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Orthopaedic Surgery > Ortho Boards - Oncology > Flashcards

Ortho Boards - Oncology Flashcards

1
Q

Work up order for bone tumors?

A

H&P
Local Staging
Systemic Staging
Biopsy (Last!)

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2
Q

Enneking’s 4 questions

A

1) Location
2) Tumor bone interaction
3) Bone-tumor interaction
4) Matrix

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3
Q

How to better evaluate tumor-bone and bone-tumor interactions from Enneking’s 4 questions?

A

Lodwick Classification

1) Geographic - sclerotic, distinct, indistinct (NOF, UBC, GCT)
2) Moth eaten - OM, mets
3) Destructive - Ewings

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4
Q

Actual location of bone tumors?

A 
Epiphysis
Metaphysis
Diaphysis
Flat bones
Spine
Sacrum
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5
Q

What needs a bone marrow biopsy as part of the work up?

A

Ewings sarcoma

Myeloma

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6
Q

Systemic staging work up?

A

Bone scan - cold in myeloma, renal cell carcinoma, thyroid carcinoma (high flow lesions)
Chest CT scan (85% found in tumors of unknown origin) - if metastatic suspicion get CT C/A/P
Labs - CBC, CMP, ESR, CRP, SPEP, UPEP

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7
Q

Myeloma dx vs. staging?

A

Diagnosis - SPEP, UPEP, bone marrow

Staging - Skeletal survey

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8
Q

When to use a PET scan?

A

18F-FDG

Used for melanoma, lymphoma, carcinoma

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9
Q

Benign bone tumors with metastasis?

A

Chondroblastoma

Giant cell tumor

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10
Q

Most common tumor stage?

A

IIB - MSTS

High grade (II), extracompartmental (B), no mets (M0)

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11
Q

Malignant bone lesions <5yo, <30, >30

A

<5years - LCH (Letter-Siwe), LCH (Hand-Schuller-Christian), metastatic rhabdomyosarcoma, metastatic neuroblastoma

< 30 years - Ewings Sarcoma, osteosarcoma

> 30 years - Chondsarcoma, mets, lymphoma, myeloma, chordoma, adamantinoma

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12
Q

Benign bone lesions: < 5 yo, < 30, > 30

A

< 5 years: osteomyelitis, osteofibrous dysplasia

< 30 years: Osteoid osteoma, osteoblastoma, chondroblastoma, ABC, LCH, osteofibrous dysplasia, non-ossifying fibroma

> 30 years: giant cell tumor, pagets disease

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13
Q

Bone lesions found at any age?

A

Infection, fibrous dysplasia, simple bone cyst

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14
Q

Lesions treated with chemo + surgery?

A

Ewings and osteosarcoma

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15
Q

Lesions treated with radiation + surgery?

A

soft tissue sarcoma

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16
Q

Lesions treated with limb salvage/wide excision?

A

Chondrosarcoma, adamantinoma, chordoma, parosteal osteosarcoma, soft tissue sarcoma

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17
Q

Lesions treated with intralesional resection?

A

giant cell tumor, ABC, NOF, LCH, osteoblastoma, chondroblastoma

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18
Q

Lesions treated with radiofrequency ablation?

A

osteoid osteoma

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19
Q

Chromosomal Translocations?

t(11;22)
t(12;16)
t(2;13)
t(12;22)
t(X;18)
t(9;22)
A

t(11;22) - Ewings sarcoma/PNET - EWS-FL1
t(12;16) - Myxoid liposarcoma - TLS-CHOP
t(2;13) - alveolar rhabdomyosarcoma - PAX3-FKHR
t(12;22) - clear cell carcinoma - EWS-ATF1
t(X;18) - synovial sarcoma - SSX1-SYT
t(9;22) - myxoid chondrosarcoma - EWS-CHN

None for osteosarcoma (Rb gene)

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20
Q

Syndrome: McCune Albright
Disease: ?
MSK Neoplasm: ?
Genetic Association: ?

A

Syndrome: McCune Albright
Disease: polyostotic fibrous dysplasia, cafe au lait spots, endocrinopathy (precocious puberty)
MSK Neoplasm: None
Genetic Association: GNAS1, Chr 20, AR

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21
Q

Syndrome: Mazabraud Syndrome
Disease: ?
MSK Neoplasm: ?
Genetic Association: ?

A

Syndrome: Mazabraud Syndrome
Disease: Fibrous dysplasia and soft tissue myxomas
MSK Neoplasm: None
Genetic Association: GNAS1

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22
Q

Syndrome: Jaffe-Campanacci
Disease: ?
MSK Neoplasm: ?
Genetic Association: ?

A

Syndrome: Jaffe-Campanacci
Disease: multiple non-ossifying fibromas with cafe au lait skin lesions
MSK Neoplasm: None
Genetic Association: None

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23
Q

Syndrome: POEMS Syndrome
Disease: ?
MSK Neoplasm: ?
Genetic Association: ?

A

Syndrome: POEMS
Disease: Polyneuropathy, organomegaly, endocrinopathy, M-protein, Skin abnormalities (hyperpigmentation)
MSK Neoplasm: Myeloma
Genetic Association: None

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24
Q

Syndrome: Li-Fraumeni Syndrome
Disease: ?
MSK Neoplasm: ?
Genetic Association: ?

A

Syndrome: Li-Fraumeni Syndrome
Disease: Sarcoma, breast, leukemia, adrenal glands
MSK Neoplasm: Osteosarcoma
Genetic Association: p53

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25
Syndrome: Retinoblastoma Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Retinoblastoma Disease: bilateral eye tumors in children MSK Neoplasm: Osteosarcoma Genetic Association: Rb1
26
Syndrome: Rothmund-Thompson Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Rothmund-Thompson Disease: Sun-sensitive rash with poikiloderma and telangiectasias MSK Neoplasm: Osteosarcoma Genetic Association: RECQL4
27
Syndrome: Multiple hereditary exostosis Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Multiple hereditary exostosis Disease: multiple osteochondromas MSK Neoplasm: Chondrosarcoma Genetic Association: ETX1, EXT2, EXT3
28
Syndrome: Ollier's Disease Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Ollier's Disease Disease: Enchondromas MSK Neoplasm: Chondrosarcoma Genetic Association: PTHR1
29
Syndrome: Maffucci's syndrome Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Maffucci's syndrome Disease: Enchondromas, angiomas and CNS, pancreatic, ovarian malignancies MSK Neoplasm: Chondrosarcoma and angiosarcomas Genetic Association: PTHR1
30
Syndrome: Hand-Schuller-Christian disease Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Hand-Schuller-Christian disease Disease: Multifocal langerhans cell histiocytosis (LCH), exopthalmos, diabetes insipidus, lytic skull lesions MSK Neoplasm: LCH Genetic Association: None
31
Syndrome: Letterer-Siwe disease Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Letterer-Siwe disease Disease: Multifocal langerhans cell histipcytosis (LCH), visceral and bone disease. FATAL MSK Neoplasm: LCH Genetic Association: ?
32
Syndrome: Stuart-Treves Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Stuart-Treves Disease: chronic lymphedema MSK Neoplasm: angiosarcoma Genetic Association: None
33
Syndrome: Neurofibromatosis type 1 Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: Neurofibromatosis type 1 Disease: multiple neurofibromas MSK Neoplasm: malignant peripheral nerve sheath tumor (MPNST) Genetic Association: NF1
34
Immunohistochemistry Stain: SMA Disease:
Smooth muscle actin - benign/malignant muscle Leiomyosarcoma
35
Immunohistochemistry Stain: Desmin Disease:
Skeletal muscle Rhabdomyosarcoma
36
Immunohistochemistry Stain: S-100 Disease:
Neural tumors Schwanoma MPNST
37
Immunohistochemistry Stain: CD34/31 Disease:
Endothelial cells/vascular tumors Hemangioma hemangioendothelioam Angiosarcoma
38
Immunohistochemistry Stain: B-catenin Disease:
membrane marker, wnt pathway Fibromatosis or extraskeletal desmoid
39
Immunohistochemistry Stain: CD99 Disease:
Ewings sarcoma Peripheral neuroectodermal tumor
40
Immunohistochemistry Stain: Keratin Disease:
Epithelpid sarcoma, synovial sarcoma, carcinoma, adamantinoma
41
Immunohistochemistry Stain: EMA Disease:
Epitheloid membrane antigen Epitheloid or synovial sarcoma
42
Immunohistochemistry Stain: MyoD1 Disease:
Myogenin Rhabdomyosarcoma
43
Immunohistochemistry Stain: Vimentin Disease:
Soft tissue sarcoma
44
Immunohistochemistry Stain: CD 20, CD 45 Disease:
Lymphoma
45
Immunohistochemistry Stain: CD138 Disease:
Myeloma
46
Benign and malignant tumors? Histologic type: Hematopoietic
Benign: None Malignant: myeloma, lymphoma
47
Benign and malignant tumors? Histologic type: Chondrogenic
Benign: Osteochondroma, chondroma, chondroblastoma, chondromyxoid fibroma Malignant: Primary/secondary chondrosarcoma, defifferentiated chondrosarcoma, mesenchymal chondrosarcoma, clear cell chondrosarcoma
48
Benign and malignant tumors? Histologic type: Osteogenic
Benign: Osteoid osteoma, osteoblastoma Malignant: Osteosarcoma, Parosteal osteosarcoma, periosteal osteosarcoma, telangectatic osteosarcoma
49
Benign and malignant tumors? Histologic type: Unknown origin
Benign: Giant cell tumor Malignant: Ewings, adamantinoma
50
Benign and malignant tumors? Histologic type: Fibrogenic
Benign: Fibroma, desmoplastic fibroma Malignant: Fibrosarcoma, malignant fibrous histiocytoma/
51
Benign and malignant tumors? Histologic type: Notocordal
Benign: None Malignant: Chordoma
52
Benign and malignant tumors? Histologic type: Vascular
Benign: hemangioma Malignant: Hemangioendothelioma, hemangiopericytoma
53
Benign and malignant tumors? Histologic type: Lipogenic
Benign: Lipoma Malignant: Liposarcoma
54
Benign and malignant tumors? Histologic type: Neurogenic
Benign: Neurilemoma Malignant: Malignant peripheral nerve sheath tumor
55
Epiphyseal Tumors?
Chondroblastoma Giant cell tumor Clear cell chondrosarcoma (femoral head)
56
Metaphyseal tumors?
Osteosarcoma Chondrosarcoma Mets
57
Diaphyseal lesions?
AEIOUY + Mets ``` Adamantinoma Eosinophilic granuloma Infection osteoid osteoma/osteoblastoma Ewings sarcoma mYleoma, lYmphona, fibrous dYsplasia Mets ```
58
Flat bone lesions?
Chondrosarcoma Fibrous dysplasia Hemangioma Pagets disease Ewings sarcoma
59
Spine lesions?
Anterior column: Giant cell tumor metastatic disease Posterior column: osteoid osteoma, Osteoblastoma, aneurysmal bone cyst
60
Sacrum lesions
Midline - Chordoma Eccentric - ANC, GCT, mets
61
Syndromes associated with osteosarcoma
Li Fraumeni Retinoblastoma Rothmund-Thompson
62
Syndromes associated with chondrosarcoma?
MHE Olliers Maffucci's
63
Syndrome: familial adenomatous polyposis Disease: ? MSK Neoplasm: ? Genetic Association: ?
Syndrome: familial adenomatous polyposis Disease: multiple intestinal polyps, colon cancer, hepatoblastomas MSK Neoplasm: desmoid tumors Genetic Association: APC
64
Chemotherapy used for what soft tissue sarcoma?
Rhabdomyosarcoma Controversial for STS
65
When is radiation used?
Local control of Ewings sarcoma, lymphoma, myeloma, metastatic bone disease
66
Chemotherapy agents for osteogenic sarcoma and Ewings sarcoma with toxicities?
Osteogenic Sarcoma - (DCM) - Doxorubicin (Adriamycin) - cardiotox - Cisplatin - audiotoxic, nephrotoxic, peripheral nerves - Methotrexate - oral cavity Ewings Sarcoma - (DIVCE) - Doxorubicin (Adriamycin) - cardiotox - Ifosfamide - nephrotox, central neurotox - Vincristine - peripheral neurotox - Cyclophosphamide (Cytoxan) - leukemia/lymphoma, cystitis, bladder cancer - Etoposide - secondary leukemia
67
Pre-operative (neoadjuvant) vs. post-operative radiation (adjuvant)
Pre-op - 50Gy (5000 cGy) - smaller field, wound complications Post-op - 66 Gy (6600 cGy) - long term fibrosis, bone necrosis and fracture (esp subtroch)
68
Most common soft tissue tumor in children?
Hemangioma
69
Most common soft tissue tumor in adults?
Lipoma
70
Most common malignant soft tissue tumor children
Rhabdomyosarcoma
71
Most common malignant soft tissue tumor in adults?
Undifferentiated pleomorphic sarcoma (UPS)
72
Most common primary benign bone tumor?
Osteochondroma
73
Most common primary malignant bone tumor?
Osteosarcoma
74
Most common secondary benign bone lesion?
ABC
75
Most common secondary malignancies?
Malignant fibrous histiocytoma, osteosarcoma, fibrosarcoma
76
Most common phalangeal tumor?
Enchondroma
77
Most common soft tissue sarcoma of wrist/hand?
Epitheloid sarcoma
78
Most common soft tissue sarcoma of the foot and ankle?
Synovial sarcoma
79
Soft tissue sarcomas with lymph node mets?
``` ESARC Epithelioid sarcoma Synovial Sarcoma Angiosarcoma Rhabdomysarcoma Clear Cell Sarcoma ```
80
Tumors of fibrous tissue?
Benign - Calcifying aponeurotic fibroma - Fibromatosis - Dupuytrens - Extraabdominal desmoid tumor - most locally invasive of all soft tissue masses, assoc with APC - Nodular fasciitis - painful rapidly enlarging mass Malignant - UNdifferentiated pleomorphic sarcoma (previously MFH) - Fibrosarcoma Dermatofibrosarcoma protuberans - nodular cutaneous tumor
81
Tumors of fatty tissue?
Benign - Lipoma - subtypes (spindle cell lipoma, pleomorphic lipoma, angiolipoma) Malignant - Liposarcoma - subtypes (well differentiated, myxoid, dedifferentiated, round-cell, pleomorphic)
82
Tumors of neural tissue?
Neurilemoma (benign schwanoma) Neurofibroma Neurofibromatosis Neurofibrosarcoma (MPNST)
83
Tumors of muscle?
Leiomyosarcoma | Rhabdomyosarcoma
84
Vascular tumors?
Hemangioma | Angiosarcoma
85
Synovial timors?
Gangila pigmented villonodular synovitis (PVNS) - nodular and diffuse - recurrent hemarthrosis Giant cell tumor of tendon sheath Synovial chondromatosis - multiple rice bodies with metaplastic change.
86
Other random rare sarcomas?
Synovial sarcoma Epitheloid sarcoma Clear cell sarcoma - slow growing mass in association with tendon or aponeuroses Alveolar clear cell sarcoma - anterior thigh
87
Post traumatic masses?
Hematoma - sarcomas can spontaneously hemorrhage and necrosis may mimic hematoma Myositis ossificans (HO) - as progression occurs look for peripheral mineralization with central clear area.
88
Tumors with small round blue cells?
``` Ewings sarcoma/PNET Neuroblastoma Rhabdomyosarcoma Wilms tumor (nephroblastoma) Synovial sarcoma Myeloma Lymphoma ```
89
What is important in soft tissue sarcoma prognosis?
Size (>5cm or > 1.5cm in hand/wrist Depth (deep to fascia) Growth Presentation
90
Most common tested soft tissue sarcomas?
undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma), liposarcoma, synovial sarcoma, leiomyosarcoma
91
Imaging of soft tissue sarcoma?
Dark on T1 Bright on T2 Except lipoma - always look exactly like fat
92
Lipoma vs. liposarcoma?
MDM2+ or ring chromosomes
93
Fibrosarcoma pathology?
Herringbone pattern
94
Malignant peripheral nerve sheath tumor pathology?
Spindle cells in whirling patterns | S-100 positive
95
Rhabdomyosarcoma pathology
Small round blue cells Desmin positive Chr t(2;13) - PAK-FKHR gene
96
Benign and malignant lesions that mineralize in soft tissues?
Benign - Lipoma, hemangioma, myositis ossificans, CPPD, calcific tendonitis Malignant - synovial sarcoma, liposarcoma, angiosarcoma
97
Lesions that can occur on both sides of a joint?
HIP(P) CATS ``` Hemophilia (blood) Infection (PUS) Pannus (inflammatory arthropathy) PVNS CPPD Arthritis TB Synovial chondromatosis ```
98
Telangiectatic osteosarcoma vs ABC?
ABC is wider than the physis TO - expands on cortex more than ABC. Path has malignant osteoid, vascular lakes/channels (similar to ABC), and giant cells.
99
Types of osteosarcoma
Central - conventional, telangiectatic, low grade, small cell, giant cell rich, secondary, non-osteogenic Surface - parosteal (stuck on) and periosteal Extraosseus
100
Pathology of osteosarcoma?
Parosteal - more bland, less aggressive Periosteal - more aggressive, can have areas of cartilage Conventional - immature looking blue cells, mitotic figures, immature woven bone
101
Histology of enchondroma?
Bland looking cartilage - acellular On hands and feet can be much more cellular
102
Tx of benign cartilage lesions
Osteochondroma/Enchondroma - latent in adults - observation Chondroblastoma and chondromyxoid fibroma - rare aggressive lesions, require treatment, curettage.
103
Imaging of chondrosarcoma vs. benign lesions?
Will see endosteal scalloping, cortical expansion, cortical disruption. If truly benign should be able to cover up lesion and rest of bone looks normal.
104
NOF vs. chondromyxoid fibroma?
NOF usually has a definable rim of bone, CMF does not.
105
NOF pathology
Spindle shaped fibroblasts, whorled pattern, giant cells and hemosiderin.
106
Osteofibrous dysplasia vs. fibrous dysplasia on pathology?
OFD - loose stroma of fibroblasts/spindle cells with scattered bone trabecular WITH rimming osteoblasts Fibrous dysplasia - similar but no rimming osteoblasts on histo - looks completely different on XR. "Chinese characters"
107
Fibrous dysplasia vs OFD on XR?
FD - ground glass (looks like frosted glass) like someone smudged the bone on XR. More smooth, cortical expansion, no normal fat, it has been replaced with fibrous tissue. OFD - Anterior cortical lesion usually on the tibia, multiloculated, soap bubble appearance with bowing of the tibia. DDx = adamantinoma.
108
Chinese characters on histology?
Fibrous dysplasia - no rimming osteoblasts.
109
Types of cafe au lait spots?
Maine - irreg - McCune Albright California - smooth - neurofibroma
110
Small round blue cell tumors?
LERN-M ``` Lymphoma Ewings - look for CD99, t(9;22), and pseudorosettes (tumor trying to make blood vessels) Rhabdomyosarcoma Neuroblastoma Myeloma ```
111
Markers for Myeloma?
CD56+ CD45 neg (Lymphoma)
112
Histology of Chordoma?
Sheets/cords of cells in myxoid stroma, vacuolated cells, Physaliferous cells (vacuolated, signet ring looking cells)
113
Other names for langerhans cell histiocytosis?
Eosinophilic granuloma (EG) Histiocytosis X
114
Punched out lesions in a skeletally immature patient?
Langerhans cell histiocytosis (LCH) - neoplastic proliferation of langerhans cells (look like a bi-lobed histiocyte - babys butt imprint...)
115
Causes of vertebra plana?
MELT Myeloma Ewings Lymphoma/LCH (EG) Tuberculosis
116
Histology of langerhans cell histiocytosis?
Eosinophils, plasma cells, langerhans cells (histiocyte with grooved nucleus - babys butt imprint) EM - bierbeck granules (tennis racket)
117
Giant cells in GCT?
Cells in the stroma look like the same as those in the giant cells. Think of chocolate chip cookies with chocolate chips spilled everywhere. Stromal cells responsible for lysis
118
Tumors with giant cells?
``` ABC Chondroblastoma Fracture GCT Giant cell rich osteosarcoma ```
119
Medical treatment for GCT?
Denosumab (Prolia) - human monoclonal antibody that binds RANKL - Stromal cells produce RANKL and giant cells express RANK to activate osteoclasts
120
Adamantinoma vs. OFD on histo and XR?
Adamantinoma is larger along tibia, less bowing because it grows faster and the bone has not yet had time to deform. Histology - OFD chinese characters with rimming osteoblasts and fibrous stroma, keratin negative. Adamantinoma epithelial nests/glands and keratin positive.
121
Stain to differentiate adamantinoma vs. OFD?
Keratin - positive in adamantinoma and negative in OFD.
122
Systems to predict pathological fractures?
Harrington - 50% destruction, lytic lesion in proximal femur > 2.5cm, lesser troch avulsion, pain after radiation ``` Mirels - score of 4-12, site, pain, lesion, size (each with score of 1-3) Site - upper, lower, peritroch Pain - mild, moderate, functional Lesion - blastic, mixed, lytic Size - <1/3, 1/3-2/3, >2/3 ``` >/= 9 - operate 8 = borderline = 7 - non-op
123
ABCs can be seen with what other lesion?
GCT, CB, CMF, FD, OB, Telangtatic OS
124
ABC vs. UBC?
ABC - can be associated with other lesions, no fallen leaf sign, eccentric, width > physis, multiple fluid-filled lesions, open curettage UBC - no other lesions, fallen leaf sign, central, width < physis, aspiration/injection. Simple bone cyst.
125
5 lesions that can look like anything?
``` FD - the great immitator Infection Mets Cartilage Langerhans cell histiocytosis (EG or HX) ```
126
CMF vs chondroblastoma
CMF - rarely crosses the physis, chondroid with myxoid background CB - crosses physis, chicken wire pathology
127
Fibrous lesions of bone?
NOF desmoplastic fibroma Fibrosarcoma Malignant fibrous histiocytoma
128
Another name for malignant fibrous histiocytoma?
Non-osteogenic osteosarcoma
129
Small round blue cell tumors with molecular markers?
LERNM Lymphoma - CD45+, CD20+, leucocyte common antigen +, look for large soft tissue mass on MRI Ewings Sarcoma - CD99+, t(11;22), FLI-1+ Rhabdomyosarcoma - Desmin+, XR normal, mass on MRI Neuroblastoma - Neuron-specific enolase (NSE+), XR normal, mass on MRI Myeloma - Kappa/lambda light chain, monoclonal spike on SPEP/UPEP, CD138+
130
Genetic abnormality in fibrous dysplasia?
Activating mutation of the GS-alpha surface protein - GNAS1 | - Increased production of cyclic adenosine monophosphate.
131
Treatment of fibrous dysplasia?
Internal fixation - usually plate | Do not use autogenous bone graft - will quickly be transformed into woven bone of fibrous dysplasia
132
Pagets disease is the result of what?
Abnormal bone remodeling
133
Vicious cycle of metastatic bone disease
Bone destruction by activated osteoclasts parathyroid hormone-related peptide (PTHrP) - stimulates release of RANKL from osteoblasts and marrow stromal cells and binds to RANK on osteoclast precursor cells Granulocyte colony stimulating factor (G-CSF) from cancer cells causes further osteoclast differentiation With bone resorption - transforming growth factor beta (TGF-B), insulin like growth factor (IGF-1), and calcium are released and cause more PTHrP to be released from cancer cells.
134
Wide excision for what tumors?
Chondrosarcoma, adamantinoma, parosteal osteosarcoma, chordoma
135
Most common malignant sarcoma of soft tissue in adults?
Undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma - not to be confused with MFH of bone).
136
MRI imaging for PVNS?
Low on T1 and T2
137
Histology of synovial sarcoma?
Biphasic - epithelial cells (carcinoma) and spindle cells (fibrosarcoma)
138
When is chemotherapy used in chondrosarcoma?
Only used as an adjunct with dedifferentiated and mesenchymal types.
139
Dedifferentiated chondrosarcoma on histology?
Look for high grade spindle cell sarcoma associated with low-grade cartilage component
140
Most common primary malignant lesions of the spine
1) Chondrosarcoma 2) Chordoma 3) Ewings Sarcoma 4) Multiple Myeloma 5) Lymphoma
141
Most common primary spine tumors in the posterior elements
ABC OO OB
142
Primary Benign Spine Tumors
8 Total 1) Aneurysmal Bone Cyst 2) Eosinophilic granuloma 3) Giant cell tumor 4) Osteoid osteoma 5) Hemangioma 6) Neurofibroma 7) Osteoblastoma 8) Osteochondroma
143
Radiosensitivity of common spine mets
Radiosensitive: Myeloma, Lymphoma, neuroblastoma, seminoma Moderate RS: Breast, Prostate Resistant: Lung, GI, renal cell, sarcoma, melanoma
144
Bone cancer staging system??
Enneking System or MSTS Grade I - Low Grade Grade II - High Grade Grade III - Any grade with distant mets A: Intracompartmental B: Extracompartmental Most common = IIB
145
IHC for leiomyosarcoma
Smooth muscle actin
146
Markers for rhabdomyosarcoma
Desmin and MyoD1/myogenin
147
Markers for schwanoma or malignant peripheral nerve sheath tumor
S-100
148
Markers for vascular tumors?
CD34 and CD31
149
Markers for Ewing’s sarcoma or Peripheral neuroectodermal tumor (PNET)
CD99
150
Markers for soft tissue sarcoma
Vimentin
151
Keratin and epithelial membrane antigen (ema) staining
Epitheloid sarcoma, synovial sarcoma, or adamantinoma (keratin only)
152
Markers for lymphoma
CD20 and CD45
153
Markers for myeloma?
CD138
154
Bone malignancies with a high grade spindle component?
De-differentiated chondrosarcoma Osteosarcoma Fibrosarcoma MFH
155
Rare subtype of heterotopic ossification and genetics?
fibrodysplasia ossificans progressiva (FOP) - ACVR1 gene (Activin A type I receptor gene a BMP-1 receptor)
156
In AJCC grading for bone and sarcomas what is the difference between Stage III and Stage IV?
Stage III - High grade with regional lymph note mets Stage IV - any mets

Orthopaedic Surgery (2 decks)

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