S2_L5: Bone Tumors Flashcards
TRUE OR FALSE: Tumors can affect fats and nerves. Tumors may happen in endocrine organs.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
The following statements are true, EXCEPT:
A. benign tumors are often asymptomatic
B. minor trauma may be the initiating event for tumors
C. x-rays are used to can often predict potentially malignant bone lesion
D. MRI is used to evaluate sites or signs of metastasis
E. None of the above
D. MRI is used to evaluate sites or signs of metastasis
NOTE: This is the CT Scan.
Match the following X-ray findings to its corresponding description.
- Slow-growing tumors on the cortical surface
- Most malignant with rapidly advancing neoplastic processes
- More rapid growth penetrating through an eroded cortex
- Very aggressive tumor growth with sunburst appearance
- Cortex forms an acute angle with an open end toward the tumor’s epicenter
A. Solid Buttress
B. Onion-skin
C. Spiculated
D. Codman’s triangle
- A
- D
- B
- C
- D
Match the following types of tumors.
- lacking the ability to invade neighboring tissue or metastasize
- ability to invade neighboring tissue or metastasize distant parts of the body
- grow but don’t spread out to other tissues
A. Benign
B. Malignant
- A
- B
- A
TRUE OR FALSE: MRI is used for better definition of tumor size, local intra-osseous or extra-osseous extent.
True
_______is a labile, sensitive structure capable of responding to traumatic stimuli or pressure from the growth of an underlying tumor by depositing new bone
Periosteum
Match the following types of tumors.
- Ewing’s sarcoma
- Aneurysmal bone cyst
- Plasma cell myeloma
- Giant cell tumor
- Codman’s tumor
A. Benign
B. Malignant
- B
- A
- B
- A
- A
Match the following types of tumors.
- Non-ossifying fibroma
- Osteoid osteoma
- Chondroma
- Parosteal osteogenic sarcoma
- Histiocytic lymph the bone
A. Benign
B. Malignant
- A
- A
- A
- B
- B
Complete the analogy of the kind/location of tumor.
Fibrous dysplasia: Fibrous tissue
Lipoma: _____________
Marrow element
Complete the analogy.
Fibrous dysplasia: Fibrous tissue
Chondrosarcoma : _____________
Cartilage
Determine the (1) type of tumor and its (2) location.
Osteoid osteoma
- Benign Tumors
- Bone
Determine the (1) type of tumor and its (2) location.
Neurofibroma
- Benign Tumors
- Vascular Tissue
Determine the (1) type of tumor and its (2) location.
Solitary bone cyst
- Benign Tumors
- Unknown/ Uncertain
What system is used for the staging of tumors?
Enneking System
The following is true about the Enneking System, EXCEPT:
A. characterizes metastatic malignant bone tumors
B. has III stages
C. subdivided according to local anatomic extent
D. each stage determine the type of treatment
E. None
A. characterizes metastatic malignant bone tumors
NOTE: It is for NON-metastatic malignant bone tumor
Classify the stage of tumor with the description given.
High-grade; Intra-compartmental
A. IA
B. IB
C. IIA
D. IIB
E. III
C. IIA
Classify the stage of tumor with the description given.
Metastatic
A. IA
B. IB
C. IIA
D. IIB
E. III
E. III
Classify the stage of tumor with the description given.
Low-grade; Extra-compartmental
A. IA
B. IB
C. IIA
D. IIB
E. III
B. IB
Enumerate the 4 techniques of tumor excision.
- Wide
- Marginal
- Radical
- Intralesional
Match the following techniques of tumor excision.
- For benign tumors
- For Low/high-grade tumors
- For High-grade tumors
A. Wide
B. Marginal
C. Radical
D. Intralesional
- D
- A
- C
Match the following techniques of tumor excision.
- Plane of dissection is through the pseudo‐capsule
- Plane of dissection is within the tumor
- Plane of dissection is in normal tissue
A. Wide
B. Marginal
C. Radical
D. Intralesional
- B
- D
- A
Match the following techniques of tumor excision.
- Dissect all the compartments that contain tumor is resected
- For benign, low-grade malignant tumors ita
- en bloc excision of the entire involved muscular compartment or amputation with no reactive tissue or tumor cells at the inked margin
A. Wide
B. Marginal
C. Radical
D. Intralesional
- C
- B
- C
This process involves preservation of limb function through conservative excision/ resection of tumor
Limb Salvage
Rhabdomyosarcoma involves a malignant tumor arising from a __________.
striated muscle
Leiomyosarcoma involves a malignant tumor arising from a __________.
smooth muscle
Where is synovial chondromatosis most common?
at the knee
This is the only primary malignant tumor that arises within the joints
Synovial sarcoma
This tumor of fatty tissue is a common benign fatty tumor that may occur in any part of the body.
Lipoma
This tumor of fatty tissue is derived from lipoma. It is most common in the buttock or thigh.
Liposarcoma
The following organs have the most common primary tumors metastasizing to bone, EXCEPT:
A. Breast
B. Heart
C. Prostate
D. Lungs
E. Kidney
B. Heart
Match the following Tumors of the Peripheral Nerve.
- firm, non-tender slowly growing tumor on the skin or subcutaneous tissue
- scoliosis and limb deformities are common findings
- may be attached to larger nerves
A. Neurilemoma
B. Malignant Schwannoma
C. Neurofibroma
D. Neurofibromatosis
E. C & D
- C
- D
- E
Neurilemoma is also called?
Schwannoma
Match the following Tumors of the Peripheral Nerve.
- solitary encapsulated benign tumor arising from Schwann cells
- symptoms arise from local mechanical pressure
- most commonly seen in patients with von Recklinghausen’s disease
A. Neurilemoma
B. Malignant Schwannoma
C. Neurofibroma
D. Neurofibromatosis
E. All of the above
- A
- D
- B
Match the following Tumors of the Peripheral Nerve.
- malignant neurilemmoma
- slow growing but has a tendency for malignant degeneration
- solitary non-encapsulated tumors arising from endoneurial fibrous connective tissue
A. Neurilemoma
B. Malignant Schwannoma
C. Neurofibroma
D. Neurofibromatosis
E. All of the above
- B
- D
- C
The following is true about von Recklinghausen’s disease, EXCEPT:
A. AKA neurofibromatosis-1 (NF-1)
B. inherited defect in tissues of endodermal origin
C. numerous pedunculated soft tissue tumors
D. has small scattered areas of skin pigmentation with smooth edges
E. None
B. inherited defect in tissues of endodermal origin
NOTE: It is ectodermal
What term is defined by small scattered areas of skin pigmentation with smooth edges
Cafe au lait spots
TRUE OR FALSE: Hemangiomas arise in almost any tissue. They may also be seen beneath the nails of hands and feet.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
Note: Glomus tumors are seen beneath the nails of hands and feet
TRUE OR FALSE: A biopsy is taken when there is significant doubt as to the diagnosis of a benign or malignant lesion. It is also done when definitive confirmation of the diagnosis is required before undertaking a hazardous, costly, or potentially disfiguring treatment.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
What are the 2 biopsy techniques?
- Needle biopsy
- Open/ Operative biopsy
What is the difference of an open incisional and an open excision biopsy?
IB - take only a sample of the mass/tumor is cut
EB - removal of the entire but small lesion/tumors involving soft tissues
This type of bone scan is a screening that indicates the presence of bone formation/ turnover
Technetium 99 MDP radioisotope
TRUE OR FALSE: In using the Technetium 99 MDP Radioisotope, the patient will be injected with radioactive dye. Areas with the least dye left are the areas of lesion
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
TRUE OR FALSE: For a needle biopsy, there is no need for general anesthesia or operating room
True
Determine which benign tumor is being described.
- slowly growing tumor composed of cartilage
- if arises within the medullary cavity, it is called Enchondromas
- seen in epiphyseal region of large bones
- common in the femur, tibia, and humerus
- common in phalanges,
metacarpals, and metatarsals
A. Chondroma
B. Chondroblastoma
- A
- A
- B
- B
- A
Determine which benign tumor is being described.
- AKA Codman’s tumor
- X-ray shows a rounded area of decreased density with smooth outline expanding beneath a narrow shell of cortical bone
- Common in ages 20-30 years old
- Common in male adolescents
- Curettage and packing of resulting bony cavity with cancellous bone graft results in permanent cure
A. Chondroma
B. Chondroblastoma
- B
- A
- A
- B
- B
Determine which benign tumor is being described.
- common in ages 10-25 yo
- AKA Giant cell tumor
- solitary lesion, seen at epiphyseal-metaphyseal region of long bones
- common in young adults ages 20-35 yo
- small solitary lesion in cancellous or cortical bone
A. Osteoid Osteoma
B. Osteoclastoma
- A
- B
- B
- B
- A
Determine which benign tumor is being described.
- brownish red appearance with areas of fibrosis and hemorrhage
- common in males
- radiolucency in the epiphyseal and metaphyseal areas with expansion and thinning of cortex
- oval nidus not more than 1.5cm surrounded by extensive and dense reactive bone
- pain worse at night and relieved by aspirin
A. Osteoid Osteoma
B. Osteoclastoma
- B
- A
- B
- A
- A
Determine which benign tumor is being described.
- May lead to paralytic symptoms when located in the vertebra
- Asymptomatic until pathologic fracture develops
- Grossly a rounded protrusion consisting of a thin shell of bone filled with spongy soft tissue, vascular channels and bloody fluid
- Targets the metaphysis of a long bone
- single or multilocular central bone defect at or near the metaphysis with a smooth, intact outline formed by thinned slightly expanded cortical bone
A. Simple Bone cyst
B. Aneurysmal Bone cyst
- B
- A
- B
- A
- A
Determine which benign tumor is being described.
- Cyst is filled with fluid or soft tissue and cavernous vascular spaces
- Most common in adolescents
- Ovoid radiolucent area bulging eccentrically giving it a blowout appearance
- Slowly growing fluid filled lesion
- Unilocular containing amber fluid
A. Simple Bone cyst
B. Aneurysmal Bone cyst
- B
- B
- B
- A
- A
Simple Bone cystis also known as?
Solitary Bone Cyst
Simple Bone cyst is most common in what location?
proximal metaphysis of humerus
Malignant tumors are often accompanied by________
pain
TRUE OR FALSE: Malignant tumors presents pain that is commonly worse as soon as the patient wakes up in the morning. It is also aggravated by exercise.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
NOTE: Pain stemming from malignant tumors are worse at night.
This is the simplest diagnostic tool that can show the lesion in the bone.
X-Ray
Fill in the blanks for limb salvage pre-conditions
A. No compromise to local (1)______
B. No compromise to long-term (2)______
C. Resulting (3)______ better than an amputated limb
- tumor control
- survival
- function
Fill in the blanks for limb salvage requisites.
A. Accurate tumor (1)______ available
B. Adequate margins of (2)_____ attainable
C. Resection (3)_____ reconstructible
D. (4)_____ function attainable with rehabilitation
- staging
- resection
- defect
- Painless
Complete the analogy.
Mobile joint: Arthroplasty Fixed joint: __________
Arthrodesis
Enumerate the 4 allied or adjuvant therapy options for a patient after resection of a tumor or limb.
- Pain Management
- Rehabilitation
- Radiotherapy
- Chemotherapy
Chondroblastoma shows of a closely packed ___________ cells with distinct cell membranes and large nuclei
round or polyhedral
TRUE OR FALSE: Patients with Chondroblastoma usually reports of gradual pain on motion. There is also palpable palpable mass, swelling, and tenderness
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
This condition is a reactive bone lesion of unknown cause rather than a neoplasm.
Osteoid Osteoma
This is a small, round or oval, radiolucent well-circumscribed area with a central area of increased density. It is seen on X-rays.
nidus
What is the best treatment for permanent relief of pain for Osteoid Osteoma?
Complete excision with bone graft
TRUE OR FALSE: Giant cell tumor is common in the vertebrae
False
Most common sites:
lower end of femur, upper end tibia, lower end of radius and sacrum
Determine which malignant tumor is being described.
- Most common malignant primary bone tumor
- Age: 10-20 years old
- Age: 5th and 6th decade
- malignant degeneration of Paget’s disease
- malignant degeneration of a previous benign lesion
A. Osteogenic sarcoma
B. Chondrosarcoma
- A
- A
- B
- A
- B
Determine which malignant tumor is being described.
- Most common sites:
proximal tibia, distal femur and proximal humerus - Most common sites:
pelvis and proximal part of femur - Aggressive tumor with rapid growth and early pulmonary metastasis
- Better prognosis
- Slow growing tumor and provoke mild symptoms
A. Osteogenic sarcoma
B. Chondrosarcoma
- A
- B
- A
- B
- B
The following is true about Osteogenic sarcoma, EXCEPT:
A. Males > Females
B. Has increased osteoblastic activity
C. Has low levels of alkaline phosphatase
D. Dull, constant, aching pain interferes with sleep
E. None
C. Has low levels of alkaline phosphatase
The following is true about Osteogenic sarcoma, EXCEPT:
A. has a sunburst appearance on X-rays
B. Has increased osteoblastic activity
C. Has low levels of alkaline phosphatase
D. Dull, constant, aching pain interferes with sleep
E. None
C. Has low levels of alkaline phosphatase
Determine which malignant tumor is being described.
- Over production of Bence Jones protein
- Proliferation of cells producing immunoglobulins
- Highly malignant tumor from bone marrow
- Malignant tumor arising from marrow cavity
- Simulates low grade osteomyelitis
A. Ewing’s Sarcoma
B. Plasma cell myeloma
- B
- B
- B
- A
- A
Determine which malignant tumor is being described.
- Pathologic fracture of rib or vertebra
- Metastasis to the lungs
- Fever with elevated leukocytes
- Back Pain
- Susceptibility to recurrent bacterial infections
A. Ewing’s Sarcoma
B. Plasma cell myeloma
- B
- A
- A
- B
- B
TRUE OR FALSE: Osteogenic sarcoma has a poor prognosis
True
Determine which malignant tumor does the statement describe.
Common in the axial skeleton (ribs, sternum, skull, and vertebrae)
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
B. Plasma cell myeloma
Determine which malignant tumor does the statement describe.
Multiple punched out appearance (black spots) on X-rays.
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
B. Plasma cell myeloma
Determine which malignant tumor does the statement describe.
superficial venous distention, elevation of skin temperature over the lesion
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
C. Osteogenic sarcoma
Determine which malignant tumor does the statement describe.
pulmonary metadid are found within a year after diagnosis
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
C. Osteogenic sarcoma
Determine which malignant tumor does the statement describe.
X-ray shows of an onion skin pattern
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
A. Ewing’s Sarcoma
Determine which malignant tumor does the statement describe.
Not obvious in early stages due to their site of involvement
A. Ewing’s Sarcoma
B. Plasma cell myeloma
C. Osteogenic sarcoma
D. Chondrosarcoma
D. Chondrosarcoma
In what age group is Ewing’s Sarcoma common?
10-25 y/o
What is the confirmatory laboratory finding that must be seen in plasma cell myeloma?
Bence Jones proteinuria
Central chondrosarcoma develop from multiple _______
enchondromas / enchondromatosis
Peripheral chondrosarcoma develop from multiple ___________
osteochondromas
Most tumors that metastasize onto bones are ___________ causing extensive bone destruction
osteolytic
Breast and prostate tumors are
A. osteolytic
B. osteoblastic
B. osteoblastic
When tumors metastasize onto bones, which 2 bones are commonly affected?
Vertebrae and pelvis
The following is true about the clinical features of Tumors Metastasizing to Bone, EXCEPT:
A. Deep aching night pains or pathologic fracture
B. Anemia
C. Low erythrocyte sedimentation rate (ESR)
D. Hypercalcemia
E. None
C. Low erythrocyte sedimentation rate
The following is true about the Tumors Metastasizing to Bone, EXCEPT:
A. Punched out appearance
B. Mottled appearance
C. Isotope bone scans
D. Poor prognosis
E. None
E. None
The pleomorphic type of Rhabdomyosarcoma is common in _____.
A. children
B. adults
B. adults
TRUE OR FALSE: Recurrence is common in patients with Liposarcoma
True
This is a tumor of vascular origin that is a small localized painful lesion consisting of small vessels lined by round cells and unmyelinated nerve fibers.
A. Hemangiomas
B. Glomus tumor
B. Glomus tumor
