SM 230: Neoplasia Flashcards by Ashwin Sunderraj

What are the 3 types of bone lesions?

Benign, Malignant, and Hematopoetic

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How does the diagnosis of bone tumors differ from other parts of the body, and why?

Dx of bone tumors use histology last

Limited potential changes in bone in response to injury/infection/neoplasm

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How should bone tumors be diagnosed?

Need to know:

Age/Sex of patient

Pre-existing bone lesions

Bone involved and location of tumor in bone Radiologic appearance of tumor

Consider histology last

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Which is the most common site of cancer: bone marrow, bone, or cartilage?

Bone marrow - almost entirely malignant

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What are the benign and malignant tumors of Bone?

Benign: Osteoma, Osteiod Osteoma, Osteoblastoma

Malignant: Osteosarcoma

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What are the benign and malignant tumors of Cartilage?

Benign: Chondromyxoid fibroma, Osteochondroma, Chondroma, Chondroblastoma

Malignant: Chondrosarcoma

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What are the benign and malignant tumors of Bone Marow?

Benign: None

Malignant: Myeloma, Malignant Lymphoma

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What is this?

Normal Bone Marrow containing Adipose and Hematopoietic stem cells

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What is this?

Normal bone showing:
Dense CT = Purple stuff

Osteocytes = Cells in small holes

Osteoblasts = Periphery of the Purple

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What is this?

Normal Cartilage showing 1 cell per space

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Are most bone tumors primary or metastatic?

Most are metastatic

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Describe the primary bone tumors?

Primary = Multiple Myeloma and Second Osteosarcoma

Generally M > F

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What is the type, age onset, and common area effected by Osteoma?

Osteoma = benign solitary

Middle age

Commonly on surface of a facial bone

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When is Osteoma clinically significant?

Generally irrelevant unless it blocks a sinus cavity

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What are the arrows pointing to?

The densities on the surface of bone are Osteoma

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What is the type, age/gender onset, and common area effected by Osteoid Osteoma?

Small benign tumor of Osteoblasts < 2cm

Age < 25, M > F

Cortex of Long Bones (Femur)

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How does Osteoid Osteoma present?

Nocturnal bone pain relieved by Aspirin

On XRay = nidus surrounded by sclerotic bone at the Femur

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If someone presents with nocturnal bone pain relieved by Asprin, consider…?

Osteoid Osteosarcoma

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What is the prognosis and treatment for Osteoid Osteoma?

Use surgery of RF ablation

Prognosis excellent if nidus is removed

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What is this?

Osteoid Osteoma: Nidus surrounded by sclerosing tissue at the femur (long bone)

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What is a “nidus”?

Anastamosing woeven bone + vascular stroma + osteoblastic rimming

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What are the tumors of Osteoblasts?

Osteoblastoma and Osteoid Osteoma

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How do Osteoid Osteoma and Osteoblastoma compare in their size, location, and response to NSAIDS?

Osteoid Osteoma + Osteoblastoma
= Osteoblast tumors

Osteoid Osteoma < 2cm + Osteoblastoma > 2cm

OO in the Long Bones (Femur) + OB in Vertebrae

OO responds to NSAIDS (Night Pain), OB does not

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Compare the size of Osteoid Osteoma to Osteoblastoma?

Osteoid Osteoma is small < 2cm

Osteoblastoma is large > 2cm

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Compare the locations of Osteoid Osteoma to Osteoblastoma?

Osteoid Osteoma is in long bomes like the Femur Osteoblastoma is in the Vertebrae

Compare the response of Osteoid Osteoma and Osteoblastoma to NSAIDs?

Osteoid Osteoma respond to NSAIDS (night pain) Osteoblastoma do not

What is the type, age/gender onset, and common area effected by Osteochondroma?

Osteochondroma: Benign bone tumor Males \< 25 Distal Femur and Proximal Tibia

What does an Osteochondroma look like?

Osteochondroma = Bone + Cartilage Bone and a cartilagenous cap arise from the Metaphysis (growth plate)

What is this?

Osteochondroma Notice the stalk with a cap growing out of the Metaphysial plate

What is shown here?

Histology of Osteochondroma showing a bony stalk on the bottom and a cartilagenous cap on top

What is the type, age/gender onset, and common area effected by Chondroma?

Benign Intramedullary Cartilagenous Tumor 20 - 40, M = F Medulla of small bones of hands and feet

If a 30 year old presents with a bone tumor in their Carpals or Tarsals, it's probably...?

Chondroma, since it effects the Medulla of the small bones of the hand and feet

How does Chondroma appear on X-ray?

Well-circumscribed with cartilage matrix calcification = Arc + Ring appearance

What is this?

Chondroma: It's in the Medulla of a small bone in the hand or feet Some matrix calcification Bright rim = bone formation at periphery

Why is this Chondroma and not Osteosarcoma?

The low cellularity and lack of pleomorphism suggests it's a benign tumor like Chondroma, not a malignant tumor like Osteosarcoma

What is the type, age/gender onset, and common area effected by Giant Cell Bone Tumor?

Benign tumor 20 - 40 years, F \> M Epiphysis of long bone (Knee region)

How does Giant cell tumor of the bone appear on XRay?

"Soap bubble" appearance with a lytic region in the epiphysis

What is this and why?

Soap-bubble in the Knee = Giant Cell Tumor of the Bone

What is this and why?

Multinucleated Giant Cells = Giant Cell Tumor of the Bone

What is the type, age/gender onset, and common area effected by Fibrous Dysplasia?

Benign + localized developmental arrest \< 30 years old + M = F May be Monostotic at Femor or Polystotic

Which bone tumor involves developmental arrest?

Fibrous dysplasia

What is McCune-Albright syndrome and what bone cancer does it involve?

McCune Albright = Cafe Au Lait Spots + Endocrinopathy + Polyostotic Fibrous Dysplasia

Describe the pathophysiology of FIbrous Dysplasia and the lesions it creates?

Fibrous dysplasia is characterized by having all of the normal components of bone present without differentiating into mature structures Creates "expansile lesions"

What is the type, age/gender onset, and common area effected by Osteosarcoma?

Osteosarcoma: Malignant proliferation of Osteoblasts Bimodal Age: 10-20 and 65+, M \> F Effects distal Femur/proximal Tibia (Knee)

What are the risk factors for Osteosarcoma?

Familial Retinoblastoma (rb) Li-Fraumeni Syndrome (p53) Paget Disease of the Bone

How does Osteosarcoma appear on XRay?

Codman Triangle due to new subperiostal bone forming outside the Cortex "Sunburst" reaction due to Periositis

What type of tumor involves periositis/sunburst appearance on Xray?

Osteosarcoma

What is this and why?

Osteosarcoma, as the highly dense and pleotropic malignant cells directy produce new bone leading to periosteal outgrowths

What is the type, age/gender onset, and common area effected by Chondrosarcoma?

Malignant tumor 50 - 70 years, M \> F Medullary/Central Cavity of Central Skeleton (Pelvis, shoulder, rib)

What sets the prognosis for Chondrosarcoma?

Prognosis depends on grade/surgical adequacy High grade = low survival

How can Chondrosarcoma be differentiated from Osteosarcoma?

Chondrosarcoma effects the Cartilage matrix and does not involve a periosteal reaction

What is this?

Chondrosarcoma, because in this slice of Cartilage, there are multiple cells per space

What is the type, age/gender onset, and common area effected by Ewing Sarcoma?

Malignant Neuroectodermal tumor \< 15-20 years, M \> F Diaphysis of long bones such as Femur

What is the prognosis for Ewing Sarcoma?

Poor, especially if it metatstasis Treat with chemotherapy like Osteosarcoma

How does Ewing sarcoma appear on X-ray?

Cortical destruction = "onion skin" lesion

Why is Ewing Sarcoma considered called a "Small Blue Cell Tumor"?

Effected cells have blueish rounded nuclei with little cytoplasm Also see focal necrosis

If you see focal necrosis on histology, consider...?

Ewing Sarcoma

What is the type, age/gender onset, and common area effected by Multiple Myeloma?

Primary Malignant Bone Tumor \> 40 years, M \> F Effects Vertebrae, Ribs, and Skull

How does someone with Multiple Myeloma present?

CRAB Hypercalcemia Renal Insufficiency Anemia Lytic Bone Lesions

How is Multiple Myeloma treated and what is the prognosis?

Treat with chemotherapy, poor prognosis

How does Multiple Myeloma appear on X-ray?

Several "punched out" Lytic lesions

What is this?

Punched Out Lesions = Multiple Myeloma

What is the pathophysiology of Multiple Myeloma and how does that explain Kappa/Lambda staining?

Multiple Myeloma involves Clonal proliferation of plasma cells, mostly IgG Light chains are Kappa or Lambda, and with MM, the antibody is IgG-Kappa Staining for Lambda will be blank, while Kappa is high