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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
Benign fibrous histiocytoma
40s-50s Pelvis and femur diaphysis or epiphysis Progressive pain Curettage or wife resection (neoplasm because of its tendency toward recurrence)
26
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 ```
27
McCune-Albright Syndrome
``` Fibrous dysplasia Cutaneous pigmentation (coast of maine) neurofibro is coast of cali Endocrine issues ```
28
Mazabraud syndrome
Fibrous dysplasia | Intramuscular myxomas
29
Osteofibrous dysplasia
10-20s Tibia diaphysis Can cause anterior bowing Obs, fx usually treated nonop
30
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
31
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
32
Hemangioma
Adults Vertebral body and skull Asymptomatic Vertically oriented trabeculae
33
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 ```
34
Brown tumor
Adults Hypercalcemia Primary hyperpara: adenoma Secondary hyperpara: chronic renal failure
35
Desmoplastic fibroma
20-30s Skull, mandible, pelvis Septate lesion Wide resection (local recurrence high)
36
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 ```
37
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
38
Chondromyxoid fibroma
10-30 male Prox tibia metaphysis Bubbly lesions Tx: extended curettage
39
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)
40
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
41
Hand Schuller Christian
Skill lesions Exophthalmos Diabetes insipidus
42
Letterer Siwe
Fever Lymphadenopathy Hepatospenomegaly Multiple bone lesions
43
Soft tissue sarcoma with mets to lymph nodes
``` RACES Rhabdomyosarcoma Angiosarcoma Clear cell sarcoma Epitheloid Synovial ```
44
MC soft tissue for foot
Synovial sarcoma
45
MC soft tissue for hand
Epitheloid sarcoma
46
MC for soft tissue for retroperitenium
Liposarcoma
47
Biphasic on histo
Adamantinoma Epitheloid Synovial sarcoma
48
Translocation for Ewings
11:22, 21:22
49
Translocation for my Myxoid liposarc
12:16
50
Translocation for alveolar rhabdomyosarcoma
2:13
51
Translocation for ABC
Usp6

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