Real msk bone tumors

Question 1

Nonossifying fibroma

Answer 1

most common bone lesion in kids (benign and asymptomatic, benign spindle cells and giant cells)

Question 2

Exostosis(osteochondroma)

Answer 2

most common bone lesion, metaphyseal location in long bones, grows away from epiphysis
Malignant transformation rare in solitary lesion

Question 3

multiple myeloma

Answer 3

multiple bones, motheaten lesions, path fratures

Most common primary malignant bone tumor in adults

Plasma cell lesion
Produces immunoglobulins and light chains
Other organs can be affected
Frequent fracture (in spine)
Multiple punched out lesions
Treatment: chemotherapy, stem cell transplants, treat/prevent pathologic fractures, monitor treat anemia and kidneys

Question 4

metastatic carcinoma

Answer 4

Majority of destructive bone lesions in adults
Lesions purely destructive (lytic) or cause bone to be made (blastic)
Most carcinomas metastasize above the knee and above the elbow

Common carcinomas to metastasize to lung then breast then prostate then kidney then thyroid then GI

5% of pt present with metastases to bone have no detectable primary, know workup for primary, treat impending pathologic fractures to improve quality of life, minimally invasive fixation techniques are available

Question 5

Osteosarcoma

Answer 5

Most common primary maliganant bone forming tumor of childhood and youth
Traditional type has peak age incidence in the teens and early 20s, composed of malignant osteoblasts forming osteoid, metaphyseal regions of bones (distal femur proximal tibia, proximal humerus and proximal femur)

Pain with activity and rest and usually have a soft tissue mass
Histology: malignant osteoblasts producing osteoid, curable sarcoma, multiagent neoadjuvant chemotherapy has allowed a high survival rate, successful chemotherapy has allowed innovative limb salvage surgeries, metastasizes to LUN most commonly

Question 6

Soft tissue sarcomas

Answer 6

Mesenchymal origin, rare tumors (<1% of all cancer), all age groups, size and depth of lesion arent always a predictor of histology or grade of tumor, most common metastases to lungs, occasional metastases to lymphnodes

High grade ST sarcomas treated with preop radiation therapy and surgery, wide margins of resection needed, surgery may require rotational or free tissue flap to close defect, continued surveillance for recurrence/ mets needed

high histologic grade tumors more prone to metastasize, staging of all tumors with imaging studies imperative before biopsy,