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Tumor Flashcards

1
Q

DD for epiphyseal lesions

A

Chondroblastoma (10-25)
Giant cell tumor (20-40)
Clear chondrosarcoma

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2
Q

DD for diaphyseal lesions

A 
Ewing sarcoma (5-25)
Lymphoma (adult)
Fibrous dysphasia (5-30)
Adamantinoma (tibia)
Histiocytosis (5-30)
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3
Q

DD for lesions of spine older than 40

A

Mets
Multiple myeloma
Hemiangioma
Chordoma (sacrum)

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4
Q

DD for lesions of spine younger than 30

A

Vertebral body: histiocytosis, hemangioma

Post elements: osteoid osteoma, osteoblastoma, ABC

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5
Q

DD for multiple lesions

A 
Enchondroma
Fibrous dysplasia
Hemangioma
Histiocytosis
Hyperparathyroidism 
Infection
Mets
Multiple myeloma
Osteochondroma
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6
Q

DD for lesions in sacrum

A

Chordoma

Giant cell tumor

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7
Q

DD for punctuate stippled calcification

A

Enchondroma
Chondrosarcoma

Cartilage formation

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8
Q

Small blue tumors

A

Ewing sarcoma
Lymphoma
Leukemia
Histiocytosis

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9
Q

Bone met sources

A 
Breast
Lung
Thyroid
Renal
Prostate
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10
Q

Benign tumor staging

A
  1. latent: intracapsular, asymptomatic, well defined margin with thick rim of reactive bone, do not require treatment and no not compromise strength of bone
  2. Active: intracapsular but actively growing, well defined margins but thin cortex TX: extended curettage
  3. Aggressive: extracapsular, broken through reactive bone tx: extended curettage and marginal or wide resection
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11
Q 
Malignant tumor staging 
Ia
Ib
IIa
IIb
III
A 
Low grade, intracompartmental,no mets
Low grade extracomp no mets
High grade intra no mets
High grade extra no mets
Anything with mets
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12
Q

Indications for primary resection (excisional biopsy)

A

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

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13
Q

Target dose for radiation therapy

A

30-40gy for myeloma

60gy for soft tissue sarcoma

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14
Q

Tumors sensitive to radiation

A

Small blue cell tumors (MM, lymphoma, ewings)
Mets other than renal cell
ST sarcomas to decrease size before resection

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15
Q

Osteoid osteoma

A

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)

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16
Q

Bone island

Osteopoikilosis

A

Adults
Asymptomatic
Observation
Osteo: multiple bone islands

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17
Q

Chondroma

A 
Adults
Phalanges of Hand, prox hum, distal femur, prox tibia
Asymptomatic 
Stippled calcifications
Observe, curettage if symptoms
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18
Q

Ollier disease

A

Multiple enchondroma

Malignant transformation is 25%

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19
Q

Maffucci syndrome

A

Multiple enchondroma with soft tissue hemangiomas

Risk of malignant transformation is 100%

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20
Q

Osteochondroma

A 
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
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21
Q

Multiple hereditary exostoses

A

AD
Ext1 or 2 mutation affect physical prehypertrophic chondrocytes
Osteochondroma
Multiple exostosis
Malignant transformation: 10% to chondrosarcoma
Ulnar deviation of hand

22
Q

Nonossifying fibroma

A 
10-20s
Metaphysis of long bone (femur and tib)
Lobulated lesion
Asymptomatic 
Spindle cells, whorled pattern (helicopter in wheat field)
Hemosiderin pigmentation
Tx: obs
23
Q

Jaffe-Campanacci syndrome

A

Multiple ninossifying fibromas with cafe au lair spots

24
Q

Cortical desmoid

A

10-15 y/o male
Posteromedial distal fem metaphysis
Obs
Reaction to pull of adductor magnus

25
Q

Benign fibrous histiocytoma

A

40s-50s
Pelvis and femur diaphysis or epiphysis
Progressive pain
Curettage or wife resection (neoplasm because of its tendency toward recurrence)

26
Q

Fibrous dysplasia

A 
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
27
Q

McCune-Albright Syndrome

A 
Fibrous dysplasia
Cutaneous pigmentation (coast of maine) neurofibro is coast of cali
Endocrine issues
28
Q

Mazabraud syndrome

A

Fibrous dysplasia

Intramuscular myxomas

29
Q

Osteofibrous dysplasia

A

10-20s
Tibia diaphysis
Can cause anterior bowing
Obs, fx usually treated nonop

30
Q

UBC

A

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

31
Q

ABC

A

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

32
Q

Hemangioma

A

Adults
Vertebral body and skull
Asymptomatic
Vertically oriented trabeculae

33
Q

Paget’s disease

A 
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
34
Q

Brown tumor

A

Adults
Hypercalcemia
Primary hyperpara: adenoma
Secondary hyperpara: chronic renal failure

35
Q

Desmoplastic fibroma

A

20-30s
Skull, mandible, pelvis
Septate lesion
Wide resection (local recurrence high)

36
Q

Giant cell

A 
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
37
Q

Chondroblastoma

A

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

38
Q

Chondromyxoid fibroma

A

10-30 male
Prox tibia metaphysis
Bubbly lesions
Tx: extended curettage

39
Q

Osteoblastoma

A

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)

40
Q

Langerhans cells histiocytosis

A

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

41
Q

Hand Schuller Christian

A

Skill lesions
Exophthalmos
Diabetes insipidus

42
Q

Letterer Siwe

A

Fever
Lymphadenopathy
Hepatospenomegaly
Multiple bone lesions

43
Q

Soft tissue sarcoma with mets to lymph nodes

A 
RACES
Rhabdomyosarcoma
Angiosarcoma
Clear cell sarcoma
Epitheloid
Synovial
44
Q

MC soft tissue for foot

A

Synovial sarcoma

45
Q

MC soft tissue for hand

A

Epitheloid sarcoma

46
Q

MC for soft tissue for retroperitenium

A

Liposarcoma

47
Q

Biphasic on histo

A

Adamantinoma
Epitheloid
Synovial sarcoma

48
Q

Translocation for Ewings

A

11:22, 21:22

49
Q

Translocation for my Myxoid liposarc

A

12:16

50
Q

Translocation for alveolar rhabdomyosarcoma

A

2:13

51
Q

Translocation for ABC

A

Usp6

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