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Alexey Ortho Flashcards > Tumor > Flashcards

Tumor Flashcards

1
Q

Bone lesions with

Localised periosteal reaction

A

MOON BIS

Metastasis
Osteomyelitis
Osteoporosis
Non-accidental Injury
Bleeding disorders
Inflammatory arthritides
Sickle cell disease
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2
Q

Bone lesions with

Symmetrical periosteal reaction

A

NJ CARS

Normal infants
Juvenile chronic arthritis (JCA)
Caffey's disease
Acute leukaemia
Rickets
Scurvy
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3
Q

Eccentric lesion of bone
Expansile
Well-defined

A

ACNE G

Aneurysmal bone cyst
Chondro-myxoid fibroma
Non-ossifying fibroma
Enchondroma
Giant cell tumor
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4
Q

Lucent lesions of bone

No marginal sclerosis

A

MEME BC

Metastases
Encondroma
Multiple myeloma
Eosinophilic granuloma
Brown tumor (hyperparathyroidism)
Chondroblastoma
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5
Q

Lucent lesions of bone
Well defined
Marginal Sclerosis
No cortical expansion

A

BE CSF

Brodie's abscess
Enchondroma
Chondroblastoma
Simple bone cyst
Fibrous dysplasia
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6
Q

Differentials for an Osteoid Osteoma (lytic nidus)

A

BB FOE

Bone island
Brodie's abscess
Fatigue fracture
Osteoblastoma
Ewing's sarcoma
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7
Q

Lesions with Fluid levels on MRI

A

Aneurysmal Bone Cyst
Telangiectatic Osteosarcoma

Goats CSF

GCT
OsteoBlastoma
ABC
Telang OsteoSarc
Sarcomas
ChondroBlastoma
Simple Bone Cyst
Fibroxanthoma
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8
Q

Lesions that are cold on bone scan

MCL MRI

A 
Myeloma
Chordoma
Lytic metastases
Melanoma
Renal Cell Carcinoma
Ischaemic bone

MCL MRI

Or: Smell A Rat
Sarcoma / Myeloma / EG / Lymphoma / Leukemia / AVn / Renal Cell / Abscess / Thyroid

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9
Q

Benign lesions that expand the bone

GAS

A

Giant cell tumor
Aneurysmal bone cyst
Simple bone cyst

(GAS)

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10
Q

Permeative, moth eaten on XR of tumor implies:

A

Malignant lesion or infection

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11
Q

Ground glass on XR of tumor implies:

A

Fibrous matrix

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12
Q

Cloudy appearance on XR of tumor implies:

A

Osteoid matrix

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13
Q

Stippled calcification (pop corn) implies:

A

Cartilage matrix

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14
Q

Dyaphysis tumors

LAMEFOE

A 
Lymphoma
Adamantinoma
Myeloma
Ewing's sarcoma
Fibrous dysplasia
Osteoid Osteoma
Eosinophilic granuloma

(LAMEFOE)

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15
Q

Metaphysis tumors

OFFICE CFO

A 
Osteochondroma
Fibrous dysplasia
Fibrous cortical defect
Infection
Cysts
Enchondroma

Chondrosarcoma
Fibrosarcoma
Osteosarcoma

OFFICE CFO

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16
Q

Epiphysis tumors

C IS AGE

A 
Chondroblastoma
Infection
Subchondral ganglion
Avascular necrosis
Giant cell tumor
Eosinophilic granuloma

C(hondroblastoma) IS AGE related

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17
Q

Sclerotic bone lesions (name 10) on XR

A 
Osteoma
Osteosarcoma
Osteopetrosis
Osteopoikilosis
Metastases
Hemangioma
Infarct
Paget’s
Hyperparathyroidism
  1. Vascular (haemangioma / infarct)
  2. Infection
  3. Neoplasm (Osteoma, Osteosarcoma, Metastasis)
  4. Drugs (Vitamin D)
  5. Inflammatory
  6. Congenital (Bone island, Osteopetrosis, Osteopoikilosis)
  7. Autoimmune
  8. Trauma
  9. Endocrine (Paget’s, Hyperparathyroidism)
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18
Q

Lucent bone lesions (there are 14) on XR

FOGMmACHhINEeS

A
  1. Fibrous dysplasia
  2. Osteoblastoma
  3. Giant cell tumor
  4. Metastases
  5. Myeloma
  6. ABC
  7. Chondroblastoma
  8. Hyperparathyroidism
  9. Haemangioma
  10. Infection
  11. Non-ossifying fibroma
  12. Enchondroma
  13. EG
  14. Simple bone cyst

FOGMACHINES

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19
Q

Causes of Vertebra plana

EAT HOME

A 
Eosinophilic Granuloma (most common)
Aneurysmal Bone Cyst
Tuberculosis
Haemangioma
Osteoporosis
Multiple Myeloma
Ewing's Sarcoma

EAT HOME

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20
Q

Biopsy Principles

A 
Longitudinal incision
Haemostasis
Intramuscular approach
Single compartment
Frozen section
Representative sample
Drain in line with incision
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21
Q

Biopsy approaches by joint

A 
Proximal humerus = Anterior deltoid
Distal humerus = Brachialis or lateral triceps
Wrist = 2nd dorsal compartment
Iliac = Abductor muscles
Supraacetabular = Smith Peterson
Femoral neck = Transtrochanteric
Distal Femur = Vastus medialis
Tibia = Subcutaneous border
22
Q

Name 3 variations of Histiocytosis X

A

Eosinophilic Granuloma
Hand-Schuller-Christian disease (Langerhans cell histiocytosis with visceral involvement)
Letterer-Siwe disease (fatal form in childhood)

23
Q

Classic triad in Hand-Schuller-Christian disease

A

Multiple lytic skull lesions
Diabetes insipidus
Exopthalmos

24
Q

What is a Marjolin’s ulcer

A

A malignant transformation of the ulcer in cases of chronic osteomyelitis.
Usually SCC, but can also be BCC and melanoma (rarely)

25
Q

Harrington’s Criteria for impending pathological fracture

A

> 50% diaphyseal destruction
75% metaphyseal destruction
Subtrochanteric femur destruction
Persistent pain after radiation

26
Q

Mirel’s criteria for impending pathological fracture

A

Pain, Site, Size, Type

Pain: Functional = 3, Moderate = 2, Mild = 1
Site: Pertrochanteric = 3, LL = 2, UL = 1
Size: > 66% = 3, >33% = 2, <33% = 1
Type: Lytic = 3, Mixed = 2, Blastic = 1

If it’s 8, intubate (with an IM nail)

27
Q

What primary bone cancers are treated with Chemotherapy (+/- surgery)

A

Chondrosarcoma (dediferentiated)
Ewing’s sarcoma
Malignant Fibrous Histiocytoma
Osteosarcoma (intramedullary and periosteal)

28
Q

Metastatic lesions to bone

A

Lead kettle (PB KTL)

Prostate
Breast
Kidney
Thyroid
Lung
29
Q

Which sarcomas can metastasize to Lymph nodes?

A

E-Sarc

Epithelioid sarcoma
Synovial sarcoma
Angiosarcoma
Rhabdomyosarcoma
Clear cell sarcoma
30
Q

“Soap Bubble” appearance on x-ray lesions

A

Fibrous dysplasia
Aneurysmal bone cyst
Non-ossifying fibroma
Giant cell tumor

Chordoma
Renal Cell Carcinoma
Adamantinoma
Plasmacytoma

31
Q

Never use Autogenous bone graft to fill what tumor?

A

Fibrous dysplasia.

The grafted bone will quickly turn into FD again.

32
Q

What is the pathophysiology of osteolysis in metastatic tumors

A

Lytic bone mets:
RANKL (produced by osteoblasts)
RANK receptor (on osteoclasts) - stimulates osteoclasts to resorb bone
OPG (produced by osteoblasts) - inhibit osteoclast differentiation

Blastic bone mets:
Endothelin 1 secreted by tumor

RANK:
Receptor Activator of Nuclear Kappa B

33
Q

Median Survival with Metastatic bone disease (from best to worst)

A 
Thyroid (48 months)
Prostate (40 months)
Breast (24 months)
Kidney (6+ months)
Lung (6 months)
34
Q

Primary cancers that can have Acral Metastases (long reach in the limbs)

A

Long
Reach
Bone

Lung (44%)
Renal (12%)
Breast (10%)

Also Colon (6%)

35
Q

Lesions that are DARK on T1 and T2

A

Desmoid
scAr tissue
fibRous tissue
Kortical bone

36
Q

Lesions that are LLigHt on T1 and T2

A

Lipoma
Liposarcoma
Haemangiomoa

37
Q

Benign bone tumors in an adult

A

HOPE

Hypothyroid
Osteonecrosis
Paget’s
Enostosis

38
Q

Vertebral BODY tumors

A

CHEMMO GI

Chordoma
Haemangioma
EG
Metastases
Myeloma
Osteosarcoma
GCT
Infection
39
Q

Vertebral posterior elements tumors

A

Osteoid osteoma
Osteoblastoma
ABC

40
Q

Wormian bones - 6 conditions that cause it

A

CHOP R Down

Cleidocranial dysostosis
Hyperthyroid
Hypophosphatasia
Osteogenesis Imperfecta
Pyknodysostosis
Rickett's
Downs
41
Q

Painful tumors

A

Glomus tumor
Osteoid osteoma
Synovial sarcoma
Haemangioma

Fibrosarcoma
Infection
Neuroma

42
Q

Liposarcoma (Def Epi Age Sex Site Points Radiol Treatment)

A 
Def: Malignant lipoblasts
Epi: 10% of STS (2nd most common)
Age: Adult (40-60)
Sex: Male
Site: Thigh / Retroperitoneum / Popliteal / Inguinal
Points: S-100 +ve stain, Does not arise from Lipoma (usually)
1/2 metastasize to lung
MRI: heterogenous signal
5 types (W,M,R,P,D)
Treat: Wide excision and PostOp RadX
43
Q

What are the 5 types of Liposarcoma

A 
Well-differentiated (low grade)
Myxoid (low grade)
Round cell (high grade)
Pleomorphic (high grade)
Dedifferentiated (high grade)
44
Q

Malignant Fibrous Histiocytoma (Undifferentiated Pleomorphic Sarcoma) (Def Epi Age Sex Site Points Radiol Treatment)

A

Def: Primitive mesenchymal cell (Macrophage and Fibroblast)
Epi: The most common soft tissue sarcoma
Age: Adult (50+)
Sex: Male
Site: Thigh / Leg / Arm / Forearm / Retroperitoneal
Points: recently being reclassified as other tumors.
Can be primary or secondary (Paget’s, Bone infarct, RadX, Osteochondromas)
Deep, aggressively enlarging, but mildly painful
50% mets on presentation
50% local recurrence
85% survival if <5cm
MRI: heterogenous, irregular
Treat: Wide resection, RadX for margins, Chemo for Mets

45
Q

Rhabdomyosarcoma (Def Epi Age Sex Site Points Radiol Treatment)

A 
Def: striated muscle
Epi: most common Malignant ST in children (<15 yo)
Age: Child (<15 yo)
Sex:
Site: Groin / Head / Neck
Points: small round blue cell tumor
Four types: BEPA
Radiol:
Treat: Neoadjuvant Chemo (in children), Wide resection +/- RadX / Wide resection and RadX in adults
46
Q

What are the 4 types of Rhabdomyosarcoma

A

BEPA

Botryoid (bunch of grapes) - hollow viscus - 30% survival

Embryonic - most common / <10 yo / 80% survival

Pleomorphic - rare / adults / skeletal muscle - 25% survival

Alveolar - adolescent / t(2:13) - 60% survival

47
Q

Synovial Sarcoma (Def Epi Age Sex Site Points Radiol Treatment)

A

Def: malignant tumor of primitive synovial-like cells that rarely arises within a joint.
Epi: Most common STS of the foot
Age: Adult (15-40)
Sex: Male
Site: most common STS of the foot, but most commonly found around the knee
Points: Mets to lymph nodes, Two types (Bi and Mono)
t(X:18) translocation
Radiol: may have calcification, heterogenous mass on MRI
Good prognosis: calcified, <5cm
Treat: PreOp RadX + Wide excision + PostOp Chemo.
Amputation preferred in hand and foot.

48
Q

Spine tumors

A 
EG
Osteochondroma
Osteoid osteoma
Osteoblastoma
ABC
GCT
Hemangioma

Ewings
Osteosarc
Chordoma
Mets

49
Q

Tokuhashi score for Vertebral mets

A 
General condition (out of 2)
Bone mets outside the spine (out of 2)
Bone mets in the spine (out of 2)
Organ mets (out of 1)
Primary type (out of 5)

Score 9-11 = 76% 6 month and 30% 12 month survival

50
Q

Small round blue cell tumors

A 
Lymphoma
Ewings
Acute lymphoblastic leukaemia
Rhabdomyosarcoma
Neuroblastoma
Retinoblastoma
Medulloblastoma
Wilms tumor
Nephroblastoma
Small cell lung cancer
51
Q

Epithelioid Sarcoma (Def Epi Age Sex Site Points Radiol Treatment)

A 
Def: 
Epi: Most common soft tissue sarcoma of hand
Age: Adolescents (10-35)
Sex:
Site: Hand / Forearm / Foot and ankle
Points: Firm, painless nodule that can ulcerate
Radiol: Calcified in 10-20%
MRI LowT1, HighT2 (indeterminate)
Treat: amputation.  Very poor prognosis

Alexey Ortho Flashcards (21 decks)

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