of ? than incisional biopsy
radiation
Pre-op xrt ?
post op xrt ?
convential radition is?
What’s proton beam therapy?
risk of cryotherapy?
genetics
MDM2 amplification
t(12;16)
t(X;18), SYT-SSX
t(11;22), EWS-FLI
t(2;13), PAX-FKHR
t(12;22), EWS-ATF
t(9;22), EWS-CHN
Infantile fibrosarcoma?
How to determine translocation?
osteoblastoma
age?
how is it different from OO?
size of lesion?
histology?
tx?
Osteiod Osteoma vs Osteoblastoma
histology?
treatment?
size?
osteosarcoma
age?
location?
xray and histology?
testable items?
Treatment: chemo + surgery
no genetic translocation but associated with alterations in Rb and p53 genes
IHC: SATB2 new differentiator
osteosarcoma surface lesions
Parosteal “PAR” =
Periosteal
ParostealPAR= stuck on bone
low grade, wide excision, good prognosis.
PERIosteal = high grade, sunburst surface lesion, eccentric
osteosarcomas
Conventional vs Par vs Peri on imaging and histology
parosteal vs HO vs MHE?
How to spot the difference on CT?
telengiectatic OSA
what will you see on histology? How to differentiate with ABC?
Paget’s disease
what cancer are they at risk for?
Prognosis?
Age?
treatments for
Parosteal osteosarcoma vs Periosteal osteosarcoma vs all other osteosarcomas?
key test item
Parosteal = wide resection
PERI and All other Osteosarcoma get chemo and surgery
chrondogenic lesions
name the 5?
Soft tissue lesions
what size cm is concerning? (size in hands ant feet)
Don’t be fooled by Soft Tissue Sarcomas because they present as?
* ALL Require appropriate evaluation before
resection
* * > 5 cm (1.5 cm hands/ feet) needs 3-D imaging (CT/MRI)
* FNA/Biopsy
- Soft Tissue Sarcomas – DONT BE FOOLED!
(STEM)
– Painless
– Insidious onset
whoops surgery: unplanned excision
What do you do if you excise a mass and it comes back as a sarcoma?
unplanned excision
why should you be aware of “atraumatic hematoma”!!, what should you do before wash out?
- Imaging of sarcoma with hemorrhage and
hematoma appear the same - BIOPSY before washout
Soft tissue sarcomas
size to be worried about?
how to stage?
better/worse prognosis indicators?
synovial sarcoma: genetics?
STS
growth characteristics?
histology?
STS
Most common STS?
STS
Predisposing factors?
STS imaging
MRI will show ?
What’s the exception
Most Common STS Pathology?
Synovial sarcoma
tx?
presentation?
genetic factos to know?
how does it look on histology?
tx: radiation therapy and surgery, some benefit to chemo (exception to the rule for STS)
Grow rapidly
t(x:18)
SYT/ssx1 & SYT/SSX2 fusion transcripts
Fatty tumors
history?
MRI shows?
Pathology?
Treatment?
liposarcoma
what are the subtypes to know?
Fatty tumors
Fatty tumor treatments
Lipoma on MRI
soft tissue sarcoma vs lipoma MRI T1 and T2
Fibrosarcoma
imaging will look the same as other STS,
pathology has a characteristic pattern?
Malignant peripheral nerve sheath tumor
what’s the association?
how does it look on path?
Treatment?
angiosarcoma
how does it spread?
what do you need to biopsy?
path?
Treatment?
rhabdomyosarcoma
common in what population?
pathology to know? (stains, genes)
how is this treatment different?
likely will show up as a distractor
epitheliod
most common in what location?
pathology?
Histology?
STS with lyphmode metases
SCARE:
Synovial Sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma
how to treat soft tisse sarcoma?
how much radiation to give? pre vs post rads complications
high yield
Chondroma
enchodroma vs enchondroma?
how does it look on xray?
histology? How does histology in hands and feet differ?
How to differentiate between low grade chrondrosarcoma and endchondroma?
Benign cartilage tumors on the surface of bone are called periosteal chondromas. When they are in the medullary cavity, they are called enchondromas. Most endochondromas necessitate no treatment
* Enchondromas appear radiographically as areas of stippled calcifications. The radiographic distinction between low-grade chondrosarcoma and enchondroma can be difficult; serial plain radiographs show cortical bone changes or lysis of the previously mineralized cartilage in chondrosarcoma. Patients with chondrosarcoma have pain
olliers disease
multiple enchondromas
dysplastic bones (escpecially ?)
risk of transformation?
Ollier disease:
* Multiple enchondromas
* Dysplastic bones (particularly a shortened ulna)
* A 30% risk of transformation to chondrosarcoma
multiple enchondromas
what are the 2 syndromes? how does the risk of malignancy differ?
- Ollier disease:
- Multiple enchondromas
- Dysplastic bones (particularly a shortened ulna)
- A 30% risk of transformation to chondrosarcoma
- Random spontaneous mutation
- Maffucci syndrome:
- Multiple enchondromas and soft tissue hemangiomas (extremity and visceral)
- A 100% risk of malignancy, chondrosarcoma, angiosarcoma, astrocytoma and GI malignancy
osteochondroma
characteristic appearance?
cartilaginous cap?
Tx?
risk of malignant transformation?
- Characteristic appearance is a surface lesion in which the cortex of the lesion and the underlying cortex are confluent and the medullary cavity of the host bone also flows into (is continuous with) the osteochondroma.
- thin cartilaginous cap, usually 2-3 mm, in a growing child may exceed 1-2cm
- When asymptomatic, these lesions are treated with observation only
- Malignant transformation into a secondary chondrosarcoma is rare, occurring in far fewer than 1% of cases.
- Thickness of the cartilage cap (>2 cm) may increase the risk of malignancy.
MHE
Genetics
Inheritance pattern?
Which mutation is worst?
Risk of transformation?
Multiple hereditary exostoses
- autosomal disorder manifesting in childhood with multiple osteochondromas.
- Mutations are found in the EXT1, EXT2, and EXT3 gene loci; the EXT1 mutation is associated with a greater
- burden of disease and higher risk of malignancy. Approximately 5%–10% of affected patients a secondary chondrosarcoma develops, which is low grade.
“EXT 1 = #1 burden, #1 risk of transformation”
chondromyxoid fibroma
where do you commonly see it? age population?
aggressive?
treatment?
Chondroblastoma
age and location?
Xrays show? MRI shows? classic histology pattern?
treatment
- Centered in the epiphysis in young patients, usually with open physes
- Radiographs show a central region of bone destruction that is usually sharply demarcated from the normal medullary cavity by a thin rim of sclerotic bone. MRI shows edema far out of proportion to the lesion.
- Treatment is with intralesional resection and curettage.
epiphyseal lesions
what are they?
which ones are seen in the immature vs mature?
must know for the test!
chrondogenic lesions treatment
osteochondroma
enchondroma
chondroblastoma
CMF
chondrosarcoma
Age?
Most common location?
treatment?
chemotherapy use?
- Occurs in patients over 50 years old, and the pelvis is the most common location
- May be primary or may arise secondarily in a previous lesion (enchondroma, osteochondroma)
- It may be extremely difficult to differentiate malignant cartilage on the basis of histologic features alone. The clinical, radiographic, and histologic features of a particular lesion must be considered in combination to avoid incorrect diagnosis.
- Treatment consists of wide-margin surgical resection.
- Chemotherapy is used only as an adjunct for dedifferentiated and mesenchymal chondrosarcomas.
- Dedifferentiated chondrosarcoma, which is the most malignant cartilage tumor, has a biomorphic histologic and radiographic appearance. In typical cases, a high-grade spindle cell sarcoma is intimately associated with the low-grade cartilage component. Treatment is with wide-margin surgical resection and chemotherapy.
chondrosarcoma
Age?
Most common location?
MRI findings?
treatment?
chemotherapy use?
- Occurs in patients over 50 years old, and the pelvis is the most common location
- May be primary or may arise secondarily in a previous lesion (enchondroma, osteochondroma)
- It may be extremely difficult to differentiate malignant cartilage on the basis of histologic features alone. The clinical, radiographic, and histologic features of a particular lesion must be considered in combination to avoid incorrect diagnosis.
- Treatment consists of wide-margin surgical resection.
- Chemotherapy is used only as an adjunct for dedifferentiated and mesenchymal chondrosarcomas.
- Dedifferentiated chondrosarcoma, which is the most malignant cartilage tumor, has a biomorphic histologic and radiographic appearance. In typical cases, a high-grade spindle cell sarcoma is intimately associated with the low-grade cartilage component. Treatment is with wide-margin surgical resection and chemotherapy.
chondrosarcoma
Age?
Most common location?
histology
treatment?
chemotherapy use?
- Occurs in patients over 50 years old, and the pelvis is the most common location
- May be primary or may arise secondarily in a previous lesion (enchondroma, osteochondroma)
- It may be extremely difficult to differentiate malignant cartilage on the basis of histologic features alone. The clinical, radiographic, and histologic features of a particular lesion must be considered in combination to avoid incorrect diagnosis.
- Treatment consists of wide-margin surgical resection.
- Chemotherapy is used only as an adjunct for dedifferentiated and mesenchymal chondrosarcomas.
- Dedifferentiated chondrosarcoma, which is the most malignant cartilage tumor, has a biomorphic histologic and radiographic appearance. In typical cases, a high-grade spindle cell sarcoma is intimately associated with the low-grade cartilage component. Treatment is with wide-margin surgical resection and chemotherapy.
chondrosarcoma
Age?
Most common location?
staging?
treatment?
chemotherapy use?
- Occurs in patients over 50 years old, and the pelvis is the most common location
- May be primary or may arise secondarily in a previous lesion (enchondroma, osteochondroma)
- It may be extremely difficult to differentiate malignant cartilage on the basis of histologic features alone. The clinical, radiographic, and histologic features of a particular lesion must be considered in combination to avoid incorrect diagnosis.
- Treatment consists of wide-margin surgical resection.
- Chemotherapy is used only as an adjunct for dedifferentiated and mesenchymal chondrosarcomas.
- Dedifferentiated chondrosarcoma, which is the most malignant cartilage tumor, has a biomorphic histologic and radiographic appearance. In typical cases, a high-grade spindle cell sarcoma is intimately associated with the low-grade cartilage component. Treatment is with wide-margin surgical resection and chemotherapy.
fibrous lesions of bone
name the 4
Non-ossifying fibroma
where does it occur? how does it look on xray? treatment?
- Metaphyseal fibrous defect (nonossifying fibroma) is an extraordinarily common lesion, occurring in approximately 30%–40% of children. The characteristic radiographic appearance is that of a lucent lesion that is metaphyseal, eccentric, and surrounded by a sclerotic rim. The overlying cortex may be slightly expanded and thinned.
- Treatment is with observation. Curettage and bone grafting are indicated in symptomatic lesions (painful or fractured) with more than 50% of cortical involvement.
osteofibrous dysplasia
where does it occur?
how does pathology look?
- This condition manifests in a manner similar to that of fibrous dysplasia but in children younger than 10 years.
- The tibia is its characteristic location.
fibrous dysplasia
how does it present? how does it look on xray? what does pathology look like?
- This condition is caused by a genetic activating mutation of the GSα surface protein, which results in increased production of cAMP.
- Its radiographic appearance is variable but classically referred to as “ground glass.”
- Its histologic appearance has been likened to “alphabet soup” and “Chinese letters.”
- Autogenous cancellous bone grafting is never used for this disorder because the transplanted bone is quickly transformed into the woven bone of fibrous dysplasia.
- Polyostotic fibrous dysplasia is less common but more symptomatic and is diagnosed earlier (before the age 10 years) than monostotic fibrous dysplasia.
- Polyostotic fibrous dysplasia with endocrinopathy is termed McCune-Albright syndrome (café au lait spots, precocious puberty, and polyostotic fibrous dysplasia).
fibrous dysplasia
how does it present? how does it look on xray? fracture risk?
- This condition is caused by a genetic activating mutation of the GSα surface protein, which results in increased production of cAMP.
- Its radiographic appearance is variable but classically referred to as “ground glass.”
- Its histologic appearance has been likened to “alphabet soup” and “Chinese letters.”
- Autogenous cancellous bone grafting is never used for this disorder because the transplanted bone is quickly transformed into the woven bone of fibrous dysplasia.
- Polyostotic fibrous dysplasia is less common but more symptomatic and is diagnosed earlier (before the age 10 years) than monostotic fibrous dysplasia.
- Polyostotic fibrous dysplasia with endocrinopathy is termed McCune-Albright syndrome (café au lait spots, precocious puberty, and polyostotic fibrous dysplasia).
fibrous dysplasia
how does it present? how does it look on xray? pathology? associated syndrome?
- This condition is caused by a genetic activating mutation of the GSα surface protein, which results in increased production of cAMP.
- Its radiographic appearance is variable but classically referred to as “ground glass.”
- Its histologic appearance has been likened to “alphabet soup” and “Chinese letters.”
- Autogenous cancellous bone grafting is never used for this disorder because the transplanted bone is quickly transformed into the woven bone of fibrous dysplasia.
- Polyostotic fibrous dysplasia is less common but more symptomatic and is diagnosed earlier (before the age 10 years) than monostotic fibrous dysplasia.
- Polyostotic fibrous dysplasia with endocrinopathy is termed McCune-Albright syndrome (café au lait spots, precocious puberty, and polyostotic fibrous dysplasia).
Osteofibrous Dysplasia vs Fibrous Dysplasia
OFD: * This condition manifests in a manner similar to that of fibrous dysplasia but in children younger than 10 years. * The tibia is its characteristic location.
hemangioma in spine?
lymphoma of bone
Age >
xrays show?
histology shows? How to differentiate from other blue cell tumors?
IHC?
NHL: nonhodgkin lymphoma
large soft tissue mass out of proportion to the amount of bone destruction is characteristic of lymphoma of the bone.
IHC CD45 and leukocyte antigen positive (LCA+)
Multiagen chemo (CHOP)
surgery to stabilize fx
myeloma
what kind of malignancy?
age?
lesions on bone scan show up as?
Histology?
IHC stains?
how to tell it from lymphoma?
chordoma
arise from what origin?
most common location?
MRI/CT scan will show?
Histology?
Tx?
- Chordoma is a malignant neoplasm that arises from primitive notochordal tissue.
- The most common location is the sacrococcygeal region, and the second most common is the sphenooccipital region.
- CT scans show a midline bone mass.
Bone tumors of unknown origin
Adamantinoma: what is it and where does it arise? DDX and how to confirm dx? Treatment?
Adamantinoma is a rare tumor that classically manifests in the anterior cortex of the tibial diaphysis. Treatment is with wide-margin surgical resection.
Langerhans Cell Histiocytosis (Histiocytosis X)
age?
neoplastic proliferation of?
xrays show?
histology?
vertebra plana? wtf
- LCH monostotic/eosinophilic granuloma
- Monostotic
- Highly destructive lesion with well-defined margin
- Self-limiting
- Hand-Schüller-Christian disease
Multiple bone lesions and visceral disease (skull defects, exophthalmos, and diabetes insipidus) - Letterer-Siwe disease (a fulminating condition in young children), Typically fatal
GCT
always on exam
- GCT is a benign but aggressive neoplasm that in rare cases metastasizes to the lung.
- It most commonly occurs about the knee and sacrum. Pain is referred to the involved joint.
- Radiographs demonstrate a purely lytic destructive lesion in the metaphysis that extends into the epiphysis and often borders the subchondral bone.
- Treatment is aimed at removal of the lesion with preservation of the involved joint. Curettage and subsequent reconstruction with subchondral bone grafts or methylmethacrylate is frequently performed.
GCT patholgy
always on exam
- GCT is a benign but aggressive neoplasm that in rare cases metastasizes to the lung.
- It most commonly occurs about the knee and sacrum. Pain is referred to the involved joint.
- Radiographs demonstrate a purely lytic destructive lesion in the metaphysis that extends into the epiphysis and often borders the subchondral bone.
- Treatment is aimed at removal of the lesion with preservation of the involved joint. Curettage and subsequent reconstruction with subchondral bone grafts or methylmethacrylate is frequently performed.
GCT bone
- stromal malignant cells produce?
- what’s responsible for the osteolytic nature of disease?
- treatment?
- how does Denosumab work?
- RANKL (receptor activator for nuclear factor kB ligand)
- Multinucleated giant cell express RANK, and are responsible for the osteolysis
- tx: remove lesion preserve jt. Chemical cauterization can be used (phenol, peroxide). Area of defect reconstructed with cubchondral bonegrafts, methylmethacrylate, or both.
- Denosumab: monoclonal antibody that binds to RANKL, inhibiting maturation of osteoclasts
ewings sarcoma
age?
presentation?
Histology features?
Xrays/MRI features?
Tx?
mets
What cancers metastasize to bone?
- The patient over 50 years old with a destructive bone lesion should be presumed to have metastatic disease.
- History, physical examination, and radiographic staging (CT of chest, abdomen, and pelvis) identify the primary source of metastasis in 85% of cases; biopsy is necessary for definitive diagnosis.
- The five carcinomas that are most likely to metastasize to bone are those of the prostate, thyroid, breast, lung, and kidney.
- Pathologic fractures secondary to metastatic disease occur most commonly in the spine.
- Histologic hallmark is the appearance of epithelial cells in a fibrous stroma; the epithelial cells are often arranged in a glandular pattern.
- Bone destruction in metastatic disease results from activation of osteoclasts. Tumor cells secrete PTHrP, which stimulates RANKL release and results in activation of osteoclasts.
lytic lesion in patient over 50?
What’s the next test? whats on the differential? What other tests need to be ordered?
- The patient over 50 years old with a destructive bone lesion should be presumed to have metastatic disease.
- History, physical examination, and radiographic staging (CT of chest, abdomen, and pelvis) identify the primary source of metastasis in 85% of cases; biopsy is necessary for definitive diagnosis.
- The five carcinomas that are most likely to metastasize to bone are those of the prostate, thyroid, breast, lung, and kidney.
- Pathologic fractures secondary to metastatic disease occur most commonly in the spine.
- Histologic hallmark is the appearance of epithelial cells in a fibrous stroma; the epithelial cells are often arranged in a glandular pattern.
- Bone destruction in metastatic disease results from activation of osteoclasts. Tumor cells secrete PTHrP, which stimulates RANKL release and results in activation of osteoclasts.
mets
general evaluation for metastatic disease: what tests need to be ordered?
- The patient over 50 years old with a destructive bone lesion should be presumed to have metastatic disease.
- History, physical examination, and radiographic staging (CT of chest, abdomen, and pelvis) identify the primary source of metastasis in 85% of cases; biopsy is necessary for definitive diagnosis.
- The five carcinomas that are most likely to metastasize to bone are those of the prostate, thyroid, breast, lung, and kidney.
- Pathologic fractures secondary to metastatic disease occur most commonly in the spine.
- Histologic hallmark is the appearance of epithelial cells in a fibrous stroma; the epithelial cells are often arranged in a glandular pattern.
- Bone destruction in metastatic disease results from activation of osteoclasts. Tumor cells secrete PTHrP, which stimulates RANKL release and results in activation of osteoclasts.
mets
how do metastatic lesions look on histology?
mets
treatment of impending path fx and healing rates?
anuerysmal bone cyst
age?
location?
characteristic xray findings
mri findings
tx
IHC
- ABC is nonneoplastic but aggressive in its ability to destroy normal bone and extend into the soft tissues.
- Characteristic radiographic finding is an eccentric, lytic, expansile area of bone destruction in the metaphysis. Fluid-fluid levels are characteristically visible on T2-weighted MRI.
- Treatment is with curettage and bone grafting. Local recurrence is common in children
IHC: USP6 positive (chromosome 17p13)
simple/unicameral bone cyst
age? location? presentation?
imaging findings?
histology?
tx?
- Unicameral bone cyst most commonly involves the proximal humerus and manifests either with pain or with a pathologic fracture.
- Characteristic radiographic finding is symmetric cystic expansion with thinning of the involved cortices.
- Comparison of ABC and unicameral bone cyst (simplified):
- ABC manifests with pain and swelling. Unicameral bone cyst manifests with pathologic fracture and pain.
- ABC is eccentric and can expand wider than the growth plate. Unicameral bone cyst is central and does not expand wider than the growth plate.
ABC vs UBS
occurance with other lesions?
fallen leaf sign?
width of lesion on xray?
treatment?
Pagets disease
disorder characterized by?
Medical treatment?
risk of malignancy and prognosis?
- This disorder is characterized by abnormal bone remodeling, which results in coarsened trabeculae and remodeled cortices.
- Medical treatment of Paget disease is aimed at retarding the activity of the osteoclasts. Agents used include bisphosphonates and calcitonin.
- Fewer than 1% of patients with Paget disease experience malignant degeneration with the formation of a sarcoma within a focus of Paget disease.
- Paget sarcomas are deadly tumors with a poor prognosis (the rate of long-term survival is less 20%).
pagets vs pelvic mets prostate ca
how to spot the difference
fibromatosis: extra-abdominal desmoid
associated with?
grows during?
pathology?
treatment?
Extraabdominal desmoid tumors are “rock-hard.” Patients with Gardner syndrome (familial adenomatous polyposis) have a 10,000-fold increased risk for such tumors. Estrogen receptor β inhibitors can be used for treatment.
plantar/palmar fibrosis vs sarcoma? how to tell the difference?
Fibrosarcoma follows the same imaging patterns on MRI scan and has the same treatment as any high-grade soft tissue sarcoma—limb salvage surgery, perioperative radiotherapy, and long-term surveillance.
schwannoma
neurofibroma:
gene association?
- Neurofibromatosis can manifest with more than one neurofibroma or one plexiform neurofibroma, with café au lait spots, with Lisch nodules (melanocytic hamartomas in the iris), and with anterolateral tibial bowing.
- Patients with NF1 have a 5% chance of malignant degeneration of a neurofibroma to an MPNST.
neurofibroma vs schwannoma
AVM/hemangioma
how does it present, what will imaging show? pathology whill show? treatment?
Vascular malformations are common in children and adults. Radiographs may reveal phleboliths. Multiple hemangiomas are associated with Maffucci syndrome.
PVNS
Pigmented vilonodular synovitis
Tenosynovial Giant Cell tumor tendon sheath
- PVNS most commonly affects the knee, followed by the hip and shoulder. Recurrent, atraumatic hemarthrosis with associated pain is the most common manifestation. Radiographs may show cystic erosions on both sides of the joint. Histologic study reveals highly vascular villi lined with plump, hyperplastic synovial cells; hemosiderin-stained, multinucleated giant cells; and chronic inflammatory cells.
- On both T1- and T2-weighted MRI sequences, PVNS appears as a low-signal lesion.
- Treatment of PVNS is complete synovectomy for diffuse disease and local resection for focal nodular PVNS.
synovial chondromatosis
synovial sarcoma vs synovial chondromatosis
- Synovial sarcoma does not originate from an intraarticular location. It most commonly occurs about the knee and is the most common sarcoma of the foot. Spotty mineralization on radiographs is highly characteristic.
- Histologic study of synovial sarcoma reveals a biphasic pattern: epithelial cells (resembling carcinoma) and spindle cells (resembling fibrosarcoma).
- All cells of synovial sarcomas have a translocation between chromosome 18 and the X chromosome that produces two gene fusion products (SYT-SSX1 and SYT-SSX2). Staining of tumor cells yields positivity for keratin and EMA.
Fibrous Dysplasia: HY
mutation?
xrays show?
if in proximal femur?
Associated condition?
Histology?
Osteoid Osteoma HY
Mechanism of Pain?
Scoliosis occurs on what side?
Histology shows?
Osteoblastoma differs in presentation how?
New non-invasive option?
MHE HY
What are the genetics involved?
risk of malignant transformation?
How are the patients clinically?
MHE patient with loss of forearm rotation gets?
Unicameral Bone Cyst HY
lesion characteristics and type?
over time it will?
Tx?
Pathologic fracture known as? What is the treatment in this scenario?
ABC HY
molecular pearl to know?
Recurrence risk associated with?
Compared to UBC, ABC is?
MRI will show which correlates to what on histology?
Tx:
Osteosarcoma HY
low grade and parosteal osteosarcomas associated with?
tumor proto oncogene?
Work up includes?
Metastisis to ?»>?
Risk factors?
Generally presents a what stage?
MSTS (enneking staging system): whats worst prognostic factor?
Tx:
improved survival if?
Whats a good prognostic factor of treatment?
Worst prognosis if?
Standard 3 drug protocol?
Local recurrence related to?
Surgery alone for osteosarcoma: ?% risk of mets dz in 5 years?
Knee endoprosthesis: what reduces infection?
- Worse prognosis if axial tumor or >10cm
- Standard 3-drug treatment is doxorubicin, cisplatin, and high-dose MTX
- Local recurrence of primary malignant bone tumors is related to surgical margin
- Surgery alone for osteosarcoma: 80% risk of metastatic disease within 5 yrs
- Knee endoprosthesis: medial gastroc muscle flap reduces infection
Ewing Sarcoma HY
Treatment?
Histology?
What increases risk of VTE in ewings?
Elevated ?? on labs is associatd with worse tumor burden?
Proximal femur replace in ewings/osteosarc, most common deficit is?
Distal femur ewing sarc or osteosarc, most durable reconstruction is?
malignant fibrous histocytoma (undifferentiated pleomorphic sarcoma) HY
what is it?
How does it look on histology>
secondary MFH/UPS may arise in what patients?
Tx?
think UP(post radiation, pagets; pleomorphic)S(spindle cells, storiform patter)
MM HY
cell type?
tests on UA?
CRAB?
whats a solitary lesion?
what causes the punched out lesions?
how does it look on bone scan?
Treatment?
enchondroma HY
what is it?
Most common tumor in the ?
MRI: T1 and T2
Histology?
How to manage?
Isolated enchondroma has ?% risk of malignant transformation?
Olliers disease: risk?
Maffuccis: risk?
Chondrosarcoma will show?
Chondroblastoma HY
1 of 3 types of tumors with this location?
Xrays show?
Histology buzz words
Mets to ?
If symptomatic?
chondrosarcoma HY
recurrence is correlated with ??
epiphyseal location?
mesenchymal chondrosarc is different from the rest of the group in that?
Dediff chondrosarcoma:
Management?
schwannoma
associated with?
MRI buzz word
Histology? (3)
management?
Schwannoma (neurilemmoma) Benign, associated with neurofibromatosis II
Target sign on MRI
Histology: S100+, Antoni A (hypercellular) & Antoni B (hypocellular) biphasic pattern
Asymptomatic → observation; symptomatic → marginal intraneural resection
malignant peripheral nerve sheath tumor (nerofibrosarcoma)
arise from what condition?
what suggests malignant transformation?
histology?
management?
Arise from peripheral nerve of neurofibroma (NF-1) → increased PET-CT uptake suggests malignant transformation
S100+
Wide excision & radiation
Giant-cell tumor of tendon sheath
where does it occur?
stains?
overexpression of?
2 types?
peak age of occurance?
Presents as?
MRI will show?
Management?
High local recurrence after?
desmoid tumor (extraabdominal fibromatosis)
common in what 2 locations?
associated with ? and ? so may consider ordering what test?
Treatment?
What has the lowest risk of morbidity?
soft tissue sarcoma HY
work up of a soft tissue mass includes:
biopsy every soft tissue mass unless?
Treatment:
Unplanned excision w/ inadequate/positive margins, next steps?
What is most associated with local recurrence risk?
Synovial Sarcoma HY
tx:
origin is not?
most common malignant sarcoma of?
Histology:
stains + for?
wide excision + radiation
Synovial sarcoma Origin is not synovium
Most common malignant sarcoma of foot
Biphasic: spindle cells & epithelial cells
Vimentin+, epithelial membrane antigen
Liposarcoma HY
what cell type?
Myxoid liposarcoma: has mets to where? tx?
well differentiated liposarcoma (ALT): management?
other liposarcomas need what management:
epithelioid sarcoma
most common soft tissue sarcoma of the?
histology:
Epithelioid sarcoma Most common soft tissue sarcoma of hand → can cause overlying skin ulceration (often mistaken for non-healing ulcer)
Histology: keratin+
Metastatic Disease HY
origins of bone mets?
worst vs best prognosis?
Lytic lesions from? because of?
Blast lesions from ? because of ?
If metastatic spine lesion: mgmt is?
Wide-spread lesions gets?
Embolize?
Proteinases are divided into cathepsins and MMPs: how do these work?
PPX fixation
hx of primary cancer w/ no isolated bone lesion or multiple bone lesions: next steps?
if path fx with no clear dx, next steps?
If IMN is performed and path + for sarcoma, next steps?
Mirels score?
PPX fixation with ?
Myiositis ossificans HO
Fibrodysplasia ossificantion progressiva: mutation of the?
MO compared to malignancy?
Waint until when from resection?
PVNS
“Tenosynovial giant cell tumor”
overexpression of?
signal on MRI T1 and T2
management
Overexpression of Colony-stimulating factor-1 (CSF-1)
Hemosiderin deposits → low signal on T1 & T2 MRI
Symptomatic → marginal excision (synovectomy) +/- radiation
synovial chondromatosis
what is it?
management?
histology shows?
Synovial chondromatosis Intraarticular loose bodies comprising synovium / cartilage
Symptomatic → synovectomy & removal of loose bodies
Histology: synovial metaplasia
glomus tumor
how does it present?
management?
Subungual bluish lesion: paroxysmal pain, cold intolerance
Small round blue cells
Marginal excision
the glomus body is a perivascular temperature regulating structure frequently located at the tip of a digit or beneath the nail
