[PATH] Bone, Joints and Soft Tissue (Part 2 Joints and Soft Tissue)[Martin]

Question 1

What is the most common benign bone tumor?

Answer 1

Osteochondroma

Question 2

Osteochondroma

Age common in?

Gender?

Genetic weirdness?

Answer 2

Age common in = Early adulthood

Gender = Men

Genetic weirdness = AD Multiple hereditary exostosis can progress to chondrosarcoma (very for benign to become metastatic)

Question 3

What is the gene associated with Osteochondroma?

Answer 3

EXT1 or EXT2

Question 4

Where do osteochondromas typically manifest?

Answer 4

Metaphysis near growth plate of tubular bone

Question 5

Name something very unique about the morphology of osteochondromas

Answer 5

Medullary cavity is continuous

Question 6

What is an enchondroma?

Answer 6

Within medullary cavity

Nodules of hyaline cartilage

Question 7

What is the syndrome name for the following:

Multiple enchondromas =

Multiple enchondromas + angiomas =

Answer 7

Multiple enchondromas = Ollier syndrome

Multiple enchondromas + angiomas = Maffucci syndrome

Question 8

What is the second most common malignant matrix producing tumor of bone?

Answer 8

Chondrosarcoma

Question 9

Chondrosarcoma

Gender?

Age?

Location?

Mets?

Answer 9

Gender = Male

Age= 40s and older

Location= Axial skeleton (pelvis, shoulders, ribs)

Mets= lungs

Question 10

Buzz word for chondrosarcoma on XRAY?

Answer 10

Flocculent densities

“tufts of wool”

Question 11

Classic presentation of Osteoid osteoma?

Answer 11

Painful

Worse at night

Responds to aspirin and NSAIDS

<2cm

Question 12

What is a radiographic clue that you have a osteoid osteoma?

Answer 12

Thick rind of reactive cortical bone

Question 13

How do you treat osteoid osteoma?

Answer 13

Radiofrequency ablation

Question 14

Osteoblastoma

Size?

Location?

Bony reaction?

Reponse to aspirin?

Treatment?

Answer 14

Size = >2cm

Location= Posterior spine

Bony reaction=NO bony reaction

Reponse to aspirin= NO response to aspirin

Treatment= Excised

Question 15

What is the most comon primary malignant tumor of bone?

Answer 15

Osteosarcoma

Question 16

Osteosarcoma

Age=

Gender=

Risk factors=

Buzzword=

Answer 16

Age= Teens

Gender= Males

Risk factors= Pagets, Prior radiation, Rb gene, Li-Fraumani syndrome

Buzzword= Codman triangle

Question 17

Ewing Sarcoma

Race?

Type of tumor?

Gene?

X-ray?

Answer 17

Race = Whites

Type of tumor = Small blue round cell tumor

Gene = t(11;22) (q24;q12) EWS-FL11 fusion gene

X-ray = Onion skin

Question 18

Histology association with ewing sarcoma?

Answer 18

Homer-wright rosettes

Question 19

Fibrous dysplasia

Define:

Answer 19

Benign proliferation of fibrous tissue and bone that do not mature

Question 20

Radiographic buzzword for fibrous dysplasia?

Answer 20

Ground glass appearance

Question 21

What are the associated clinical manifestations seen with McCune-Albright disease?

Answer 21

Cafe-au lait

Prevocious puberty

Question 22

What are the associated clinical manifestations with mazabraud syndrome?

Answer 22

Polyostotic ; multiple skeletal deformities in childhood

Soft tissue myxomas

Question 23

What are the histologic buzzwords associated with fibrous dysplasia?

Answer 23

Curvilinear trabeculae

Chinese characters

Question 24

Giant cell tumor of bone

Age?

Benign/malignant?

Location?

Makeup?

Answer 24

20-40

Benign

Epiphyses, knee

Multinucleated osteoclast-type giant cells

Question 25

What is the most common form of skeletal malignancy?

Answer 25

Metastatic tumors

Question 26

Where are the 4 most common locations metastatic tumors originate from(in adults)?

Answer 26

Prostate Breast Kidney Lung

Question 27

Where do metastatic tumors typically originate from in children?

Answer 27

Neuroblastomas Wilms Osteosarcoma Ewing Rhabdomyosarcoma

Question 28

What is the one **blastic** bone forming cancer?

Answer 28

Prostatic adenocarcinoma

Question 29

JOINTS

Question 30

Osteoarthritis Location in women vs men: Disease of? Worse in morning or evening?

Answer 30

Women=Hands and knees, Men=Hips CARTILAGE, 'wear and tear' EVENING stiffness, worse with use

Question 31

Rheumatoid arthritis (RA) Gender? DIsease? Worse in morning or evening?

Answer 31

Women Autoimmune Morning stiffness

Question 32

What are tests that support the diagnosis of RA if elevated?

Answer 32

Rheumatoid factor (RF) Anti-cyclic citrullinated peptide (CCP) antibodies Erythrocyte sedimentation rate (ESR0 C-reactive protein (CRP)

Question 33

What are the typical signs of rheumatoid arthritis?

Answer 33

Boutonneire Swan neck Ulnar deviation of fingers Radial deviation of the wrist

Question 34

What are the typical histological features of **RA?**

Answer 34

**Pannus** Synovial hypertrophy Lymphoid aggregates

Question 35

Describe the differences b/w **osteo** and **RA**

Answer 35

Question 36

Ankylosing spondylitis is associated with?

Answer 36

HLA-B27

Question 37

What is the triad associated with **reactive arthritis?**

Answer 37

Arthritis Urethritis/cervicitis **Conjunctivitis**

Question 38

Answer 38

Psoriatic arthritis

Question 39

What is the associated radiographic finding with **psoriatic arthritis?**

Answer 39

Pencil-in-cup

Question 40

Suppurative arthritis Name the most likely organism \<2yo Adults

Answer 40

\<2yo = H.Influenza Adults = Staph aureus, Gonococcus

Question 41

Describe the disease process of **gout**

Answer 41

Transient attacks of acute arthritis initiated by **crystallization of monosodium urate (MSU)** within and around joints

Question 42

What would be the **plasma** levels in a gout attack?

Answer 42

Plasma levels \>**6.8 mg/dl**

Question 43

What cytokine is associated with **acute gouty arthritis?**

Answer 43

IL-1

Question 44

Pseudo gout histology?

Answer 44

Crystals form **chalky, white friable deposits** Oval blue-purple aggregates

Question 45

What is a **ganglion cyst?**

Answer 45

On the **wrist**, firm **fluctuant** pea-sized translucent nodule

Question 46

What is a **lipoma?**

Answer 46

Benign tumor of **adipose tissue** \*Most common soft tissue of adults

Question 47

What is the malignant tumor of fat?

Answer 47

Liposarcoma

Question 48

What is the most common histologic varient of **liposarcomas?**

Answer 48

Myxoid

Question 49

What is a **rhabdomyosarcoma?**

Answer 49

Malignant skeletal muscle tumor

Question 50

What is the gross appearance of **rhabdomyosarcoma?**

Answer 50

Grape like "Cambium layer"

Question 51

What are the characteristics of **leiomyoma?**

Answer 51

Benign **smooth muscle** tumor Most common neoplasm in women

Question 52

What are the characteristics of **leiomyosarcomas?**

Answer 52

Local extension, mets to lungs

Question 53

Synovial sarcoma Age? Positive for? Mets? Prognosis?

Answer 53

20s-40s (+) for keratins, epithelial markers Lung Poor