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Bone Pathology II > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Malignancy of giant cell tumor

A

90% benign
10% malignant
Osteoclastic giant cells
6th most common bone tumor

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2
Q

Giant cell tumor history

A

20-40 yo

More commonly malignant in males

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3
Q

Signs and symptoms of Giant Cell Tumor

A

Intermittent, aching pain
Localized swelling and tenderness
Restricted joint movement
The pathologic fracture that occurs in 30% of people may be the only source of symptoms

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4
Q

Giant Cell Tumor Location

A

Metaphyseal and extending to subarticular (85%)
Distal femur, proximal tibia, distal radius, proximal humerus
Most common benign tumor of the sacrum; patella

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5
Q

Plain film findings of Giant Cell Tumor

A

eccentric, expansile
Thinned cortex and expanded
Aggressive appearance with cortical break and soft tissue mass but no sclerosis or periosteal response

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6
Q

Prognosis and treatment of Giant Cell Tumor

A

No radiographic differentiation of benign versus malignant
Curretage and packing with bone chips or wide local excision
Possible recurrence

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7
Q

What is the most common benign skeletal tumor?

A

Osteochondroma

35% of all benign bone tumors

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8
Q

Signs and symptoms of Osteochondroma

A

Asymptomatic (pushes on vessels or nerves)
May restrict joint motion
Hard, painless mass near joint
Pathologic fracture possible
Pain, rapid growth, growth after maturity may indicate malignant degeneration

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9
Q

Plain film findings of Osteochondroma

A

Bony exostosis
Cartilage cap may calcify
Projects away from the joint
Sessile version produces asymmetric widening

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10
Q

Indications for malignant transformation of benign tumors

A 
>30 y.o.
Pain
Growth after skeletal maturity
Change  on  sequential  studies
Dispersal of calcifications in cap
Osseous  destruction
Soft  tissue  mass
Thickened  cartilaginous  cap, >1.5cm (CT, MRI)
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11
Q

Prognosis and treatment of osteochondroma

A

Most require no treatment
May be resected for cosmetic purposes
Subungal exostosis requires removal

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12
Q

Characteristics of hereditary Multiple Exostosis

A

Multiple osteochondromas (10-100’s)
Dx occurs at 2-10 years old
Painless lumpy joints
25% have malignant degenration

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13
Q

Hemangioma types

A

Cavernous: vertebrae, skull, common
Capillary: flat or long bones

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14
Q

Characteristics of hemangioma

A

Most common benign tumor fo the spine
Seen after 40
Most asymptomatic

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15
Q

In what cases of hemangioma can neurological compromise be possible?

A

Ballooning of vertebral body
Extension of tumor into central canal
Pathologic fracture
Hemorrhage

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16
Q

Plain film findings of hemangioma

A

Commonly in spinal and skull
Spine: vertebral body, courderoy cloth, body expansion is rare
Skull: Lytic lesion with spoke-wheel appearance

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17
Q

DDX list for hemangioma, paget, osteoporosis

A

Hemangioma: Single lesion, normal cortex, occasional body expansion
Paget: Single or multiple lesions, thickened cortex, common body expansion
Osteoporosis: Multiple lesions, thinned cortex, no body expansion

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18
Q

Soft tissue hemangioma presentations

A

Masses frequently contain phelboliths

Maffuci syndrome

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19
Q

Gardner syndrome triad

A

45%
Multiple osteomas
Colonic polyps
Soft tissue fibromas

Polyps are considered premalignant

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20
Q

Bone Island (enostosis)

A

Solitary discrete area of sclerosis
Usually asymptomatic
Any age but more common in adults

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21
Q

Common places for bone islands

A

Pelvis, sacrum, proximal femur

Uncommon in spine

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22
Q

DDx for bone islands

A

osteoblastic metastasis, osteoid osteoma, osteoma

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23
Q

DDX list for osteoblastic metastasis, osteoid osteoma, osteoma against bone island

A

osteoblastic metastasis - Bone scan, no brush border
osteoid osteoma - pain, nidus
osteoma - location, surface contour

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24
Q

Pain characteristics of osteoid osteoma

A

Painful, rigid scoliosis

Classic  symptoms (65-75%):  increasingly severe, deep, aching pain
not relieved by rest, worse at night, relieved by aspirin
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25
Q

Location of osteoid osteoma

A

Can occur in any bone (most commonly cortical)
70% in long bones, especially proximal femur, 20% phalanges, 10% in spine, mostly neural arch lumbar > cervical > thoracic

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26
Q

Plain film findings of osteoid osteoma

A

80% cortical lesion: lucent round/oval nidus

Intramedullary and intrascapular lesions (hip)

27
Q

treatment for osteoid osteoma

A 
Surgical exision (must remove nidus entirely, spinal lesions may require bone grafting after surgery)
Commonly treated with radiofrequency ablation being used
28
Q

DDX list for painful scoliosis

A

Osteoid osteoma - sclerotic pedicle
Aneurysmal bone cyst - lucent
Osteoblastoma - lucent

29
Q

Location and age of osteoblastoma

A

40% in neural arch of spine
30% in long bone metaphysis, diaphysis
30% hands, feet, skull, face

70% <20 y.o.; 3-78 y.o

30
Q

Signs and symptoms of osteoblastomas

A

Spinal lesions: painful scoliosis*
Pain is typically less severe, not nocturnal, not relieved by aspirin
Local tenderness, palpable mass in extremities
Local muscle spasm, rigidity, referred pain, spinal stenosis

31
Q

Plain film findings of osteoblastomas

A

Spine: Expansile lytic lesion, rim of sclerosis, 4-6 cm
Extremities: Lytic, expansile; epiphysis usually spared; cortex thinned; lucent nidus >2cm
Rapid increase in size

32
Q

Treatment for osteoblastoma

A

Surgical resection/excision
Radiantion/chemotherapy for aggressive or unresectable
Percutaneous ablation

33
Q

Enchondroma frequency and age

A

2nd most common benign tumor
Cartilaginous
Most common age 10-30 y.o

34
Q

Enchondroma location

A

50% in hands or feet (most common tumor of phalanges)
50% femur, tibia, humerus, ribs

Lesions near axial skeleton more often symptomatic
Lesions near axial skeleton higher potential for malignant transformation

35
Q

Radio findings of enchondroma

A 
Lytic, geographic
Expansile
Thinned  cortex,  endosteal  scalloping
Metaphyseal-diaphyseal
Calcification (cartilage) in  50%
No periosteal reaction; no soft tissue mass
36
Q

Treatment and prognosis of enchondroma

A

Malignant transformation is rare but the likelihood increases with multiple lesions
Surgical removal for deforming or painful

37
Q

Enchondromatosis can be due to which two diseases?

A

Ollier Disease: Multiple enchondromas, usually unilateral, monomelic (may cause growth change, shortened limb, severe deformities); Malignant transformation rate 25-50%; Chondrosarcoma

Maffucci syndrome: Multiple enchondromatosis soft tissue hemangiomas (venous malformations), phleboliths
Rare; malignant transformation rate up to 25%

38
Q

Characteristics of chondrobalstoma

A 
Cartilaginous 
Usually seen before epiphyseal  closure
Most patients 5-25 y.o.
Mild, dull pain
Local tenderness, swelling, effusion
39
Q

Chondrobalstoma location

A

Epiphyseal: May extend to metaphysis

Apophyseal: Greater trochanter, greater tuberosity, femur, tibia, humerus, tarsals, pelvis
2/3 lower extremity; 50% at knee

40
Q

Appearance of chondroblastoma

A 
Lytic, geographic
Epiphyseal / Apophyseal
Eccentric  (most)
Sharp  zone  of  transition
Rim  of  sclerosis
Calcification  in  50%
Periosteal  response  possible (solid)
41
Q

Chrondroblastoma ddx with clear cell chondrosarcoma and giant cell tumor

A

Clear cell chondrosarcoma: Older patients, Larger mass

Giant cell tumor: Larger, no sclerotic border, no calcification, skeletally mature (growth plates closed)

42
Q

ChondroblastomaTreatment & Prognosis

A

Pathologic fracture can occur
Growth disturbance / limb length discrepancy
Surgical removal (curettage) and bone grafting
Local recurrence in up to 20%

43
Q

Nonossifying fibroma and fibrous cortical defect

A

FCD: 2-8 yo - less than 2cm in cortex
NOF: 8-20 yo - greater than 2cm extends into medullary cavity
Not true neoplasm
Frequent spontaneous resolution over 2-4 years
30-40% of children have FCD

44
Q

Fibrous Cortical Defect/Nonossifying Fibroma lesions and location

A

Large (>8cm) lesions more likely symptomatic
Pathologic fracture possible (only reason for treatment)
Most common sites
Lower extremity (90% in tibia or fibula) and humerus
Also ribs, ilium

45
Q

FCD/NOFRadiographic Appearance

A 
Lytic, ovoid
Sclerotic border
Diametaphyseal, eccentric
Thins, may expand cortex
Appears sclerotic when healing due to osteoblastic activity
Multiple lesions with neurofibromatosis
46
Q

Characteristics of simple bone cyst

A

3% of primary bone lesions
Not true neoplasm; fluid-filled cyst
Usually found in teenagers: Asymptomatic unless fractured, 2/3 undergo pathologic fracture

47
Q

Simple bone cyst locations

A

Proximal humerus: 50-60%
Proximal femur: 30% - less commonly: talus, calcaneus, iliac wing
Metaphyseal, immediately adjacent to physis
Latent cysts shift toward diaphysis
Central

48
Q

Simple bone cyst radiographic findings

A 
Geographic, lytic
Short zone of transition
Broad-based at physis, narrows toward diaphysis
Mild bone expansion
“Fallen  fragment” sign with fracture
49
Q

Simple bone cyst prognosis and treatment

A

Surgical treatment is recommended due to high fracture rate
30-40% recurrence rate with curettage
Steroid injection into cyst reduces recurrence

50
Q

Aneurysmal bone cyst characteristics

A

Highly expansile (or aneurysmal) cystic cavity filled with numerous blood-filled channels
5-20 y.o.
Pain and swelling either acute or more insidious onset
Pathologic fracture common

51
Q

Aneurysmal bone cyst location

A

Long tubular bones 50-60%: Most common benign tumor of clavicle
Spine & Sacrum: Posterior arch, painful scoliosis

52
Q

Aneurysmal bone cyst radio findings

A 
Highly expansile
Lytic,  septated
Eccentric
Markedly  thinned  cortex
Metaphyseal,  may extend to epiphysis  (only  benign  tumor  to  cross  growth  plate)
Periosteal  response  more  common
53
Q

Aneurysmal bone cyst treatment and prognosis

A

Surgical curettage & bone grafting
Recurrence rate ~20%

Secondary ABC: GCT, osteosarcoma, simple bone cyst, NOF, fibrous dysplasia

54
Q

Intraosseous lipoma characteristics

A 
Rarest primary benign tumor
Wide age range
Asymptomatic
Metaphysis; calcaneus
Lytic, geographic, sclerotic border
“Target” or “doughnut-shaped” sequestrum  =  central  density
CT or MRI shows fat matrix
55
Q

Paget’s disease characteristics

A

Osteitis deformans
Largely asymptomatic
Increased osteoclastic activity with immature weak bone

56
Q

Etiologies of Paget’s disease

A

Viral infection + hereditary factors
Others: Inflammatory disorder, endocrine disorder,
autoimmune disorder, inborn error of connective tissue metabolism, vascular disorder, neoplasm

57
Q

Pagets disease clinical features

A

Rare before age 40
Localized pain & tenderness
Hypervascularity leads to focal increased temperature
Increased bone size
Deformities/pathologic fracture may occur
Polyostotic
High-output congestive heart failure may result

58
Q

Phases of Paget’s disease

A

Phase 1: osteoclastic activity
Phase 2: osteoclastic + osteoblastic activity
Phase 3: osteoblastic activity
Phase 4: malignant degeneration (1-3%)

59
Q

Appearance of Paget’s disease

A 
Usually diagnostic, bone scan can identify additional sites
Increased or decreased bone density
Coarsened trabeculae 
Thickened cortex 
Bone  expansion
60
Q

Paget’s disease location

A

Usually polyostotic
Pelvis, femur, skull, tibia, vertebrae, clavicle, humerus, ribs
Lower extremity > upper extremity
Right side > left side
Spinal: most common at mid lumbar (L3-L4), lower thoracic, upper cervical

61
Q

Paget DiseaseRadiographic Signs

A

Skull: osteoporosis circumscripta; cottonwool appearance
Spine: picture frame vertebra; ivory vertebra
Pelvis: brim or rim sign, protrusio acetabuli
Femur and tibia: blade of grass or candle flame appearance

62
Q

Complications of paget’s disease

A

Skull: osteoporosis circumscripta; cottonwool appearance
Spine: picture frame vertebra; ivory vertebra
Pelvis: brim or rim sign, protrusio acetabuli
Femur and tibia: blade of grass or candle flame appearance

Psuedofractures
Stenosis - Spinal, Bone expansion, deformity, pathologic fracture, upper thoracic and lumbar spine m/c
Cranial - Hearing loss, cranial nerve compression

Malignant degeneration - 1-3%, Higher incidence in humerus, lower in vertebrae, Osteosarcoma, fibrosarcoma, chondrosarcoma, Lytic destruction within Pagetic bone, Cortical destruction, Usually no periosteal response, Soft tissue mass, Cannonball mets to lung

63
Q

Lab changes with Paget’s disease

A

Increased serum alkaline phosphatase possible - produced as bone attempts to rebuild
Increased urinary hydroxyproline
Normal serum calcium and phosphorus

64
Q

Treatment and prognosis of Paget’s disease

A

Bisphosphonates - Reduces osteoclastic activity
Supportive braces
Slow progression

Bone Pathology II (3 decks)

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