Tumor Flashcards
Enneking IA
low grade intracompartmental
Enneking IB
low grade extracompartmental
Enneking IIA
high grade intracompartmental
Enneking IIB
high grade extracompartmental
Enneking III
has mets
AEIOU and sometimes Y
diaphyseal bone lesions: adamantinoma, eosinophilic granuloma, infection, osteoid osteoma/osteoblastoma, Ewing’s, mYeloma/lYmphoma/fibrous dYsplasia
MELT
vertebra plana: mets/myeloma, EG/ewings, lymphoma/leukemia, trauma/TB
distinguishing between simple bone cysts and ABC on plain films
ABC are wider than the physis above them; simple bone cysts are not. ABC can look like osteoblastoma?
LERNM
small round blue cell tumors: lymphoma, ewings, rhabdomyosarcoma, neuroblastoma, myeloma
RACES
tumors that spread to lymph nodes: rhabdo, angiosarcoma, clear cell sarcoma, epithelioid, and synovial sarc
the tumors that FNA is not the best for
the LERNM tumors, small round blue cells
ewings immunostain
CD99
lymphoma immunostain
CD45, CD20
t(12;16)
myxoid liposarcoma
t(11;22)
ewings
t(x;18)
synovial sarc
t(9;22)
myxoid chondrosarcoma
t(2;13)
rhabdomyosarcoma
general characteristics of tumors that don’t need XRT
low grade,
these benign, locally aggressive, soft-tissue tumors have positivity for estrogen receptor B
extra-abdominal desmoid
condition to associate with multiple rock-hard soft-tissue nodules
gardners (familial adenomatous polyposis) is 10,000x more likely to develop desmoid tumors
painful, rapidly enlarging soft tissue mass in a young person
nodular fasciitis
the 2 malignant fibrous tumors
malignant fibrous histiocytoma and fibrosarcoma
histology of fibrosarcoma
herringbone spindle cells
histology of malignant fibrous histiocytoma
storiform spindle cells cartwheeling around slit-like vessels
difference bt pre and postop soft tissue tumor XRT
postop has fewer postop wound complications, but higher postop fibrosis
checklist for observation of a lipoma
No symptoms, and looks uniformly like a lipoma on all MRI sequences. If it is growing or symptomatic, cut it out
the histology of neural tumor with MRI snake-egg appearance
neurilemoma (benign schwannoma) has MRI appearance of eccentric mass in peripheral nerve. On histology there are the Antoni A and Antoni B. A has the palisading whorled cells.
the exception to the use of chemo in soft-tissue tumors
normally chemo is reserved for use in bone tumors. However, rhabdomyosarcoma is chemo-sensitive
this is the most common sarcoma in the young pt
rhabdomyosarcoma (good thing it is chemo sensitive…)
phleboliths
hemangioma
stuart-treves
lymphedema s/p BRCA mastectomy, leads to angiosarcoma
joints most affected by PVNS
knee, hip, shoulder
most common location for tumor associated with t(x;18)
synovial sarc is most common in the foot
on xrays alone, why synovial sarcoma and hemangioma might be confused
both have mineralization within the lesion, (up to 25% in synovial sarc) but the irregular contour of synovial sarc sets it apart from the round calcifications of hemangioma
this is the most common sarcoma of the hand
epithelioid
these immunostains are positive in the tumor resulting from SYT-SSX1
keratin and epithelial membrane antigen are positive in synovial sarcoma. SYT-SSX1 and 2 are the fusion proteins from t(x;18).
two physical exam findings that are concerning for a sarcoma that has spontaneously bled, or bled after minor trauma
lack of fascial plane tracking, and subcutaneous ecchymosis suggests that the bleeding is being contained by a pseudocapsule
scoliosis due to osteoid osteoma
lesion on the concave side, thought to be from paravertebral muscle spasm
MRI vs CT for osteoid osteoma
CT provides better contrast bt the lucent nidus and the reactive sclerosis
mgmt of osteoblastoma
curretage, or marginal resection
two exceptions to the rule of chemo for bone tumors
parosteal osteosarcoma and chondrosarcoma. Remember chondrosarc because for chemo to work there has to be fast turnover, and cartilage doesn’t regenerate quickly
logic for using chemo in bone tumors
kills micromets, and sterilizes the reactive zone around the tumor
these are associated with multiple enchondromas of Maffuccis
soft tissue angiomas
risk of malignancy in Olliers
30%
concern in 10% of pts with EXT1 and EXT2 gene mutations
development of secondary chondrosarcoma. higher risk in EXT1
epiphyseal lesions
chondroblastoma, giant cell, clear cell (femoral head)
mgmt of chondroblastoma
curretage, bone grafting
rate of metastasis in benign chondroblastomas
2% will mets to the lungs
these metaphyseal fibrous defects can be observed
if an NOF is radiographically characteristic and has low risk of pathologic fx, you can watch them. If they are painful or involve >50% of the cortex, they need curettage and bone grafting
histology of MFH
abundant foamy cytoplasm, storiform fibrous tissue
recurrence rate in chordoma
high; how often can you get wide margin around the spine? So add radiation if necessary
appearance of vertebral hemangiomas
vertical striations
surgical mgmt of lymphoma
usually reserved for mgmt of fractures
medical mgmt of myeloma
bisphosphonates
rate of metastasis in giant cell
2% will mets to the lungs (interesting, bc this is other epiphyseal lesion along with chondroblastoma, which also has 2% mets rate to lungs)
mgmt of giant cell
curettage, adjunct therapy, reconstruction (bone graft, PMMA, etc)
when bone marrow biopsy is part of the treatment plan
in the staging of ewings. presumably to look for micromets, which portend the same prognosis as macromets
histology of adamantinoma
glandular appearance
75% of pts with ABC are this age
under 20 yo
histology of ABC
cavernous blood-filled spaces without endothelial lining
how mgmt might differ for UBC of the proximal femur and proximal humerus
UBC can be treated with aspiration and injection of steroid, but in the femur you would worry about fracture, so that would get curettage, bone graft, fixation
histology of EG
nests of bilobed histiocytes
genetic mutation in fibrous dysplasia
activating mutation of the GS alpha surface protein: increased production of cAMP
this plus skin abnormalities and multiple bone lesions equals McCune-Albright Syndrome
endocrine abnormalities
this treatment is never used in the grafting of fibrous dysplasia
autogenous grafting; it gets turned into fibrous tissue too quickly.
osteofibrous dysplasia vs fibrous dysplasia
OFD is predominantly a tibial lesion, has rimming Osteoblasts, and involves cOrtical bone
quiet Pagets with new onset pain
development of secondary osteosarc
osteofibrous dysplasia AKA
ossifying fibroma
medical mgmt of pagets dz
aimed at retarding the osteoclasts; bisphophonates and calcitonin
perioperative concern with arthroplasty in Pagets
should treat with bisphophonates to decrease bleeding at time of surgery
possible explanation for the most common locations of bony mets
Batson’s venous plexus
mechanism for metastatic bone destruction
tumor releases PTHrP, which stimulates the release of RANKL from the osteoblasts, and G-CSF, both of which lead to osteoclast activation
this can differentiate bt benign lipoma and atypical lipomas
cytogenetic testing will show MDM2 ring chromosome
these have rimming osteoblasts
osteofibrous dysplasia and osteoblastoma
blooming artifact
hemosiderin
3 most common benign tumors of the wrist
ganglions, GCT of tendon sheath, and hemangiomas
histology of adamantinoma
stringy epithelial cells in fibrous stroma
translocation and fusion protein for rhabdomyosarcoma
t(2:13) PAX-FKHR
translocation and fusion protein for DFSP
t(17:22) PDGFB?
translocation and fusion for myxoid liposarc
t(12:16) TLS CHOP
t(12:16) TLS CHOP
translocation and fusion for myxoid liposarcoma
this can be stained for to mark desmoid tumors
nuclear Beta catenin
2 exceptions to the general mgmt of chondrosarcoma
- LOWgrade chondrosarc in the EXTREMITIES can be curetted and cemented; this is not the case everywhere else, when it gets widely excised.
- dedifferentiated chondrosarc benefits from chemo
when NOF is surgically managed and how
if NOF is painful or impending fracture, then it can be curetted
4 tumors for which the mgmt is ROUTINELY curettage and bone grafting
chondroblastoma, GCT, CMF, and osteoblastoma. Curette the motherfucking giant blasts
main issue with UBC mgmt
recurrence
true or false, osteosarc is the only type of secondary Pagetoid conversion
False; there are also chondrosarc and spindle cell sarc variants of malignant transformation in pagets
2 lesions that usually resolve by skeletal maturity (may not be the only ones…)
OFD, and UBC in the foot.
this can be confused for ABC (not everything with a fluid-fluid level is ABC…) but has immature bone on histo
telangiectatic osteosarcoma
this soft-tissue tumor does not need radiation, even if subfascial or >5cm
myxoma
gene in stone man (FOP)
ACVR