Trigger - Bone Disease Flashcards
where are places that bone metastases may originate from
breasts
prostate
lungs
thyroid
kidneys
what do you order to assess if bone cancer has metastasized to the thorax
CT
If you are planning to biopsy a bone tumor, what imaging would you order
MRI w contrast!!
benign bone tumor originating from osteoblasts
osteoid osteoma
what is the MC location for osteoid osteoma
femur!
tibial and humeral shaft also common
this cancer presents with pain due to a “nidus” secreting prostaglandins
osteoid osteoma
osteoblastoma
worse with activity and ETOH!!
improves with NSAIDs and ASA
osteoid osteoma
You have a 25M patient with a limp and referred pain to their knee. Their dull, aching, pain is worse at night, but it gets better if he takes an aspirin. The doctor says he has a benign bone tumor that builds bone. He forgot the name of it. Although this is an atypical presentation of it, the bone tumor you suspect is…
osteoid osteoma
presents with hip pain with walking that has caused a limp. Pain radiates to the knee and is made better with aspirin or NSAIDs.
osteoid osteoma
radio-opaque area of a bone that is described as a “bell” surrounded by sclerotic/calcified bone
Osteoid osteoma
What are indications for ordering a CT w IV contrast after visualizing a osteoid osteoma on XR
- XR appears abnormal but nidus isnt visible
- residual or recurent tumor present
- tumor located in critical area (spine or femoral neck)
A 19y/o M patient presents with constant dull, aching pain in his left thigh. He reports its worse at night and wakes him from sleep and improves with NSAIDs or aspirin. you order an XR which is clear. what other scans could you order and what would you see
- CT w/IV contrast (WITHHHH, doesnt say what youd see)
- radionuclide scanning aka bone scan (double density sign)
- MRI w/gadolinium (only if cant get CT either)
this is osteoid osteoma
double density sign on bone scan
osteoid osteoma
What is the treatment & prognosis for osteoid osteoma
- NSAIDs w serial imaging Q 4-6 mo
- if uncontrolled pain, limp or scoliosis occur refer to surgery
- untreated (nonsurgical) patients will resolve spontaneously
MC location for this tumor is the posterior column of the spine
spinous processes, lamina, pedicles
osteoblastoma
This diagnosis has a Nidus that is >2cm and is NOT relieved w NSAID use
osteoblastoma
XR of lesion on the posterior spine shows Well-circumscribed, radiolucent nidus > 2 cm
osteoblastoma
CT is indicated in ALL patients dianosed with this disease
osteoblastoma
If a patient has a osteoblastoma that extends into the soft tissue, bone marrow and spine. What imaging do you order?
MRI
Tx for osteoblastoma
surgical resection (curettage and burring followed by bone grafting)
MC solitary benign bone tumor
osteochondroma
cartilage capped bony projection on the external surface of a bone
osteocartilaginous exostosis
osteochondroma (benign)
MC in the knee or proximal humerus
adjacent to epiphyseal plates… ceases when growth stops
osteochondroma
Assocaited with HMO which causes a genetic mutation in the tumor suppressor genes EXT1 and EXT 2
osteochondroma
hereditary multiple osteochondromas
bone spur extending away from a joint
osteochondroma
A patient with a known osteochondroma comes in for their yearly check up. you note that the tumor has grown, what do you order?
MRI
benign cartilage forming tumors that develop in the bone marrow of long bones
enchodroma
“ENside the bone”
MC in the hands and feet
enchondromas
XR shows centrally located round lesion that is well circumsized with lobulations inside of it. It has a sclerotic border
enchondroma
MC occurs in the epiphysis of proximal humerus
chondroblastoma
Small, well-defined lesions with a sclerotic border than may cross the physis/growth plate
chondroblastoma
what is the management for chondroblastoma
curettage and bone grafting
BIOPSY prior to surgery!
this disease can lead to benign pulm mets, monitor with CXR or CT w/ con if very sus.
chondroblastoma
Associated with McCune albright syndrome
fibrous dysplasia
Varus deformity of the proximal femur, a shepherd’s crook
fibrous dysplasia
Spongy-like appearance on CT of of the orbits, jaw, and cranial base might suggest
fibrous dysplasia
ground glass appearance on XR with thin cortical bone and possible bowing
fibrous dysplasia
Must do a bone scan once this disease is diagnosed
fibrous dysplasia
what is the management of fibrous dysplasia
Curettage and bone grafting (adults only)
IV bisphosphonates
can present w facial asymmetry due to hemicranial involveemnt
fibrous dysplasia
MC in the tibia and fibula for kids and the mandible in adults
ossifying fibroma
XR shows Cortex thinned with multiple lytic lesions of lucency and well circumscribed intracortical lesions
ossifying fibroma
MC benign bone lesion in children
nonossifuying fibromas
Small, well-defined, eccentric, lytic lesions, found in Distal diaphysis/metaphysis, Can have multiple
non ossifying fibroma
Pathologic fx caused by these may have a fallen leaf or fallen fragment sign.
this disease is typically asymptomatic until the pathologic fracture occurs!!
unicameral bone cysts
Well-defined cystic lesion at metaphysis or metadiaphysis that generally involved the ENTIRE diameter of the bone!
unicameral bone cysts
What is the treatment if you are worried about fracture for unicameral bone cysts
aspiration w injection of methylprednisolone or bone marrow.
curettage and grafting reserved for very large cysts
benign, rapidly growing but destructive cysts filled with blood
aneurysmal cyst
MC occurs in the tibia and femur
aneurysmal bone cysts
Aggressive, expansile, lytic metaphyseal lesion with sharp borders and an eggshell sclerotic rhim. has a soap bubble appearance
aneurysmal bone cysts
MC MALIGNANT bone tumor
osteosarcoma
XR shows:
moth eaten appearance
Starburst appearance
Codman’s triangle
osteosarcoma
After the age of 50
MC in Pelvic and shoulder girdles
chondrosarcomas
XR:
Bony contour is thinned and expanded
Endosteal scalloping
Lesion often > 5 cm
chondrosarcoma
chromosomal translocation between 11 and 22
Ewing Sarcoma
XR shows:
Poorly marginated destructive lesion
Onion skin appearance
Ewing Sarcoma
