Pediatric Tumors Flashcards
Signs/Symptoms of Bone Tumors & Bone Tumor-like Lesions
Persistent skeletal pain & swelling
Limitation of motion
Spontaneous fracture
Proceed with clinical, radiographic, lab & biopsy exam
Examples of Osteoblastic Connective Tissue Tumors
Osteoid osteoma
Osteosarcoma
Examples of Cartilage Tumors
Enchondromas
Chondromyxoid fibromas
Chondrosarcomas
Examples of Bone Tumors
Giant cell
Chondroblastomas
Ewing’s sarcoma
Things to Beware of
Night pain
Constant pain
Unusual symptoms
No improvement with conservative management
General symptoms
X-ray findings with lytic or blastic bone changes, soft tissue calcification or periosteal reaction
Unexplained mass
Evaluation of Pediatric Tumors
Physical exam
X-rays
Possible: bone scan, CT/MRI, chest x-rays/CT for high risk lesions
Consider: labs, consults/referrals
Biopsy of Tumor
Ideal if “ultimate” surgeon performing
Treatment of Clearly Benign Tumors
Observation vs. excision/curettage
Treatment of Possibly Malignant Tumors
Consider referral to regional cancer center
Who is all part of the team at regional cancer centers?
Pathologists Radiologists Surgeons Oncologists Radiation therapists
Classification of Tumors
Bony vs. soft tissue
Benign vs. malignant
Primary vs. metastatic
Epidemiology of Osteosarcoma
2nd most common primary bone tumor
High risk mets
Male = Female
Appendicular
X-ray Findings in Osteosarcoma
Mixed lytic/sclerotic lesions with cortical destruction
Epidemiology of Ewing’s
Highly anapestic
Long bone diaphyses
X-ray Findings in Ewing’s
Lytic, moth-eaten, indistinct margins, “onion skin”
Prognosis of Ewing’s with Pre-op Chemotherapy
Survival rate: 80-90%
Types of Resection with Soft Tissue Tumors
Intra-lesional
Marginal
Wide
Radical
Describe Soft Tissue Tumors
Small, superficial cystic lesions: benign/observed
Large, deep solid tumors: studies/biopsy
Different Classes with Soft Tissue Tumors
Fibrous Lipomatous Smooth muscle Striated muscle Vascular Synovial Neurologic
Determinants of Staging of Soft Tissue Tumors
Tumor grade
Location
Extension
Mets
What is the most common cause of bone tumors?
Metastatic disease
What cancers primarily have mets in the bones?
Breast
Lung
Prostate
Kidney
Most Common Bones for Metastatic Disease
Spine
Ribs
Pelvis
Proximal limb girdles
Common Pitfalls with Metastatic Bone Disease
Assume metastatic
Inadequate workup, planning, or fixation
Not knowing when to refer
Treatment of Metastatic Bone Disease
Fracture risk
Function
Palliation
Benign Bone Tumors
Osteochondroma
Osteoid osteoma
Bone cyst
Non-ossifying fibroma
What is the most common of benign primary bone tumors?
Osteochondroma
Most Common Location of Osteochondroma
Knee
Proximal humerus
Gender Distribution of Osteochondroma
Males > females
2:1
When does Osteochondroma generally occur?
2nd & 3rd decades
When do osteochondromas generally stop growing?
At skeletal maturity
What tests can you run if you are unclear on the diagnosis of an osteochondroma?
CT
MRI
Treatment for Osteochondroma
Surgery
Excise cartilage & perichondrium
Define Nidus
Well demarcated, bone forming, up to 1 cm
When do osteoid osteoma generally present themselves?
2nd & 3rd decade
Gender Distribution of Osteoid Osteoma
Male > Female
3:1
Most Common Location of Osteoid Osteoma
Long bones lower extremity
Cortex
Posterior elements lumbar spine
Presentation of Osteoid Osteoma
Dull/sharp pain
Worse at night
Better with aspirin/NSAIDs
Tests to Diagnosis Osteoid Osteoma
X-ray
CT
Treatment of Osteoid Osteoma
En bloc resection
Percutaneous radio frequency ablation
Gender Distribution of Unicameral Bone Cyst
Male > Female
3:1
Age 5-15
Most Common Location of Unicameral Bone Cyst
Proximal humerus
Describe a Unicameral Bone Cyst
Central radiolucent lesion metaphysical side of growth plate on long bones
Test if Unsure on Diagnosis of Unicameral Bone Cysts
MRI
When is fibrous cortical defect/non-ossifying fibroma (FCD-NOF) common?
Common in childhood
First 2 decades
Where is fibrous cortical defect/non-ossifying fibroma (FCD/NOF) commonly found?
Metaphysics of long bones
How to treat if weakening of the bone in fibrous cortical defect/non-ossifying fibroma (FCD-NOF)?
Currettage/graft
Treatment of Fractures in Fibrous Cortical Defect/Non-Ossifying Firoma (FCD-NOF)
Immobilize
Observe
Sometimes lesion heals
Malignant Bone Tumors
Osteosarcoma
Ewing’s
Metastatic disease