[PATH] Bone, Joints and Soft Tissue (Part 2 Joints and Soft Tissue)[Martin] Flashcards
What is the most common benign bone tumor?
Osteochondroma
Osteochondroma
Age common in?
Gender?
Genetic weirdness?
Age common in = Early adulthood
Gender = Men
Genetic weirdness = AD Multiple hereditary exostosis can progress to chondrosarcoma (very for benign to become metastatic)
What is the gene associated with Osteochondroma?
EXT1 or EXT2
Where do osteochondromas typically manifest?
Metaphysis near growth plate of tubular bone
Name something very unique about the morphology of osteochondromas
Medullary cavity is continuous
What is an enchondroma?
Within medullary cavity
Nodules of hyaline cartilage
What is the syndrome name for the following:
Multiple enchondromas =
Multiple enchondromas + angiomas =
Multiple enchondromas = Ollier syndrome
Multiple enchondromas + angiomas = Maffucci syndrome
What is the second most common malignant matrix producing tumor of bone?
Chondrosarcoma
Chondrosarcoma
Gender?
Age?
Location?
Mets?
Gender = Male
Age= 40s and older
Location= Axial skeleton (pelvis, shoulders, ribs)
Mets= lungs
Buzz word for chondrosarcoma on XRAY?
Flocculent densities
“tufts of wool”
Classic presentation of Osteoid osteoma?
Painful
Worse at night
Responds to aspirin and NSAIDS
<2cm
What is a radiographic clue that you have a osteoid osteoma?
Thick rind of reactive cortical bone
How do you treat osteoid osteoma?
Radiofrequency ablation
Osteoblastoma
Size?
Location?
Bony reaction?
Reponse to aspirin?
Treatment?
Size = >2cm
Location= Posterior spine
Bony reaction=NO bony reaction
Reponse to aspirin= NO response to aspirin
Treatment= Excised
What is the most comon primary malignant tumor of bone?
Osteosarcoma
Osteosarcoma
Age=
Gender=
Risk factors=
Buzzword=
Age= Teens
Gender= Males
Risk factors= Pagets, Prior radiation, Rb gene, Li-Fraumani syndrome
Buzzword= Codman triangle
Ewing Sarcoma
Race?
Type of tumor?
Gene?
X-ray?
Race = Whites
Type of tumor = Small blue round cell tumor
Gene = t(11;22) (q24;q12) EWS-FL11 fusion gene
X-ray = Onion skin
Histology association with ewing sarcoma?
Homer-wright rosettes
Fibrous dysplasia
Define:
Benign proliferation of fibrous tissue and bone that do not mature
Radiographic buzzword for fibrous dysplasia?
Ground glass appearance
What are the associated clinical manifestations seen with McCune-Albright disease?
Cafe-au lait
Prevocious puberty
What are the associated clinical manifestations with mazabraud syndrome?
Polyostotic ; multiple skeletal deformities in childhood
Soft tissue myxomas
What are the histologic buzzwords associated with fibrous dysplasia?
Curvilinear trabeculae
Chinese characters
Giant cell tumor of bone
Age?
Benign/malignant?
Location?
Makeup?
20-40
Benign
Epiphyses, knee
Multinucleated osteoclast-type giant cells
What is the most common form of skeletal malignancy?
Metastatic tumors
Where are the 4 most common locations metastatic tumors originate from(in adults)?
Prostate
Breast
Kidney
Lung
Where do metastatic tumors typically originate from in children?
Neuroblastomas
Wilms
Osteosarcoma
Ewing
Rhabdomyosarcoma
What is the one blastic bone forming cancer?
Prostatic adenocarcinoma
JOINTS
Osteoarthritis
Location in women vs men:
Disease of?
Worse in morning or evening?
Women=Hands and knees, Men=Hips
CARTILAGE, ‘wear and tear’
EVENING stiffness, worse with use
Rheumatoid arthritis (RA)
Gender?
DIsease?
Worse in morning or evening?
Women
Autoimmune
Morning stiffness
What are tests that support the diagnosis of RA if elevated?
Rheumatoid factor (RF)
Anti-cyclic citrullinated peptide (CCP) antibodies
Erythrocyte sedimentation rate (ESR0
C-reactive protein (CRP)
What are the typical signs of rheumatoid arthritis?
Boutonneire
Swan neck
Ulnar deviation of fingers
Radial deviation of the wrist
What are the typical histological features of RA?
Pannus
Synovial hypertrophy
Lymphoid aggregates
Describe the differences b/w osteo and RA
Ankylosing spondylitis is associated with?
HLA-B27
What is the triad associated with reactive arthritis?
Arthritis
Urethritis/cervicitis
Conjunctivitis
Psoriatic arthritis
What is the associated radiographic finding with psoriatic arthritis?
Pencil-in-cup
Suppurative arthritis
Name the most likely organism
<2yo
Adults
<2yo = H.Influenza
Adults = Staph aureus, Gonococcus
Describe the disease process of gout
Transient attacks of acute arthritis initiated by crystallization of monosodium urate (MSU) within and around joints
What would be the plasma levels in a gout attack?
Plasma levels >6.8 mg/dl
What cytokine is associated with acute gouty arthritis?
IL-1
Pseudo gout histology?
Crystals form chalky, white friable deposits
Oval blue-purple aggregates
What is a ganglion cyst?
On the wrist, firm fluctuant pea-sized translucent nodule
What is a lipoma?
Benign tumor of adipose tissue
*Most common soft tissue of adults
What is the malignant tumor of fat?
Liposarcoma
What is the most common histologic varient of liposarcomas?
Myxoid
What is a rhabdomyosarcoma?
Malignant skeletal muscle tumor
What is the gross appearance of rhabdomyosarcoma?
Grape like
“Cambium layer”
What are the characteristics of leiomyoma?
Benign smooth muscle tumor
Most common neoplasm in women
What are the characteristics of leiomyosarcomas?
Local extension, mets to lungs
Synovial sarcoma
Age?
Positive for?
Mets?
Prognosis?
20s-40s
(+) for keratins, epithelial markers
Lung
Poor
