Tumor Flashcards
DD for epiphyseal lesions
Chondroblastoma (10-25)
Giant cell tumor (20-40)
Clear chondrosarcoma
DD for diaphyseal lesions
Ewing sarcoma (5-25) Lymphoma (adult) Fibrous dysphasia (5-30) Adamantinoma (tibia) Histiocytosis (5-30)
DD for lesions of spine older than 40
Mets
Multiple myeloma
Hemiangioma
Chordoma (sacrum)
DD for lesions of spine younger than 30
Vertebral body: histiocytosis, hemangioma
Post elements: osteoid osteoma, osteoblastoma, ABC
DD for multiple lesions
Enchondroma Fibrous dysplasia Hemangioma Histiocytosis Hyperparathyroidism Infection Mets Multiple myeloma Osteochondroma
DD for lesions in sacrum
Chordoma
Giant cell tumor
DD for punctuate stippled calcification
Enchondroma
Chondrosarcoma
Cartilage formation
Small blue tumors
Ewing sarcoma
Lymphoma
Leukemia
Histiocytosis
Bone met sources
Breast Lung Thyroid Renal Prostate
Benign tumor staging
- latent: intracapsular, asymptomatic, well defined margin with thick rim of reactive bone, do not require treatment and no not compromise strength of bone
- Active: intracapsular but actively growing, well defined margins but thin cortex TX: extended curettage
- Aggressive: extracapsular, broken through reactive bone tx: extended curettage and marginal or wide resection
Malignant tumor staging Ia Ib IIa IIb III
Low grade, intracompartmental,no mets Low grade extracomp no mets High grade intra no mets High grade extra no mets Anything with mets
Indications for primary resection (excisional biopsy)
Small less then 3cm subq mass that is unlikely to be malignant
Osteoid osteoma or osteochondroma
Painful lesion in prox fib or distal ulna that would need resection whether malignant or benign
Target dose for radiation therapy
30-40gy for myeloma
60gy for soft tissue sarcoma
Tumors sensitive to radiation
Small blue cell tumors (MM, lymphoma, ewings)
Mets other than renal cell
ST sarcomas to decrease size before resection
Osteoid osteoma
Male 20-30
Pain at night
Post elements of spine
Relieved by NSAIDS
Increased cyclooxygenase and prostaglandins
CT with central nidus
TX: antiinflam will heal lesion in 3-4 years
Radiofreq ablation for pelvis or LE 90 degrees Celsius for 6 minutes (can’t do in vertebra and small bones of hand and feet)
Bone island
Osteopoikilosis
Adults
Asymptomatic
Observation
Osteo: multiple bone islands
Chondroma
Adults Phalanges of Hand, prox hum, distal femur, prox tibia Asymptomatic Stippled calcifications Observe, curettage if symptoms
Ollier disease
Multiple enchondroma
Malignant transformation is 25%
Maffucci syndrome
Multiple enchondroma with soft tissue hemangiomas
Risk of malignant transformation is 100%
Osteochondroma
20-30s Bony mass with stalk Metaphysis of long bone Presents with mass Pedunculated lesion with cartilage cap Obs but resection if symptoms 1% chance of malignant change (chondrosarcoma) Recurrence: failure to remove entire cartilaginous cap Subungal exostosis: at hallux
Multiple hereditary exostoses
AD
Ext1 or 2 mutation affect physical prehypertrophic chondrocytes
Osteochondroma
Multiple exostosis
Malignant transformation: 10% to chondrosarcoma
Ulnar deviation of hand
Nonossifying fibroma
10-20s Metaphysis of long bone (femur and tib) Lobulated lesion Asymptomatic Spindle cells, whorled pattern (helicopter in wheat field) Hemosiderin pigmentation Tx: obs
Jaffe-Campanacci syndrome
Multiple ninossifying fibromas with cafe au lair spots
Cortical desmoid
10-15 y/o male
Posteromedial distal fem metaphysis
Obs
Reaction to pull of adductor magnus
Benign fibrous histiocytoma
40s-50s
Pelvis and femur diaphysis or epiphysis
Progressive pain
Curettage or wife resection (neoplasm because of its tendency toward recurrence)
Fibrous dysplasia
10-30s Femur and tibia Ground glass Activating mutation of GS alpha surface protein, increased camp Shepherds crook deformity on XR Alphabet soup or Chinese letters Tx:ppx fixation, bisphos if severe
McCune-Albright Syndrome
Fibrous dysplasia Cutaneous pigmentation (coast of maine) neurofibro is coast of cali Endocrine issues
Mazabraud syndrome
Fibrous dysplasia
Intramuscular myxomas
Osteofibrous dysplasia
10-20s
Tibia diaphysis
Can cause anterior bowing
Obs, fx usually treated nonop
UBC
10-20s male
Prox hum, prox femur dysphysis, calc in adults
Lining is fibroblasts
Straw colored cystic fluid
No periosteum elevation
Asymptomatic
Obs with immobilization alone aspiration/injection
Fallen leaf sign: ubc with fracture in cyst
ABC
10-20s female
Prox hum, distal femur, prox tibia, spine metaphysis
Pain
Blood filled lakes with endothelial lining Elevated periosteum, bubbly appearance on XR
Fluid fluid levels on MRI, hemorrhagic cavernous spaces on histo
Extended curettage with grafting
Arterial embolization
Hemangioma
Adults
Vertebral body and skull
Asymptomatic
Vertically oriented trabeculae
Paget’s disease
50-80s male Excessive osteoblasts and clasts Vertebral body, pelvis, prox femur Woven bone, mosaic pattern Elevated alk phos and urine pyridinium levels Bisphos, nsaids, calcitonin Phases: lytic, mixed, sclerotic
Brown tumor
Adults
Hypercalcemia
Primary hyperpara: adenoma
Secondary hyperpara: chronic renal failure
Desmoplastic fibroma
20-30s
Skull, mandible, pelvis
Septate lesion
Wide resection (local recurrence high)
Giant cell
20-40 female Distal fem/prox tibia/distal radius Epiphysis, giant cells Tx: extended curettage with with chemical cauterizarion (phenol) bone grafting and cement 3% incidence of benign pulm mets Lytic Get cxr at time of diagnosis to stage Recurrance or mets usually occurs within 3 years
Chondroblastoma
10-20 male
Dist femur/prox tibia/prox hum, flat bones
May cross open physis!!!
Well circumscribed, in center of epiphysis
Greater tub or greater troch
Chicken wire calcification
Intralesional calcifications
Tx: extended curettage
1% incidence of benign pulm mets
Recurrance 10-20%
Follow up with XR every 6 months for at least 3 years
Chondromyxoid fibroma
10-30 male
Prox tibia metaphysis
Bubbly lesions
Tx: extended curettage
Osteoblastoma
10-30 male
Post elements of spine
Tx: extended curettage or resection, may require stabilization
Can have nidus…usually greater than 1.5cm (osteoid osteoma less than 1.5cm)
Langerhans cells histiocytosis
Less then 20 male
Vertebral bodies, flat bones
Hole within a whole appearance on XR
Veretebral plana (flattening of veretebral body)!!!
Eosinophilic granuloma, Indented nucleus with abundant cytoplasm (langerhan cell)
S-100 positive
Tx: obs(most regress spontaneously), steroid injection if painful
Hand Schuller Christian
Skill lesions
Exophthalmos
Diabetes insipidus
Letterer Siwe
Fever
Lymphadenopathy
Hepatospenomegaly
Multiple bone lesions
Soft tissue sarcoma with mets to lymph nodes
RACES Rhabdomyosarcoma Angiosarcoma Clear cell sarcoma Epitheloid Synovial
MC soft tissue for foot
Synovial sarcoma
MC soft tissue for hand
Epitheloid sarcoma
MC for soft tissue for retroperitenium
Liposarcoma
Biphasic on histo
Adamantinoma
Epitheloid
Synovial sarcoma
Translocation for Ewings
11:22, 21:22
Translocation for my Myxoid liposarc
12:16
Translocation for alveolar rhabdomyosarcoma
2:13
Translocation for ABC
Usp6
