Orthopedic Pathology: Introduction Flashcards
Order of importance for AJCC staging system
- stage
- metastases
- skip lesions
- grade
- size
Enneking System
I - Low grade
II - High grade
III - Any grade with metastases
A - Intracompartmental
B - Extracompartmental
EXAMPLES : IA, IB, IIA, IIB, IIIA, IIIB
Low grade tumors:
BONE
* parosteal osteosarcoma
* primary chondrosarcoma
* secondary chondrosarcoma
* hemagioendothelioma
* chordoma
* adamantinoma
High grade tumors:BONE
* intramedullary osteosarcoma (classic)
* post-radiation sarcoma
* paget sarcoma
* fibrosarcoma
* malignant fibrous histiocytoma
Low grade tumors:SOFT TISSUE
* myxoid liposarcoma
* lipoma-like liposarcoma
* angiomatoid malignant fibrous histiocytoma
* rhabdomyosarcoma
High grade tumors:SOFT TISSUE
* malignant fibrous histiocytoma
* pleomorphic liposarcoma
* synovial sarcoma
* alveolar cell sarcoma
Common metastatic bone lesions:BIRTH TO 5 YEARS
* Leukemia
* metastatic neuroblastoma
* metastatic rhabdomyosarcoma
Common benign bone lesions:BIRTH TO 5 YEARS
* osteomyelitis
* osteofibrous dysplasia
Common metastatic bone lesions:10-25 YEARS
* osteosarcoma
* ewing tumor
* leukemia
Common benign bone lesions:10-25 YEARS
* eosinophilic granuloma
* osteomyelitis
* enchondroma
* fibrous dysplasia
Common metastatic bone lesions:40-80 years
* metastatic bone disease
* myeloma
* malignant fibrous histiocytoma
* paget sarcoma
* post-radiation sarcoma
* lymphoma
* chondrosarcoma
B HEMP
Common benign bone lesions:40-80 years
* hyperparathyroidism
* paget disease
* mastocytosis
* enchondroma
* bone infarcts
Most common soft tissue tumor in children?
Hemangioma
Most common soft tissue tumor in adults?
Lipoma
Most common malignant soft tissue tumor in children?
Rhabdomyosarcoma
Most common malignant soft tissue tumor in adults?
Malignant fibrous histiocytoma
Most common primary benign bone tumor?
Osteochondroma
Most common primary malignant bone tumor?
Osteosarcoma
Most common secondary benign lesion?
Aneurysmal bone cyst
Most common secondary malignant lesions?
* Malignant fibrous histiocytoma
* Osteosarcoma
* Fibrosarcoma
Most common phalangeal tumor?
Enchondroma
Most common sarcoma of hand/wrist?
Epithelioid sarcoma
Most common sarcoma of the foot/ankle?
Synovial sarcoma
Typical neoplasms of whole bone:TIBIA
* adamantinoma
* osteofibrous dysplasia
Typical neoplasms of whole bone:POSTERIOR CORTEX OF FEMUR
* parosteal osteosarcoma
* pariosteal desmoid
Typical neoplasms of part bone:EPIPHYSIS
* giant cell tumor (starts in the meta and works down to epi)
* chondroblastoma
* aneurysmal bone cysts
* osteomyelitis (TB, fungus)
Typical neoplasms of part bone:METAPHYSIS
* metaphyseal fibrous defect
* aneurysmal bone cyst
* giant cell tumor (starts in the meta and works down to epi)
* osteosarcoma
Typical neoplasms of part bone:DIAPHYSIS
* ewing sarcoma
* fibrous dysplasia
* eosinophilic granuloma (histocytosis)
* multiple myeloma
Tumor immunostatins:LANGERHANS CELL HISTIOCYTOSIS
S100, +CD1A
Tumor immunostatins:LYMPHOMA
+CD20
Tumor immunostatins:EWING SARCOMA
+CD99
Tumor immunostatins:CHORDOMA
Keratin, S100
Tumor immunostatins:MYELOMA
+CD138
Tumor immunostatins:ADAMANTINOMA
Keratin
What two essential criteria must be met for a limb salvage procedure?
- local control of the lesion must be at least equal to amputation
- the limb that has been saved must be functional
What are the types of surgical margins?
- Intralesional margin - directly through tumor, 100% reoccurrence
- Marginal margin - through reactive zone, 25-50% local reoccurrence
- Wide margin - cuff of normal tissue, <10% local reoccurence
- Radical margin - entire tumor with surrounding compartment is removed
External beam radiation is indicated for which scenarios?
Local control of:
- Ewing sarcoma
- Lymphoma
- Myeloma
- Metastatic bone diseases
What are late affects of radiation therapy?
- post-radiation sarcoms (mostly osteosarcoma, fibrosarcoma, or malignant fibrous histiocytoma)
- late stress fractures (subtroch and diaphysis of femur MC)
Genetic defect: OSTEOSARCOMA
retinoblastoma tumor suppressor gene
Genetic defect: EWING SARCOMA
t(11,22)
Genetic defect: MYXOID LIPOSARCOMA
t(12,16)
Genetic defect: SYNOVIAL SARCOMA
t(X,18)
Genetic defect: MYXOID CHONDROSARCOMA
t(9,22)
Genetic defect: RHABDOMYOSARCOMA
t(1,13) or t(2,13)