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MSK/Derm > SM 230: Neoplasia > Flashcards

SM 230: Neoplasia Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the 3 types of bone lesions?

A

Benign, Malignant, and Hematopoetic

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2
Q

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

A

Dx of bone tumors use histology last

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

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3
Q

How should bone tumors be diagnosed?

A

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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4
Q

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

A

Bone marrow - almost entirely malignant

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5
Q

What are the benign and malignant tumors of Bone?

A

Benign: Osteoma, Osteiod Osteoma, Osteoblastoma

Malignant: Osteosarcoma

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6
Q

What are the benign and malignant tumors of Cartilage?

A

Benign: Chondromyxoid fibroma, Osteochondroma, Chondroma, Chondroblastoma

Malignant: Chondrosarcoma

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7
Q

What are the benign and malignant tumors of Bone Marow?

A

Benign: None

Malignant: Myeloma, Malignant Lymphoma

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8
Q

What is this?

A

Normal Bone Marrow containing Adipose and Hematopoietic stem cells

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9
Q

What is this?

A

Normal bone showing:
Dense CT = Purple stuff

Osteocytes = Cells in small holes

Osteoblasts = Periphery of the Purple

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10
Q

What is this?

A

Normal Cartilage showing 1 cell per space

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11
Q

Are most bone tumors primary or metastatic?

A

Most are metastatic

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12
Q

Describe the primary bone tumors?

A

Primary = Multiple Myeloma and Second Osteosarcoma

Generally M > F

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13
Q

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

A

Osteoma = benign solitary

Middle age

Commonly on surface of a facial bone

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14
Q

When is Osteoma clinically significant?

A

Generally irrelevant unless it blocks a sinus cavity

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15
Q

What are the arrows pointing to?

A

The densities on the surface of bone are Osteoma

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16
Q

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

A

Small benign tumor of Osteoblasts < 2cm

Age < 25, M > F

Cortex of Long Bones (Femur)

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17
Q

How does Osteoid Osteoma present?

A

Nocturnal bone pain relieved by Aspirin

On XRay = nidus surrounded by sclerotic bone at the Femur

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18
Q

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

A

Osteoid Osteosarcoma

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19
Q

What is the prognosis and treatment for Osteoid Osteoma?

A

Use surgery of RF ablation

Prognosis excellent if nidus is removed

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20
Q

What is this?

A

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

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21
Q

What is a “nidus”?

A

Anastamosing woeven bone + vascular stroma + osteoblastic rimming

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22
Q

What are the tumors of Osteoblasts?

A

Osteoblastoma and Osteoid Osteoma

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23
Q

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

A

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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24
Q

Compare the size of Osteoid Osteoma to Osteoblastoma?

A

Osteoid Osteoma is small < 2cm

Osteoblastoma is large > 2cm

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25
Q

Compare the locations of Osteoid Osteoma to Osteoblastoma?

A

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

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26
Q

Compare the response of Osteoid Osteoma and Osteoblastoma to NSAIDs?

A

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

27
Q

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

A

Osteochondroma:

Benign bone tumor

Males < 25

Distal Femur and Proximal Tibia

28
Q

What does an Osteochondroma look like?

A

Osteochondroma = Bone + Cartilage

Bone and a cartilagenous cap arise from the Metaphysis (growth plate)

29
Q

What is this?

A

Osteochondroma

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

30
Q

What is shown here?

A

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

31
Q

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

A

Benign Intramedullary Cartilagenous Tumor

20 - 40, M = F

Medulla of small bones of hands and feet

32
Q

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

A

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

33
Q

How does Chondroma appear on X-ray?

A

Well-circumscribed with cartilage matrix calcification

= Arc + Ring appearance

34
Q

What is this?

A

Chondroma:
It’s in the Medulla of a small bone in the hand or feet

Some matrix calcification

Bright rim = bone formation at periphery

35
Q

Why is this Chondroma and not Osteosarcoma?

A

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

36
Q

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

A

Benign tumor

20 - 40 years, F > M

Epiphysis of long bone (Knee region)

37
Q

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

A

“Soap bubble” appearance with a lytic region in the epiphysis

38
Q

What is this and why?

A

Soap-bubble in the Knee

= Giant Cell Tumor of the Bone

39
Q

What is this and why?

A

Multinucleated Giant Cells
= Giant Cell Tumor of the Bone

40
Q

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

A

Benign + localized developmental arrest

< 30 years old + M = F

May be Monostotic at Femor or Polystotic

41
Q

Which bone tumor involves developmental arrest?

A

Fibrous dysplasia

42
Q

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

A

McCune Albright

= Cafe Au Lait Spots + Endocrinopathy + Polyostotic Fibrous Dysplasia

43
Q

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

A

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

Creates “expansile lesions”

44
Q

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

A

Osteosarcoma:
Malignant proliferation of Osteoblasts

Bimodal Age: 10-20 and 65+, M > F

Effects distal Femur/proximal Tibia (Knee)

45
Q

What are the risk factors for Osteosarcoma?

A

Familial Retinoblastoma (rb)

Li-Fraumeni Syndrome (p53)

Paget Disease of the Bone

46
Q

How does Osteosarcoma appear on XRay?

A

Codman Triangle due to new subperiostal bone forming outside the Cortex

“Sunburst” reaction due to Periositis

47
Q

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

A

Osteosarcoma

48
Q

What is this and why?

A

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

49
Q

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

A

Malignant tumor

50 - 70 years, M > F

Medullary/Central Cavity of Central Skeleton (Pelvis, shoulder, rib)

50
Q

What sets the prognosis for Chondrosarcoma?

A

Prognosis depends on grade/surgical adequacy

High grade = low survival

51
Q

How can Chondrosarcoma be differentiated from Osteosarcoma?

A

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

52
Q

What is this?

A

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

53
Q

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

A

Malignant Neuroectodermal tumor

< 15-20 years, M > F

Diaphysis of long bones such as Femur

54
Q

What is the prognosis for Ewing Sarcoma?

A

Poor, especially if it metatstasis

Treat with chemotherapy like Osteosarcoma

55
Q

How does Ewing sarcoma appear on X-ray?

A

Cortical destruction = “onion skin” lesion

56
Q

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

A

Effected cells have blueish rounded nuclei with little cytoplasm

Also see focal necrosis

57
Q

If you see focal necrosis on histology, consider…?

A

Ewing Sarcoma

58
Q

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

A

Primary Malignant Bone Tumor

> 40 years, M > F

Effects Vertebrae, Ribs, and Skull

59
Q

How does someone with Multiple Myeloma present?

A

CRAB

Hypercalcemia

Renal Insufficiency

Anemia

Lytic Bone Lesions

60
Q

How is Multiple Myeloma treated and what is the prognosis?

A

Treat with chemotherapy, poor prognosis

61
Q

How does Multiple Myeloma appear on X-ray?

A

Several “punched out” Lytic lesions

62
Q

What is this?

A

Punched Out Lesions = Multiple Myeloma

63
Q

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

A

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

MSK/Derm (46 decks)

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