Pathology Flashcards
are these sensitive to chemo:
- chondrosarc
- Ewings
- MFH
- rhabdomyosarcoma
- osteosarcoma
- chondrosarc NO
- Ewings YES
- MFH YES
- rhabdo YES
- osteosarcoma YES
two mechanisms of action for radiotherapy
amount of Grays for tissue healing
production of free radicals
direct genetic damage
<45 heals no worries >60 unlikely to heal
Enneking classification
classification of benign lesions
stage 1 - latent
stage 2 - active
stage 3 - aggressive
osteoblastoma
- most common location
- differences to osteoid osteoma
- posterior element of spine
- > 1.5cm. More giant cells
Osteoid osteoma
- M/F and age
- classic pain history is ___
- pathophysiology attributed to ___
- nidus made of ___ and best imaged on ___
- if larger than ___ then likely a ___
- management options
males, 5-25
at night, relieved with NSAIDs
prostaglandin E2 and COX1 COX2
osteoblasts, on CT
1.5cm, osteoblastoma
NSAIDs and watch, RF ablation, surgical resection
Osteosarcoma
- the most common _____
- can develop from ____
- associated with other malignancy:
- high blood markers:
- chemo
- 5 year survival:
malignant childhood tumour
Paget’s, fibrous dysplasia, bone infarct
retinoblastoma
ALP and LDH
chemo yes
70%
Parosteal osteosarcoma
- order prognosis of osteosarcoma / parosteal sarcoma / periosteal sarcoma
- 80% at which part of which bone
- typical histological feature
- treatment
osteosarcoma worst | parosteal sarcoma best
metaphyseal femur
atypical spindle cells, similar to fibrous dysplasia
local resection only
Periosteal osteosarcoma
- what differentiates from classic osteosarcoma
- associated with ___ mutation
- XR and bone scan appearance
- typical histology
- treatment
does not involve medulla
p53
sunburst, hot
chondroblastic matrix but with osteoid
wide resection and chemotherapy
Enchondroma
- most common tumour of the ___
- rarely will transform into ___
- specific syndrome
- specific disease
- pathophysiology
- differentiating from bone infarct
hand
chondrosarcoma
Maffucci’s syndrome - enchondroams with haemangiomas, 100% develop some malignancy
Ollier’s disease - enchondromatosis or multiple enchondromas, 30% malignant, sporadic mutation
incomplete endochondral ossification - epiphyseal cartilage escapes from physis
enchondroma high T2 on MRI scan
telangiectatatic osteosarcoma
- location similar to
- histology similar to
- treatment
- prognosis
ABC
ABC
wide local excision and chemo
70% 5-year survival, very poor if metastasised
Osteochondroma
- most common ___
- multiple hereditary exostosis inheritance pattern:
- risk of malignant transformation is ___
- specific disease
benign bone lesion
autosomal dominant with incomplete penetrance
10% if multiple, 1% if single
Trevor’s disease - osteochondroma on epiphyseal side, causes varus/valgus
chondroblastoma
- associated with ___
- pathophysiology
- classic appearance and location
- demographic
- managed with ___
- recurrence rate ___
ABCs
epiphysis of proximal tibia, distal femur - thin sclerotic rim
thought to arise from physeal plate
<25 years
curette and bone graft
20%
chondrosarcoma
- incidence
- genetic association
- chemotherapy ____
- prognosis
20% of all primary malignant bone tumours
p53 gene
chemo if metastasised but OFTEN resistant
5-year survival depends on grade
1 - 90%
2 - 70%
3 - 40%
GCT
- peak age
- histo shows ___
- metastases
- radiotherapy ___
20-30
multi-nucleated giant cells
2% pulmonary mets
increases recurrence rate
Ewing’s sarcoma
- originates from___
- genetic association
- immunostaining positive for
- 5 year survival
- treatment with
endothelial cells in the marrow
t(11:22) translocation
CD99
70%
wide local resection, chemo and radiotherapy
MFH
- stands for ___
- now known as
- in a sentence f
- typical appearance
- ___% arise from ___
- radiotherapy ___
- 5 year survival
- malignant fibrous histiocytoma
- pleomorphic sarcoma of bone
- primary mesenchymal tumour that resembles fibrosarcoma
- lytic lesion in metaphysis
- 25% arise from Paget’s, bony infarct or radiation
- resistant to radiotherapy
- 5 year survival 50%
chordomas
- origin
- classic presentation
- what is CONTRA-indicated
- important differentiator from chondrosarcoma
primitive notochordal origin arising commonly in sacrum
>50yo back pain, bladder/bowel dysfunction
transrectal biopsy
keratin positive on histo
fibrosarcoma
- radiographically looks like___
- treatment
- prognosis
osteosarcoma
wide excision and chemo
30% 5 year survival if high grade (most are)
Eosinophilic granuloma
- known as the “___ ___”
- natural history
- can be managed with
- solitary lesion in__%
- mildest form of ___. Disseminated form of which is ___
great imitator - infection and neoplasm
self-limiting
prednisolone
60-80%
Langerhans cell histiocytosis. Disseminated form is Hand-Schuller-Christian disease - triad of exophthalmos, diabetes insipidus, lytic skull lesions
Fibrous dysplasia
- a slow growing ____
- associated with ___
- radiation ___
- genetic association
- characteristic histological finding
- if symptomatic can treat with
hamartoma
cafe au lait spots
increases risk of malignant transformation
GNAS mutation
Chinese letters
bisphosphonates
aneurysmal bone cyst
- does not have ___, this would suggest ___
- radiological appearance
- location
- calcification, chondroblastoma or chondrosarcoma
- lytic, expansile with septae
- spine, long bones, calcaneus
unicameral bone cyst
- commonly discovered with ___
- specific XR sign
- natural history
- most common site
- recurrence is ___
- to determine if active vs latent
pathological fractures
fallen fragment sign
moves into diaphysis and matures
proximal humerus
high
active if adjacent to physis
haemangioma
- best seen on which scan
- can look like a
- common sites
- treatment
Gad MRI scan
osteoid osteoma
vertebrae, skull
observation, or curette and graft is symptomatic
Synovial sarcoma
- most common ___
- ___ have metastases, usually to the ___
- 5 year survival
- derived from the ___, NOT from ___
- treated with ___
malignant sarcoma of the foot
30-60%, lung
50%
mesenchyme, NOT synovial cells
resection, radiotherapy, NOT chemotherapy
myositis ossificans
- form of ___
- occurs as a result of ___
- at centre of lesion is ___ and periphery is ___
- matures in which area first
- does not progress to ___
- acute phase has similarities to ___
- treatment
HO
trauma or intramuscular haematoma
immature fibroblasts. mature lamella bone with calcification
periphery
fibrodysplasia ossificans progressiva
sarcoma
wait until matures, then excise if symptomatic - minimum 6 months after matures
risk factors for osteonecrosis and for bone infarct
classic XR finding of bone infarct
sickle cell
thalassaemia
Gaucher’s
steroids
alcohol
radiotherapy
chemotherapy
smoke up the chimney
non-ossifying fibroma
- age and location
- treatment
age 5-15, metaphysics long bones - femur tibia most common
usually observation only, curette and graft if symptomatic / large
FOP
- stands for
- nickname
- inheritance and gene
- what happens
fibrodysplasia ossicans progressiva
stone man disease
autosomal dominant - ACVR1 gene
fibrous tissue osssifies
