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Pathology > Pathology Low Yield > Flashcards

Pathology Low Yield Flashcards

1
Q

What is the difference between fine needle aspiration and core needle biopsy?

A

FNA- takes only cytology, used in carcinoma mostly

Core biopsy- cytology and stromal, used mostly in sarcoma

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2
Q

What is important about an open incisional biospy?

A

1) All contacted tissues are consindered contaminated
2) Avoid exposing neurovascular structures
3) Plan for extensile approach
4) Release tourniquet prior to closure

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3
Q

Describe the MSTS (Enneking) tumor staging system?

A

System for bengin (1- latent, 2- active, 3- aggressive) and malignant (I-low grade, II-high grade, III-metastatic) that takes into account the site (T1-intracompartmental, T2-extracompartmental) and metastasis (M0 or M1)
1- Non-ossifying fibroma, enchondroma
2- ABC, UBC, chondromblastoma
3- Giant cell tumor

Osteosarcoma most commonly presents as stage IIB (high grade, extracompartmental, M0)

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4
Q

What is the mechanism of action for radiation therapy?

A

1) production of free radicals

2) Genetic damage

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5
Q

When is radiation therapy used in the setting of orthopedics?

A

1) Primary bone tumors
- Ewings sarcoma
- Primary lymphoma of bone
- solitary plasmacytoma
2) Adjuvant to soft tissue sarcoma
3) Metastatic bone disease
- Prostate very radisensitive
- Breast 70% sensitive
- GI and renal not radiosensitive

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6
Q

What are some effects of radiation on tissue?

A

1) Early
- delayed wound healing
- infection
- desquamination
2) Late
- fibrosis
- joint stiffness
- secondary sarcoma (13%)
- fractures (25%)

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7
Q

How do you distinguish telangiectatic osteosarcoma (TO) from aneurysmal bone cyst (ABC)?

A

1) They have similar radiographs (expansile eccentric lytic lesion with boney septae)
2) both have fluid-fluid levels on MRI; TO has less defined levels
3) Both have lakes of blood on histology; ABC has spindle cells, TO has malignant cells

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8
Q

What are the imaging and histological characteristics of periosteal osteosarcoma?

A

1) “sunburst” appearance on radiograph, very hot on bone scan
2) histology shows osteoid with chondroblastic matrix (if no osteoid then would be classified as chondrosarcoma)

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9
Q

What is a periosteal chondroma?

A

Rare benign chondrogenic lesion that occurs on surface of long bones; 10-20 year olds
60% in proximal humerus (also prox and distal femur)

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10
Q

What is the treatment for periosteal chondroma?

A

If symptomatic; marginal excision with excision of underlying cortex (will recur if cartilage left behind)

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11
Q

What is a chordoma?

A

Malignant tumor of primitive notochordal origin; 50% recurrence rate after tx; 50% occur in sacrum and coccyx

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12
Q

What are the most common sites for lymphoma of bone?

A

Pelvis, ribs and spine

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13
Q

What are radiographic and histologic findings in lymphoma?

A

1) large ill-defined diffuse lytic lesions
2) More common in diaphysis
3) CD20 , CD45 and lymphocyte antigen positive

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14
Q

What is the treatment for lymphoma?

A

Multi-agent chemo; can use radiation for local disease

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15
Q

What is malignant fibrous histiocytoma?

A

Similar in presentation to osteosarcoma but does not create osteoid. Rare. Also known as undifferentiated pleomorphic sarcoma

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16
Q

What are imaging and histiologic characteristics of malignant fibrous histiocytoma?

A

Heterogenous mass on MRI
Metaphyseal destructive lesion
Multinucleated giant cells with mitotic figures, pleomorphic spindle cells

17
Q

What is the radiologic appearance of a bone infarct?

A

Medullary lesion of sheet-like central lucency surrounded by sclerosis with a serpiginous border; “smoke up a chimney”
On MRI central lesion will still have normal marrow signal

18
Q

What is characterized by calcium salt deposits in the extra-capsular soft tissues?

A

Tumoral calcinosis; more common in women and african-americans in the hip and shoulder joints

19
Q

What is melorheostosis and how does it appear?

A

1) Rare benign painful disorder of the extremities characterized by formation of periosteal new bone
2) Looks like “dripping candle wax”

20
Q

What are the imaging and histiologic appearance of myositis ossificans?

A

Radiographically, there is peripheral bone formation and central lucency, compared with malignancy which has central bone formation. Histologically, there is mature lamellar bone on the periphery with osteoblastic rimming, and immature fibroblasts in the center. A cartilage component may be present.

21
Q

What is a benign dysplasia that leads to unilateral varus of the tibia?

A

Focal fibrocartilagenous dysplasia; majority are seen in toddlers or infants and auto-correct

22
Q

What is synovial chondromatosis?

A

A proliferative disease of the synodium associated with cartilage metaplasia that results in multiple intra-articular loose bodies

23
Q

Most cases of malignant peripheral nerve sheath tumors are associated with what disease?

A

Neurofibromatosis-1; the tumors are also known as neurofibrosarcoma and malignant schwannoma

24
Q

What are the histology characteristics of malignant peripheral nerve sheath tumors?

A

Spindle cells with wavy nuclei; S-100 positive, keratin negative; most are treated with wide resection and radiation

25
Q

What is the differential for Small-round-cell tumor differential (by age)?

A 
< 5 yrs: neuroblastoma or leukemia
5-10 yrs: eosinophilic granuloma
5-30 yrs: Ewing's sarcoma
>30 yrs: lymphoma
> 50 yrs: myeloma
26
Q

What is the most common solid malignant tumor of childhood?

A

Neuroblastoma; sympathetic neural tissue is cell of origin

27
Q

What is the histology of neuroblastoma?

A

Small blue cells forming rosettes

28
Q

What staining would you expect with leiomyosarcoma?

A

actin and vimentin

29
Q

What is the most common sarcoma in children?

A

rhabdomyosarcoma

30
Q

What tumor would stain MyoD1, myoglobin, myosin, desmin and vimentin positive?

A

rhabdomyosarcoma

31
Q

How are adult and pediatric rhabdomyosarcoma treated differently?

A

Child- wide resection and chemo

Adult- wide resection and radiation

32
Q

What soft tissue tumor can have calcium deposits on radiographs and fat signal on T1?

A

Hemangioma of soft tissues; can erode adjacent bone

33
Q

What is a Rare malignant and very aggressive tumor that derives from endothelium of blood vessels?

A

Angiosarcoma; is CD31 positive; treated with wide resection

34
Q

What is a Marjolin’s ulcer?

A

Area of squamous cell carcinoma that develops from chronic draining wounds or burns

35
Q

What is the classic triad of a Gloria tumor?

A

Paroxysmal pain, tender to touch, cold intolerance

36
Q

Multiple intramuscular myxomas are associated with what disease?

A

Mazabraud’s syndrome; multiple myxomas and polyostotic or monostotic fibrous dysplasia

Pathology (28 decks)

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