Tumores Benignos Flashcards
Qual a predileção de envolvimento do osteoma osteoide?
Predilection for the lower extremity, with half the cases involving the femur or tibia.
Qual a população mais comumente afetada por osteoma osteoide?
Homem jovem (2a e 3a décadas de vida)
Qual é apresentação clássica do osteoma osteoide?
The typical patient with an osteoid osteoma has pain that is worse at night and is relieved by aspirin or other nonsteroidal antiinflammatory medications.
O que pode ocorrer com uma articulação ou com a coluna vertebral de um paciente com osteoma osteoide nessas localizações?
When the lesion is near a joint, swelling, stifness, and contracture may occur. When the lesion is in a vertebra, scoliosis may occur.
Qual é a aparência do osteoma osteoide no rx?
The lesion consists of a small (<1.5 cm) central radiolucent nidus with surrounding bony sclerosis.
Qual é o melhor metodo de imagem para diagnostico de osteoma osteoide?
Tomografia
Quando indicar biopsia para ostema osteoide?
Raramente
Como tratar osteoma osteoide?
Multiple treatment options are available, including medical treatment, percutaneous radiofrequency ablation, and open surgical procedures. If the patient’s symptoms are adequately controlled, and the patient is willing to undergo long-term medical management, antiinflammatory medication can be used as the definitive treatment. Patients treated in this manner usually experience spontaneous healing of the lesion within 3 to 4 years.
Most patients with lesions of the pelvis or long bones of the extremities can be treated with percutaneous radiofrequency ablation.
Qual a taxa de recorrencia do osteoma osteoide?
Menos que 10%
Como é realizada a tecnica de radiofrequencia?
This technique involves a CT-guided core needle biopsy after which a radiofrequency electrode is inserted through the cannula of the biopsy needle. The temperature at the tip is increased to 90°C for 6 minutes.
Em quais osteomas osteoides a tecnica de radiofrequencia é contra-indicada?
The procedure may not be indicated for vertebral lesions (due to risk of thermal injury to the spinal cord) or lesions of the small bones of the hands or feet (due to risk of thermal injury to the skin).
Quais são os locais mais comum de ilhas osseas/enostoses?
Almost any bone can be involved, but the pelvis and the femur are the most common sites.
Qual diagnostico diferencia deve ser feito com enostoses?
Osteopoikilosis is a rare condition consisting of multiple small bone islands throughout the skeleton. Autosomal dominant and sporadic forms of the syndrome have been identiied.
Qual é a aparencia radiografica das enostoses?
They typically are small, round or oval areas of homogeneous increased density within the cancellous bone. Radiating spicules on the periphery of the bone islands merge with the native bone creating a brushlike border.
Como tratar um paciente com enostoses?
Most patients with bone islands can be treated with observation with serial plain radiographs. As long as the lesions remain asymptomatic and do not grow, no further intervention is indicated. If a patient experiences pain, or if the lesion grows, biopsy is indicated to rule out more aggressive lesions, such as a sclerosing osteosarcoma, blastic metastasis, or sclerotic myeloma.
Qual a região mais comum de localização dos condromas?
Although any bone can be involved, the phalanges of the hand are the most common location. They are the most common tumor of the small bones of the hands and feet.
Como é o crescimento dos condromas?
They usually arise in the medullary canal, where they are referred to as “enchondromas.” Rarely, they arise on the surface of the bone, where they are referred to as “periosteal chondromas” or “juxtacortical chondromas.
Como se caracteriza a Doença de Ollier?
Multiple enchondromatosis, also known as Ollier disease, is a rare condition in which many cartilaginous tumors appear in the large and small tubular bones and in the flat bones. It is caused by failure of normal endochondral ossification.
The tumors are located in the epiphysis and the adjacent parts of the metaphysis and shat, and many bones may be afected.
Como se caracteriza a Síndrome de Mafucci?
Multiple lesions of the small bones of the hand may cause considerable disability. When associated with hemangiomas of the overlying soft tissues the disease is known as Mafucci syndrome.
Qual a porcentagem de malignização dos condromas na Doença de Ollier?
Approximately 25% of patients with Ollier disease are diagnosed with sarcomas by 40 years of age.
Qual o aspecto radiologico dos condromas?
Enchondromas are benign-appearing tumors with intralesional calcification. The calcification is irregular and has been described as “stippled,” “punctate,” or “popcorn”.
Como diferenciar radiograficamente um condroma de um condrossarcoma?
In more proximal locations (e.g., the pelvis, proximal humerus, or proximal femur), deep endosteal erosion (two thirds of the thickness of the cortex) frequently indicates a chondrosarcoma. An associated soft tissue mass is never present with an enchondroma and always indicates a chondrosarcoma.
Como tratar um paciente com condroma?
Treatment of patients with solitary enchondromas usually consists of observation with serial radiographs. If the lesion remains radiographically stable and asymptomatic, no further intervention is indicated. If a lesion grows, or if it becomes symptomatic, extended curettage usually is curative.
Como tratar um paciente com encondromatose multipla?
Treatment of patients with multiple enchondromatosis can be more diicult. Although the individual lesions usually are not treated, the more obvious deformities can be corrected by osteotomy. These patients also must be monitored indefinitely for malignant change.
Como se caracteriza o comportamento dos osteocondromas?
The lesions consist of a bony mass, often in the form of a stalk, produced by progressive endochondral ossification of a growing cartilaginous cap. In contrast to true neoplasms, their growth usually parallels that of the patient and usually ceases when skeletal maturity is reached. Most lesions are found during the period of rapid skeletal growth. About 90% of patients have only a single lesion. Osteochondromas may occur on any bone preformed in cartilage but usually are found on the metaphysis of a long bone near the physis.
Quais são os locais mais comuns de desenvolvimento de osteocondromas?
They are seen most often on the distal femur, the proximal tibia, and the proximal humerus.
O que é a doença de Trevor?
Trevor disease (dysplasia epiphysealis hemimelica) refers to an intraarticular epiphyseal osteochondroma. When multiple joints are involved, it is usually unilateral (hemimelica).
Quais são as caracteristicas geneticas da exostose multipla hereditaria?
Multiple hereditary exostoses is an autosomal dominant condition with variable penetrance. Most patients with this disorder have a mutation in one of two genes: EXT1, which is located on chromosome 8q24.11-q24.13, or EXT2, which is located on chromosome 11p11-12.
Quais são as caracteristicas clinicas da exostose multipla familiar?
Presence of many exostoses, but disturbances in growth also occur, such as abnormal tubulation of bones, producing broad and blunt metaphyses, and sometimes bowing of the radius and shortening of the ulna, producing ulnar deviation of the hand. The disease occurs only 5% to 10% as often as solitary osteochondroma and is more common in males.
Como são classificados os osteocondromas?
Osteochondromas are of two types: pedunculated and broad based or sessile.
Quais são as caracteristicas dos osteocondromas pedunculados?
Pedunculated tumors are more common, and any definite stalk is directed away from the physis adjacent to which it takes its origin. The projecting part of the lesion has cortical and cancellous components, both of which are continuous with corresponding components of the parent bone. The lesion is covered by a cartilaginous cap that often is irregular and usually cannot be seen on radiographs; occasionally, calciication within the cap may be seen. Typically, the cap is only a few millimeters thick in adults, although it may be 2 cm thick in a child.
Qual é a taxa de malignização dos osteocondromas?
Approximately 1% for patients with a solitary osteochondroma and 5% for patients with multiple hereditary exostoses.
Quando suspeitar de transformação maligna de um osteocondroma?
Malignant transformation should be suspected when a previously quiescent lesion in an adult grows rapidly; it usually takes the form of a low-grade chondrosarcoma. In these cases, the cartilage cap usually is more than 2 cm thick. Malignant transformation is best evaluated by CT or MRI.
Quais são as caracteristicas da exostose subungueal?
A similar lesion, subungual exostosis, may develop on a distal phalanx, especially of the great toe. Often there is a definite history of trauma. Excision is indicated when elevation of the nail produces pain. The history and location of the lesion distinguish it from a true osteochondroma.
Qual a porcentagem de crianças que se acredita possuirem fibromas não-ossificantes?
Nonossifying fibromas (also known as metaphyseal fibrous defects, fibrous cortical defects, and fibroxanthomas) are common developmental abnormalities and are believed to occur in 35% of children.
Comente a epidemiologia dos fibromas não-ossificantes.
Generally, these lesions occur in the metaphyseal region of long bones in individuals 2 to 20 years old. Although any bone may be involved, approximately 40% of these lesions are found in the distal femur, 40% in the tibia, and 10% in the fibula.
Quais são as caracteristicas radiologicas dos fibromas não-ossificantes?
On plain radiographs, a nonossifying ibroma appears as a well-defined lobulated lesion located eccentrically in the metaphysis. Multilocular appearance or ridges in the bony wall, sclerotic scalloped borders, and erosion of the cortex are frequent findings. There is no periosteal reaction in the absence of a pathological fracture.
Como tratar um fibroma não-ossificante?
Most nonossifying fibromas are asymptomatic and regress spontaneously in adulthood. Most pathological fractures can be treated nonoperatively.
Some authors have recommended treatment for lesions that are larger than 50% of the diameter of the bone because of a theoretical increased risk of pathological fracture, although this parameter is not universally accepted as an indication for surgery. Recurrence ater curettage is rare.
Quais são as caracteristicas de um “cortical desmoid”?
A cortical desmoid is an irregularity in the posteromedial aspect of the distal femoral metaphysis and usually is seen in boys 10 to 15 years old. It may be a reaction to muscle stress exerted by the adductor magnus. The lesion is best seen on an oblique radiograph made with the lower extremity externally rotated 20 to 45 degrees. Clinical symptoms, if any, include soft tissue swelling and pain. Radiographs and MRI reveal erosion of the cortex with a sclerotic base. A biopsy is not warranted. Treatment usually consists of observation.
Qual é a caracteristica da displasia fibrosa? Quais são as suas formas?
The hallmark is replacement of normal bone and marrow by fibrous tissue and small, woven spicules of bone. May exist in a monostotic or polyostotic form.
Quais são as localizações da displasia fibrosa? Quais outros achados clinicos podem estar associados?
Fibrous distrophy can occur in the epiphysis, metaphysis, or diaphysis. Associated abnormalities, such as sexual precocity, abnormal skin pigmentation, intramuscular myxoma, and thyroid disease, may be present.
Quais são os achados da síndrome de McCune-Albright?
McCune-Albright syndrome refers to polyostotic fibrous dysplasia, cutaneous pigmentation, and endocrine abdonormalites.
Como se caracteriza a sindrome de Mazabraud?
Mazabraud syndrome is polyostotic fibrous dysplasia with intramuscular myxomas.
Quais são as caracteristicas radiologicas da displasia fibrosa?
The radiographic appearance is characteristic, with the lucent area having a granular, ground-glass appearance with a well-defined sclerotic rim.
Como tratar a displasia fibrosa?
Surgical treatment is indicated when significant deformity or pathological fracture occurs or when significant pain exists. Actual and impending pathological fractures are best treated with intra-medullary fixation when possible. Deformities are corrected by osteotomy with internal ixation.
Qual tipo de medicação os estudos mostram alguma eficacia para pacientes com displasia fibrosa?
Studies suggest that treatment with bisphosphonates probably is beneficial for patients with extensive disease.
O que é a doença de Campanacci?
Osteoibrous dysplasia (ossifying fibroma of long bones, also known as Campanacci disease) is a rare lesion usually afecting the tibia and fibula.
Qual a região mais comumente afetada pela displasia osteofibrosa?
The middle third of the tibia is the most frequently afected location, and although the lesion usually is diaphyseal, it may encroach on the metaphysis. The tibia is enlarged and often bowed anterolaterally.
Qual é a caracteristica radiografica da displasia osteofibrosa?
The radiographs show eccentric intracortical osteolysis with expansion of the cortex.
Quais são os diagnosticos diferenciais da displasia osteofibrosa?
The lesion must be distinguished from adamantinoma and monostotic fibrous dysplasia.
Qual o curso natural da displasia osteofibrosa?
Unpredictble. Some lesions regress spontaneously during childhood; most progress during childhood, but not ater puberty. Recurrence rates are high ater curettage or marginal resection in children. Conversely, recurrence rates are low ater surgery in skeletally mature patients. Pathological fractures can be treated nonoperatively. Surgical management is aimed at preventing or correcting deformity.
Quais são as caracteristicas do fibroma desmoplastico?
Raro, localmente agressivo, incidencia maior em pessoas na 2-3a decadas de vida. Envolve mais comumente ossos longos tubulares, mas casos de envolvimento pelvico, coluna vertebral, cranio e mandibula já foram descritos.
Quais são os achados radiológicos dos fibromas desmoplasticos?
Radiographs typically reveal a well-circumscribed lytic lesion with a narrow zone of transition and frequently a thin rim of reactive bone. Cortical destruction may be present. The lesion sometimes appears septate. On MRI, desmoplastic ibroma, similar to other fibrous tumors, may show low signal intensity on T1- and T2-weighted images.
Qual o tratamento recomendado para os fibromas desmoplasticos?
This tumor does not metastasize, but local recurrence is common after simple curettage. Most authors have recommended wide resection.
Qual a faixa etaria de incidencia dos cistos osseos unicamerais?
Unicameral bone cysts are common lesions of childhood more consistent with a developmental or reactive lesion than a true tumor. Eighty-five percent occur in the first 2 decades with a 2 : 1 male predominance.
Quais são os locais de acometimento mais comum dos cistos osseos?
Most common in the proximal humerus and femur (child). In adults, the ilium and calcaneus are more common locations.
Qual o comportamento classico dos cistos osseos?
The lesions are most active during skeletal growth and usually heal spontaneously at maturity. Unicameral bone cysts often are asymptomatic, unless a pathological fracture has occurred. Two thirds of patients present with fractures, which can stimulate the cyst to heal.
Quais são os achados radiograficos dos cistos osseos unicamerais?
Plain radiographs reveal a centrally located, purely lytic lesion with a well-marginated outline and usually are diagnostic for a unicameral bone cyst. The cyst may expand concentrically but never penetrates the cortex. Prominent osseous ridges on the inner cortical wall may give it a multiloculated appearance. No periosteal reaction is present, unless there has been a fracture.
Qual é o sinal radiografico patognomonico de cisto osseo unicameral fraturado?
Occasionally (20%), a thinned cortical fragment fractures and falls into the base of the lesion, confirming its empty cystic nature. This “fallen fragment” sign is pathognomonic of a unicameral bone cyst with a fracture.
Como são classificados os cistos osseos unicamerais?
Unicameral bone cysts are classified as active when they are within 1 cm of the physis and latent when they are closer to the diaphysis.
Como tratar os cistos osseos unicamerais?
Small, asymptomatic lesions in the upper extremities can be treated with observation with serial plain radiographs. Larger lesions (lesions at risk for pathological fracture), symptomatic lesions, and lesions in the lower extremities usually are treated with curettage (with or without bone grafting or internal fixation) or aspiration and injection (often using corticosteroids, bone marrow aspirate, demineralized bone matrix, or other materials). Pathological fractures in the upper extremity can be treated conservatively because the fracture may initiate cyst “healing.” Fractures through unicameral bone cysts in the proximal femur should be treated with curettage, bone grafting, and internal fixation. Flexible intramedullary nailing has been used in the femur and humerus and provides early stability, often obviating the need for a cast, and decreases the risk of further pathological fracture.
Quais são os locais de acometimento mais comuns do cisto osseo aneurismatico?
Most common locations include the proximal humerus, distal femur, proximal tibia, and spine.
Quando acomete a vertebra, qual o local mais comumumente afetado?
Vertebral lesions, accounting for 15% to 20% of these entities, are located in the posterior elements with frequent extension into the vertebral body or to adjacent levels.
Qual é a faixa etária de incidencia do cisto osseo aneurismático e o genero mais acometido?
Most occur in patients younger than 20 years old, and there is a slight female predominance.
Quais são os achados radiográficos dos cistos osseos aneurismaticos?
Radiographs reveal an expansile lytic lesion that elevates the periosteum but remains contained by a thin shell of cortical bone. An aneurysmal bone cyst can have well-defined margins or a permeative appearance that mimics a malignancy. It is most often eccentrically located in the metaphysis.
Como diferenciar um cisto osseo simples de um cisto osseo aneurismarico na ressonancia magnetica?
When diferentiating between a unicameral and aneurysmal bone cyst using MRI, the presence of a double-density fluid level and intralesional septations usually indicates an aneurysmal bone cyst.
Como tratar os cistos osseos aneurismaticos?
We treat most aneurysmal bone cysts with extended curettage and grafting with a bone graft substitute. Because the lesion may produce heavy bleeding, tourniquet control is advised. Marginal resection sometimes is indicated for lesions in expendable bones. Lesions in the spine or pelvis can be treated with preoperative embolization to minimize surgical blood loss
Qual é a taxa de recorrencia dos cistos osseos aneurismaticos após o tratamento?
The recurrence rate after curettage of an aneurysmal bone cyst is 10% to 20%. Recurrence has been correlated with age younger than 15 years, centrally located cysts, and incomplete removal of the cystic cavity contents.
Quais são os locais tipicos de acometimento dos cistos intraosseos ganglionicos?
Occur typically in the ends of the long bones of middle-aged men, particularly the distal tibia, although the knee and shoulder are other common areas.
Quais são os achados radiograficos tipicos do cisto ganglionico intraosseo?
On radiographs and MRI they appear as uniloculated or multiloculated, well-demarcated, lytic defects with a thin rim of sclerotic bone.
Como tratar os cistos ganglionicos intraosseos?
Treatment of symptomatic lesions is by local excision of overlying sot tissues and curettage of the involved bone. Recurrence is uncommon.
Qual o local mais comum de acometimento dos cistos epidermoides?
Are found most often in the skull.
Qual a aparencia radiografica dos cistos epidermoides?
Radiographically, they appear as rarefied defects surrounded by sclerotic bone.
Qual a aparencia radiologica dos lipomas intra-osseos?
They usually appear as well-defined lucencies possibly with a thin rim of reactive bone. CT and MRI show well-defined lesions with the same signal characteristics as fat. Central necrosis or calcification sometimes is evident.
Quando indicar cirurgia para o lipoma intraosseo?
Surgery is indicated only for the rare symptomatic lesion. In these cases, simple curettage usually is curative.
Qual a porcentagem estimada de hemangioma na coluna vertebral assintomatica na população?
It is estimated that 10% of the population has asymptomatic lesions of the vertebral bodies.
Quais locais comuns de aparecimento de hemangiomas?
Vertebras e cranio
Qual o achado radiologico do hemangioma vertebral?
The radiographic appearance in the spine usually is characteristic, with thickened, vertically oriented trabeculae giving the classic “jailhouse” appearance. In cross section, these thickened trabeculae have a “polka dot” pattern on CT.
Qual o manejo dos hemangiomas?
Treatment usually is not necessary; however, multiple options exist for symptomatic lesions. Nerve root or cord decompression with spinal stabilization is needed for rare cases of vertebral collapse with neurological compromise. Most lesions of the long bones can be treated adequately with extended curettage.
Qual a população afetada pela doença de Paget?
Paget disease may afect 4% of people of Anglo-Saxon descent who are older than age 55 years, but it is rare in most other populations.
Quais são as fases da doença de Paget?
It is a disorder of unregulated bone turnover. Excessive osteoclastic resorption is followed by increased osteoblastic activity. An early lytic phase is followed by excessive bone production with cortical and trabecular thickening.
Quais são os achados radiograficos da doença de Paget?
Radiographic indings depend on the stage of the disease. In the lytic phase, bone resorption can take on a “blade of grass” or “flame” appearance beginning at the end of the bone and extending toward the diaphysis. Later the radiographs show bony sclerosis, thickened cortices, and thickened trabeculae. Bone scans usually are “hot”.
Qual o padrão caracteristico da biopsia na doença de Paget?
Biopsy usually reveals a characteristic “mosaic” pattern with widened lamellae, irregular cement lines, and fibrovascular connective tissue.
Qual o manejo da doença de Paget?
Medical management of Paget disease consists of non-steroidal antiinflammatory drugs, calcitonin, or bisphosphonates. Serum alkaline phosphatase levels and urine pyridinium crosslinks can be used to monitor the activity of the disease. Orthopaedic management consists of correcting deformity and treating pathological fractures. During periods of active disease, intraoperative bleeding from afected bones can be massive.
Qual o risco de um paciente com doença de Paget desenvolver um sarcoma secundário?
Approximately 1% of patients with Paget disease develop a secondary bone sarcoma, usually an osteosarcoma. This risk is probably higher for patients with polyostotic disease.
Quais são as causas de hiperparatireoidismo?
Primary hyperparathyroidism usually is caused by an adenoma of the parathyroid glands. Secondary hyperparathyroidism can occur in patients with chronic renal failure.
Qual é o diagnostico diferencial do tumor marrom do hiperparatireioidismo?
Tumor de celulas gigantes. In hyperparathyroidism (1) the giant cells are a little smaller, often occurring in a nodular arrangement, especially around areas of hemorrhage; (2) the stromal cells are more spindle shaped and delicate; and (3) evidence of osseous metaplasia within the stroma is prominent.
