Pathology

Question 1

Differentiate nodular fasciitis and fibromatosis

Answer 1

Nodular fasciitis: A rapidly growing reactive lesion that probably results from trauma and affects the superficial tissues of the forearm, trunk, and back

self- limiting and cured by surgical excision

Fibromatosis-, is a locally invasive, slow growing collagenous mass that may be seen in any part of the body.

Frequently originate in a muscular fascia. Large firm and whitish.

Recur after resection, complete excision is curative

Both occur commonly with REPEATED TRAMA

Question 2

Differentiate the tissues involved in soft tissue tumors

Answer 2

-Includes skeletal and smooth muscles, fat, fibrous tissue, blood vessels and lymphatics.

Question 3

Explain general characteristics of soft tissue tumors. How common are they?

Answer 3

Neoplasms that arise from certain extraskeletal mesodermal tissues of the body.

less than 1% of all cancers in U.S.

Benign tumors are 100 times more common than malignant tumors.

Question 4

Distinguish the three types of fibromatosis

Answer 4

*Palmar/Dupuytren contracture-most common.
Fibrous nodules and cordlike bands in the palmar fascia that eventually leads to flexion contractures of the fingers.

Plantar- similar to palmar but involves the plantar aponeurosis.

Penile/Peyronie disease (macaroni)- least common. Characterized by an mass in the shaft of the penis causing it to curve toward the affected side. It may lead to urethral obstruction and pain on erection.

Question 5

Differentiate fibroma vs. fibrosarcoma. Define, describe, locations, and other components.

Answer 5

Fibroma-

A benign tumor of fibroblasts.
Most arise in ovaries and along nerve trunks (neurofibromas)

Morph-Usually small tumors that are firm and encapsulated pearly-gray on cross section.

Fibrosarcoma

A malignant tumor of fibroblasts most often found in the thigh, particularly around the knee.

Risk groups -Typically occurs in adults, but can be congenital

location -Arises from fascia, periosteum and tendons.

morph-No encapsulation: sharply demarcated with hemorrhage and necrosis.

Herring-bone pattern- /////////////
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Question 6

Describe the pathology involved in malignant fibrous histiocytoma (MFH). Define, location, and pathology.

Ends in -oma but is malignant

Answer 6

A soft tissue tumor that contains foci of histiocytic (macrophage) differentiation.

MFH typically arises in the deep fascia or within a skeletal muscle.

MOST COMMON SARCOMA ENCOUNTERED AFTER RADIATION THERAPY

Pathology- well differentiated spindle-shaped tumor cells (that resemble fibroblasts). Can look grossly encapsulated, but is not.

Question 7

Differentiate between lipoma vs. malignant liposarcoma. Specifically- where they occur on the body, morphology, histologic characteristics, and any genetic components

Answer 7

Lipoma -The most common soft tissue tumor.

Location-It can occur at any site of the body, but most appear in the subcutaneous tissue of the upper half of the body, esp. trunk and neck, and wrist.

Grossly- encapsulated, soft, yellow lesions of variable sizes, but may be large.

Histologically, it is indistinguishable from normal adipose tissue,

Liposarcoma -Comprise 20% of all malignant soft tissue tumors

Location-Most frequently found in the deep thigh and retroperitoneum, tend to grow slowly, and may attain VERY LARGE sizes.

Is there a genetic component? -Yes-Most exhibits a translocation especially myxoid (12:16).

What is the pathology of a Liposarcoma?

Morphology-Tumor varies depending on fat, mucinous, and fibrous tissue proportions

Well differentiated liposarcomas can be confused with lipomas. These have better prognosis

Histologically, the most common pattern is the presence of round “lipoblasts”

Question 8

Identify pathologic and clinical features of rhabdomyosarcomas

Answer 8

What is it?-A malignant tumor of striated (skeletal) muscle.

- The most common soft tissue tumor of children and young adults.
- Most tumors are likely derived from primitive mesenchyme that has retained the capacity for skeletal muscle differentiation.

4 different classes

1) Embryonal-
The most common form in children
Location-Frequently involves the head and neck, genitourinary tract, and retroperitoneum.
Morph-Most are well-differentiated tumors that contain the characteristic Rhabdomyoblast,

2) Sarcoma Bo-tryoi-des-
Morph-This tumor is distinguished by the formation of polypoid, grape-like tumor masses, most common in hollow visceral organs, including the vagina and the urinary bladder.
Seen exclusively in girls around 4 years
Path-tumor arises beneath the vagina or bladder in the cambium layer (dense rhabdomyoblasts)

3) Alveolar-Affects young persons.
location-Most common in extremities, but can also be seen in same sites as the embryonal types.
Morph-Club-shaped tumor cells clumps with rhabdomyoblasts
Genetic -Has a characteristic translocation.

4) Pleomorphic- least common; found in elderly
location-Most often seen in the muscle of the thigh
Morph -Differs from the other types by the marked pleomorphism of the cells.
Multinucleated giant cells are also common with this variant.

Generally 80% cure rate with combined therapies for 1,2.
3,4 is 20%.

Question 9

Describe the pathologic and clinical features of synovial sarcomas. Define, location, gross pathology, histology, clinical recurrence rate

Answer 9

What is a Synovial Sarcoma?

Define-A highly malignant soft tissue tumor arising in the area of a joint capsule, tendon and bursae.
location-mostly the knee, and hip joint of young people
Genetic -Exhibit a translocation (X:18).

What is the pathology of a Synovial Sarcoma?

Grossly, they are well- round, masses attached to a joint capsule.The tumor appears to be surrounded by a pseudocapsule.

Histologically-“biphasic Pattern”

clinical-The recurrence rate is high, and metastases occur in over 60% of cases.

Question 10

Differentiate the pathology of leiomyomas and leiomyosarcomas

Answer 10

leiomyoma- 90% the UTERUS, uterine fibroids. encapsulated, painful lesion.
Histologically-smooth muscle
Excision is curative

leiomyosarcoma- with be malignant from its origins, does not arise from the leiomyoma.

Also in uterus. Larger and softer than myoma, all the characteristics of malignant tissue. Not encapsulated etc.

Question 11

Distinguish the various 4 types of hemangiomas

Answer 11

Benign blood vessel

Usually occurs in the skin, but can also be found inside internal organs.

May be considered a hamartoma, masses of mature but disorganized cells and tissues that are native to that particular organ,

NO NEOPLASM

Capillary hemangiomas-birth marks

Most common sites are the skin, subcutaneous tissues, mucous membranes of the lips and the mouth
Cosmetic

Juvenile (Strawberry) Hemangiomas. red belly button

These lesions are found on the skin of newborns

- They grow rapidly in the first few months of life, begins to fade 
- They are composed of packed blood-filled masses of capillaries.  Have no malignant potential.

Cavernous Hemangiomas-

Lesions consisting of large vascular channels.

When they occur on the skin, they are termed “port wine stains”, but can also occur on mucosal surfaces and visceral organs,
Appears as a blue-red, soft, spongy mass, does not regress spontaneously. Gorbachof and purple butt

Question 12

Illustrate pathologic features of angiosarcomas and their locations

Answer 12

Angiosarcoma

A rare, highly malignant tumor composed of masses of malignant endothelial cells.

Occurs in either sex at any age.

- Begins as a small, painless, sharply demarcated, red nodule, on skin soft tissue
- Most enlarge to become pale gray fleshy masses without a capsule, with necrosis and hemorrhage. Crazy arm

50% mortality rate

Liver-associated with environmental exposure to arsenic and vinyl chloride. Long latency period between exposure and development of maliganancy.

Question 13

Describe the pathologic features involved in Kaposi sarcomas

Answer 13

A malignant tumor derived from endothelial cells
-Has an association with AIDS related to a loss of immunity.
Human Herpesvirus 8 (HHV8) has been detected in endothelial and spindle cells of Kaposi,
Begins as a painful purple or brown nodule in the skin, anywhere in the body.

Question 14

What are some risk factors for a worse prognosis with rhabdomyosarcoma?

Answer 14

Risks for worse prognosis->10y/o, tumor > 5cm, pleomorphic, alveolar subtypes, and advanced stages of the disease.

Question 15

Soft tissue tumors love which tissue types the most?

Answer 15

Retroperitonium, aorta, and pancreas.

Question 16

Macrophages hang out in which tissue types in great abundance?

Answer 16

lungs, and connective tissue

Question 17

What do fibroblast produce in great abundance? How common are these products in the body?

Answer 17

collagen, most abundant proteins.

Question 18

In general lipomas are described how? What about liposarcomas?

Answer 18

superficial, avascular, calcification.

deep, large, rapid growth, hypervascular (blood and lymph) calcification

Question 19

Identify the basic histology of cartilage

Answer 19

1) Fibers-collagen, elastic
2) chondrocytes-live in lacunae
3) glycoprotein, polysaccarides

Question 20

Differentiate the three types of cartilage

Answer 20

Hyaline- most common, called gristle, bluish-white, glossy.

Found- nasal septum, larynx, tracheal rings, bronchi and bronchial tubes. Also is found at JOINTS OVER THE ENDS OF LONG BONE (articular cartilage) and forms the COSTAL cartilages at the ventral ends of the ribs. It forms most of the embryonic skeleton

His- Aggregations of chondrocytes embedded in ground sub reinforced by collagen fibers

Fibrocartillage
Found-intervertebral discs, symphysis pubis and some articular cartilages.
Function-strength and stability, fibers in direction of stresses

Elastic cartilage (EEEE)
External Ear, External Auditory canal, Epiglottis, larngEal carilage, and Eustachian tubes

Function- elasticity and strength
Numerous bundles of fibers (less collagen more elastic fibers)

Question 21

Summarize the components of bone and the cell types of bone cells

Answer 21

Specialized form of connective tissue, in which the extracellular components (osteoid) are mineralized

Composed of the big 3-
ground sub-glycoproteins, , collagen fibers, osteoblasts, osteocytes and osteoclasts.

Bone matrix composition

Inorganic-
Hydroxyapatite (Ca-Phosphate) 99% of bodies Ca2+

Organic-
Type 1 Collagen

Question 22

Describe the various terminology of long bones

Answer 22

Periosteum-A dense, white fibrous membrane covering the remaining surface of the bone. Consists of two layers: outer fibrous, and the inner osteogenic layer.

Outer fibrous layer-composed of connective tissue containing blood vessels, lymphatics, and nerves that pass into the bone

Inner Osteogenic Layer: contains elastic fibers, blood vessels and Osteoblasts, the cells responsible for forming new bone during growth and repair.

Fuction-The periosteum is essential for bone growth, repair, and nutrition and for attachments.

Metaphysis: The conical area of the bone between the Epiphysis and the Diaphysis

Question 23

Distinguish between cancellous and compact bone

Answer 23

Spongy/Cancellous bone- contains many large spaces filled with marrow. It makes up most of the bone tissue of short, flat and irregularly shaped bones and most of the epiphyses of long bones. It also provides a storage area for marrow.

Compact (Dense) Bone: contains few spaces, and is deposited in a thin layer over the spongy bone tissue. Provides protection and support and helps the long bones resist the stress of weight placed on them.
-Adult compact bone has a concentric-ring like structure, whereas spongy bone does not. Blood vessels and nerves from the periosteum penetrates the compact bone

Question 24

Describe the histologic parts of cancellous bone

Answer 24

It contains an irregular latticework of thin plates of bone called Trabeculae and the spaces between the trabeculae are filled with red marrow.
Blood vessels from the periosteum penetrate the spongy bone and the Osteocytes in the trabeculae and are nourished directly from the blood circulating through the marrow cavities.

Question 25

Describe the histologic parts of compact bone

Answer 25

These blood vessels and nerves from the periosteum penetrate the compact bone through Volkmann’s Canals. The blood vessels of these canals connect with blood vessels of the medullary cavity (central part of the bone itself) and those of the Haversian Canals.
These canals run longitudinally through the bone, around them are the Lamellae, which are concentric rings of hard, calcified, intercellular substances.

Between the lamellae are small spaces called Lacunae, where Osteocytes are found

Radiating in all directions from the lacunae are minute canals called Canaliculi, which connect with other lacunae and eventually with the haversian canal.

Question 26

Summarize components of the Haversian system

Answer 26

Haversian system includes: lamellae, lacunae, osteocytes, and canaliculi. Not found in cancellous bone.

Canals help nutrients reach osteocytes

Question 27

Describe the histology of tendons and ligaments

Answer 27

Tendons

Components
Collagen type I (86%)
Proteoglycan matrix
Fibroblasts in parallel

Function
Transmit force between muscle & bone
Carry compressive forces at corners

Ligaments

Components
Collagen type I fibrils less organized than tendon
Higher percentage of proteoglycan than tendons

Function
Connect bone to bone, particularly in joints

Question 28

There are 3 things all connective tissue needs what are they?

Answer 28

Fibers- collagen 80%, elastic 20%

Cells- chondro, osteocytes, fibroblasts-produce collagen

Ground substance-polysaccaride, glycoprotein-support, flexibility, and immunology (histocytes/MO)

Question 29

What are some of the major types of connective tissue?

Answer 29

Dense regular, Dense irregular, bone, blood, cartilage, and adipose tissue.

Question 30

Describe the role of osteoblasts, cytes, and clasts in the formation and destruction of bone

Answer 30

Osteoblasts-line blood vessels produce osteoid which trapps them upon mineralization and hardening by which they become osteocytes (stuck on site). Osteoclasts (multi-nucleate) live in howship lacunae and eat the osteoid, and because they’re next to the blood vessels they can easily release Ca2+ in a hypocalemic state.

Question 31

Define osteoporosis as well as types, presentation,causes, patho. Also, explain risk factor differences in men vs women.

Answer 31

Osteoporosis characterized by an absolute reduction of the total bone mass and is extremely common.

Presentation-Mostly a disease of the elderly, who commonly present with hip (most incapacitating), and wrist, fractures, or spinal compression. Also, kyphosis and decreased height.

Secondary Osteoporosis may occur at any age and is related to: Immobilization/chronic disease, trauma, tumors, hormone imbalance, or malabsorption of nutrients (vit D, Ca) .

Causes: Genetic, parathyroid, inactivity (decreased bone density), aging.

Pathology: Bone resorption (matrix and minerals) outpaces bone formation. 0.5%-3% yr females more so than males.
Bone loss is both cortical and cancellous. Thinning vertebrae and loss of trabeculae, fat replacement.

Post menopausal women have accelerated bone loss related to estrogen. Small framed women, with smaller initial bone mass, are most at risk. Men have denser bones, and blacks generally have denser bones than whites.

Despite a marked loss of bone substance, pt’s with osteoporosis show no biochemical abnormalities.
Calcium, phosphate, and alkaline phosphatase levels are all normal. crazy!

Best diagnosed with x-ray or DEXA scan.

Question 32

Define osteopetrosis as well as types, presentation,causes, patho. Also, explain risk factor differences in men vs women.

Answer 32

AKA Marble bone disease-genetic disorder. Autosomal recessive most fatal: anemia, cranial nerve entrapment, hydrocephalus and infection. Osteopetrosis, Type II is the most common type (AD).

Patho-Genetic disorder that causes mutation in genes associated with osteoclast formation or function= decreased bone resorption and thus larger cortical bone formation. 2-3x larger (Erlenmeyer flask), also weaker (can’t remodel along lines of stress).

Histology-bone tissue is irregular with disorganization of the bony trabeculae, and absence of marrow.

Lack of bone marrow, suppresses hematopoiesis in the medullary cavity, to compensate this will have to occur more in the spleen, liver and lymph nodes which will enlarge.

Complications- AR type= death, nerve strangulation and loss of function (blindness, deafness),

Treat-bone marrow transplant-get new osteoclasts.

Question 33

What is osteomalacia? Rickets?

Answer 33

Osteomalacia-soft bones: is a disorder of adults characterized by inadequate mineralization of newly formed bone matrix. Thick osteoid

Present-aches and pains, waddling gait or no walking

Rickets is a similar disorder in children in whom the growth plates are open. They have inadequate mineralization in bone and cartilaginous matrix of the growth plate.

Present- Buddha position, Cupped shaped epiphysis, frontal bone prominence, Rachitic Rosary (enlarged costal cartilage), pigeon breast, pot belly, short and deformed limbs. Wider limbs and joints.

Underlying conditions-lack Vit D (sun, absorption, diet), phosphate deficiency, and defects in the mineralization process.

*Cod liver oil and fortified milk terminated european rickets epidemic of the 17-19th centuries.

Mal-absorption is more common in industrialized nations
usually from disease of small intestines, or anything that impedes fat absorption (fat soluble vit).

What conditions can lead to this? Phosphate deficiency, hypophosphatemia, and hypophosphatasia (low activity of bone phosphatase).

Question 34

What is Fanconi’s syndrome?

Answer 34

Inborn metabolic disorder characterized by a renal waste of phosphate (hypo), glucose etc due to renal tubular damage.

Question 35

What are some of the consequences of phosphate deficiency?

Answer 35

osteomalacia-soft bones, phosphate and calcium make up the bone matrix. If the kidneys are unable to reabsorb phosphate it will not be available for bone formation.

Question 36

What is Paget Disease?

Answer 36

A chronic condition of bone resulting from DISORDERED MODELING in which excessive bone resorption results in LYTIC LESIONS followed by disorganized and excessive bone formation.

Question 37

What is the etiology of paget disease? What is its pathology?

Answer 37

May be AD trait or related to viral infection (paramyxovirus)

Path-locations: skull, spine, pelvis, and legs mostly.
Osteolysis with marrow fibrosis, thick cortex, large bones, and with vertebral involvement “picture frame” appearance (outside bigger than inside)

Osteoclastic resorption phase then,
Mixed phase -osteoblast and clast
Burnt-out phase- little cell activity, thickened, disordered bone.
Hallmark of this phase- arrangment of lamellar bone, jigsaw puzzle “mosasic pattern”

Question 38

What is the characteristic cell of paget disease? What are the clinical features? Most useful lab test?

Answer 38

osteoclast

1) Pain in the bone.
2) Localized lysis of bone in the frontal and parietal bones of the skull. osetoperosis circumscripta
3) Thickening of the skull can collapse C1 and cause compression of brain and spinal cord.
4) facial bone size increases-picture “lion face”
5) bones snap like chalk-transversly
6) increased CO
7) Malignancies (tumors) can arise

Lab test- serum alkaline phosphatase level: correlates with osetoclast activity.

Treat- most asymptomatic and require no treatment.

Question 39

What is Osteogenesis Imperfecta?

Answer 39

A group of heritable disorders of connective tissue, caused by mutations in the gene for Type I Collagen. (Autosomal Dominant)
Affects the skeleton, joints, teeth, sclera, skin, ligaments, and the ears.
Involves mutations of COL1A1 and COL1A2 genes, which encode for the chains of Type I Procollagen, the major structural protein of bone.

Mutations is COL1A1 are seen in all types of OI. Affect 3/4 of Type I collagen molecule

Mutations in COL1A2 affect about 1/2 molecule.

There are 4 types.

Question 40

Describe Type 1 Osteogenesis Imperfecta (OI)

Answer 40

Type 1-mildest, extremely thin bones, prone to very frequent fracture, blue sclera.

Fractures decrease in severity and Hz as the child grows up. May become deaf in adulthood due to fusion of the ossicles.

joint laxity= kyphosis and flat feet, blue teeth,

Question 41

Describe Type 2-4 Osteogenesis Imperfecta (OI)

Answer 41

Type II- lethal perinatal disease:still born or die quick. Crushed in the uterus or birth canal.

Type III-most progressive and severely deforming

Type IV-similar to type I with normal sclera. Treated with many othopedic devices (rods) to prevent dwarfing effect from fractures.

Question 42

Describe the etiology, clinical features and pathology of aseptic bone necrosis

Answer 42

AKA-osteonecrosis-ischemia due to emboli or trauma, radiation therapy.

Higher risk among children and adolescents.
High risk bones-carpals, femur

Question 43

Explain the pathology/clinical features of Polyarteritis Nodosa (PAN)

Answer 43

An acute, necrotizing vasculitis that affects muscular arteries
Not as common compared to other vasculitides

The most prominent feature of the affected artery is an area of fibrinoid necrosis in which the medial muscle and adjacent tissue are fused into a eosinophilic mass of fibrin. Acute inflammatory response surrounds the area along with immune cells PMNs etc.

Injury to larger arteries is associated with the formation of small aneurysms, particularly in the renal, coronary, and cerebral arteries. Can be fatal if ruptured.

Diagnose with P-ANCA Ab

Usually fatal without treatment of corticosteroids

Question 44

Describe genetic cause and HgB results in SSA

Answer 44

Caused by a genetic defect in the synthesis of beta chain hemoglobin. Glut-Val sub. Normal Hgb A is replaced with abnormal S.

Question 45

Explain characteristics and etiology of SSA

Answer 45

Prevalent in African Americans and more so in native Africans due to its protective affect against malaria.

At the same time, the abnormal blood cells are hemolyzed in the spleen at an accelerated rate, so the patient develops signs of chronic anemia and jaundice, and the bone marrow undergoes compensatory erythroid hyperplasia.

usually noticed symptoms 1-2 y/o when Hgb F (fetal) is replaced with Hgb A

Question 46

Differentiate path and clinical findings of SSA

Answer 46

Hgb S > so do symptoms starting at 40%

HgbS polymerizes at low O2 causing RBC deformities/sickling. These cells can aggregate and occlude small blood vessels causing ischemia.

Anemia-periodic exacerbation’s are termed sickle crisis or hemolytic crisis: usually aggravated by some type of hypoxia (exercise, Mt.climbing)

Jaundice-hyperbilirubinemia

Path- repeated sickle crisis cause multiple infarcts in various organs.

Question 47

Describe the soft tissue and bone complications involved in SSA

Answer 47

Pain in hands and feet (hand-foot syndrome), visual problems, neurologic defects (stroke) and mental retardation, aseptic bone necrosis (increase risk of infection) and osteomyelitis. Cardiac hypertrophy and failure (trys to compensate for low O2), lead to pulmoary edema and pneumonia. occlusion of small vessels exaserbates condition by increasing resistance.

Autosplenectomy- fibrosis of the spleen from multiple infarcts leads to shrinkage and necrosis. All organs have some scarring.

Question 48

Explain the lab findings in the diagnosis of SSA

Answer 48

Both the spleen and liver are overloaded with hemosiderin derived from hemolyzed red cells. Loss of the spleen and the overloading of hepatic phagocytic cells with hemosiderin reduces the body’s defense against infection.

Lab- hemoglobin electrophoresis migration of A vs S are different. Test tube of blood exposed to low O2 sickles.

Question 49

Describe the relevant features of osteosarcoma

Answer 49

Osteosarcoma-is a highly malignant, and most common primary tumor of bone.
Risk factors-tall adolescent boys, can be complication of Paget disease, radiation exposure, or preexisting benign bone lesion.

Locations- Metaphysis of a long bone esp. KNEE (tibia and distal femur), hip, humerous and face.

X ray-codman triangle, sunburst (looks like yeast growing on an agar plate)

Question 50

Chrondrosarcoma

Answer 50

A malignant tumor originating from cartilage producing cells

It is the second most common primary malignant bone tumor.

Common presentation-Arises in the medullary cavity of the pelvis, ribs and long bones. H&N in the medullary cavity.

Clinical-deep pain increases over time. Generally not detectable through palpation. Unlike osteosarcoma they can penetrate the cortex, but do not generally extend beyond the periosteum. Grows slow.

Gen-trisomy 7
Treat-wide excision.

Question 51

Explain the pathology and clinical features of Osteosarcoma

Answer 51

Presents how? hemorrhagic, cystic bony area which may break through the cortex to elevate the periosteum. Can also spread into marrow or joint space.

Histo-Woven bone, laid down haphazardly.

path-spread to lungs 98%

clinically- intermittent pain, the adjacent joint limited ROM.

Diagnosis- increased serum alkaline phosphatase test (just like Pagent disease).
.

Question 52

Describe bone tumors in general. FYI, may help with the set up of a question stem.

Answer 52

Uncommon tumors that occur mostly in children and young persons that are potentially lethal.
May arise from any of the cellular bone elements
Most occur near the metaphysis and more than 80% of all primary tumors occur in either the distal femur or the proximal tibia.
In the growing child, these areas are character-ized by increased growth activity, and therefore, more likely to develop a tumor.

Question 53

Ewings Sarcoma

Answer 53

An uncommon malignant bone tumor.
Composed of small, round, blue cells.
Seen in childhood and adolescence,

Genetic- (9:22) trans-location in 90%. Results in aberrant fusion protein responsible for malignant transformation.

location-long bone young, pelvis and spine 30+

Path- In some cases, the neoplastic cells form rosettes.
Presence of a large amount of glycogen in tumor cells

Likes to metastasize to the lungs

X-ray onion pattern of periosteal bone, more spherical than the yeast like expansion of
osteosarcoma.

Often mistaken as osteomyelitis due to fever and weakness.

Question 54

Giant cell tumor of bone

Answer 54

Potentially malignant tumor- treat as malignant- normal life span for most patients.

Characterized by the presence of osteoclastic, multinucleated giant cells,

more common in asians, and women.

90% junction between the metaphysis and epiphysis of long bone esp. knee.

X-ray soap bubble appearance , (bony shell that expands the bone).

path- clearly circumscribed, contains focal H&N; usually limited by periosteum.

His- Two cell types: Mononuclear stromal cells
Large osteoclastic giant cells

The diagnosis of malignancy is based on the morphology of the mononuclear cells alone.

Clinic-joint pain adjacent to tumor, fracture due to thinning cortex.

Treat-curettage (cure-eh-tauge)

Question 55

multiple myeloma

Answer 55

malignant tumor of plasma cells. These cells secrete cytokines that recruit osteoclasts that cause lytic bone lesions.

Locations-skull (punched-out lesions; black circle on x-ray, up close it looks like lots of moles) spine, ribs, pelvis and femur.

Fractures common

Treat-radiation and chemo
Prognosis-poor usually die infection or kidney failure.

Question 56

Metastatic bone tumors

Answer 56

The most common malignant tumors of bone.
Carcinomas comprise most of these metastatic sites: breast, skin…
Skeletal metastasis is found in at least 85% of cancer cases; esp spine.