Tumors-2017 Flashcards
What type of tumor is most common is adults?
Metastatic
What type of bone tumors rare and happen mostly younger patients?
Primary bone tumors
T/F: Osteosarcoma is bimodal.
True
What is a common history patients have when they are diagnosed with tumors? (general)
- Night pain, persistent pain
- Non-activity related pain and fatigue
- Night sweats wt. loss (late)
What is a common PE patients have when they are diagnosed with tumors? (general)
- Swelling
- Tenderness/ mass w/o bruise or trauma
- Look for nodes (3rd most likely place for mets. after lungs and bones)
Generally, what 3 images are useful when diagnosing tumors?
- Plain films
- CT and MRI
- Bone scan
What are Enneking’s Four Questions about bone tumors
- Where is the lesion?
- What is it doing to the bone?
- What is the bone doing to it?
- Any intrinsic clues to the histologic diagnosis?
What are Mankin’s 4 questions?
- Is the lesion big or small? (big is bad, small is good)
- Is the bone cortex intact? (Y/N)
- Is the lesion marginated? (zone of transition)
- Is there a soft tissue component/mass?
What does “FOG MACHINES” stand for?
Lytic bone lesions
F : Fibrous dysplasia
O : Osteoblastoma
G: GCT
M : Multiple myeloma/ mets A : Aneurysmal bone cyst C: Chondroblastoma H: Hyperparathyroidism/ hemangioma I : Infections N : NOF E : Eosinophilic granuloma/ enchondroma S : Simple bone cyst
List the Cartilage tumors of bone
- Osteochondroma
- Enchondroma
- Chondroblastoma
4, Chondromyxoid fibroma - Chondrosarcoma
What is the 3rd most common place for mets after lungs and bone?
Lymph nodes
Your Ortho preceptor asks you what image would be best to use if you wanted to assess:
- tumor characteristics
- biological activity
- cortical destruction
- periosteal reaction
Plain film
Why is are CT and MRI useful images?
These are better in evaluating the extent of the lesion and soft tissue invasion;
- also used for following response to treatment
- and detecting recurrence, but should not be interpreted without plain films for correlation
What type of images should not be interpreted without plain films for correlation?
CT and MRI
A fellow student is asking why bone scans are a big deal. Explain why…
Bone scans are particularly useful in identifying metastatic foci or multifocal tumors
What types of tumors are cold to bone scans?
- Some Myeloma,
- renal cells,
- thyroid,
- and lymphomas
Think about Radiographic features of bone lesions–what can you NOT tell by radiograph?
-More of a thought question to keep in mind the limitations of X-rays
- Site of lesion
- Nature of the border of the -lesion/transitional area
- Type of matrix
- Type of bone destruction
- Periosteal reaction
- Presence of soft tissue extension?
What is the most common neoplasm of bone
Osteochondroma
When does Osteochondroma occur and when does it stop growing?
Occurs in an immature skeleton–most likely during a growth spurt
It stops growing with skeletal maturity
What is osteochondroma’s effect on the bone
Medullary and cortical continuity with host bone with cartilage cap
An older pediatric patient (18 year old) is diagnosed with osteochondroma. Explain why this is possibly a bad finding…
If a growth of tumor occurs past skeletal maturity think malig transformation
T/F: The chances of Osteochondroma developing into a malignancy are low (<1%)
True
Less than 1% undergo malignant transformation
A patient is diagnosed with osteochondroma and they have opted for removal via surgery. Explain the parameters for the procedure. (Does the patient have to wait until they are older? Will the growth return?)
- The surgeon can perform the procedure whenever without waiting for a certain age
- There is no low to nothing chance of the growth returning
What is Enchondroma?
Most common tumor in a phalanx of the hand
Where do you see Enchondroma?
- Phalanx of the hand
- Central location in long bones
- Usually solitary
T/F: Enchondroma is strictly a cartilage tumor.
FALSE: May have calcifications
What effect does Enchondroma have on the body?
Expansile remodeling of bone and cortical thinning
What is Enchondroma called when it manifests in multiple? Explain why this is a bad finding.
- Ollie’s disease
- greater incidence of malignant transformation
On your rotations, your preceptor tells you he has a patient with multiple enchondromas with hemangiomas, but he can’t remember the name of this–what is it?
Maffucci syndrome
Looking at an X-ray, when you can see a hole, what percentage of bone is gone? j
50%
There is a finding in the clinic with a patient who is suffering from a tumor in the phalanx of her hand and on her radius and ulna. There have been hemangioma’s noted. What is the diagnosis?
Maffucci syndrome
What is Chondroblastoma?
benign appearing cystic lesions occurring in children and young adults
If a patient is diagnosed with Chondroblastoma, where would you expect to see the lesions on the bone?
in epiphysis or apophysis of a long bone
Chondromyxoid fibroma is a type of what?
Chondroblastoma
Your preceptor is talking about a bone tumor that is more aggressive and destructive that may arise from Chondroblastoma, but you know it can also arise de novo. What is this tumor?
Chondrosarcoma
An elderly patient is diagnosed with an aggressive and destructive bone tumor found in the ulna, humerus, and even the femur. The patient came in complaining of pain. Upon PE, there is a palpable lump. What is the diagnosis?
Chondrosarcoma
An elderly patient is diagnosed with an aggressive and destructive bone tumor found in the ulna, humerus, and even the femur. The patient came in complaining of pain. Upon PE, there is a palpable lump. The patient is also hypoglycemic. What is the diagnosis?
Chondrosarcoma with paraneoplastic syndrome
List the Fibrous Lesions of bone
- NON-OSSIFYING FIBROMA- FIBROUS CORTICAL DEFECT
- FIBROUS DYSPLASIA
- FIBROSARCOMA
- MALIGNANT FIBROUS HISTIOCYTOMA (MFH)
A patient is seen with a tumor in the posterior distal femur, specifically in the metaphysics. The lesion has a sclerotic margin on x-ray and a scalloped contour. There is a fracture though the lesion. Although the patient is asymptomatic. What is the diagnosis?
NON-OSSIFYING FIBROMA
What is a fibrous cortical defect?
Smaller lesions of a non-ossifying fibroma
How common are Non-ossifying fibromas?
Very common–as many as 1/3 of children
What is this:
A genetic disorder characterized by the association of:
- endocrinopathy: precocious puberty
- polyostotic fibrous dysplasia: more severe than in sporadic cases
- cutaneous pigmentation: coast of Maine ‘cafe au lait’ spots
McCune-Albright syndrome (MAS)
A young patient–8 year old–is diagnosed as both monostotic and polyostotic. X-ray results showed a ground-glass matrix and the lesion being sharply marginated. A fellow resident you are rotating with is stunted at what this might be. What do you suggest as a differential to this med student?
FIBROUS DYSPLASIA–and explain that their appearance has a wide spectrum
Define “benign”
Will not metastasize
T/F: A benign tumor will not hurt a patient
FALSE
A 45 year old male patient is diagnosed with an osteolytic lesion in his humerus, femur, radius, and ulna. Your preceptor is discussing the case with you and she tells you this lesion resembles giant cell tumor, lymphoma, or telangiectatic osteosarcoma. What is the diagnosis?
Fibrosarcoma
A 45 year old male patient is diagnosed with an osteolytic lesion in his humerus, femur, radius, and ulna. Your preceptor is discussing the case with you and she tells you this lesion resembles giant cell tumor, lymphoma, or telangiectatic osteosarcoma. What are some ways this condition developed?
May develop in certain benign conditions such as such as Paget disease, bone infarction, or chronic osteomyelitis
formerly known as fibrosarcoma
Malignant Fibrous Histiocytoma (MFH)
Most common aggressive soft tissue sarcomas
Malignant Fibrous Histiocytoma (MFH)
This very aggressive soft tissue sarcoma may present w/Paget disease and has a predilection for the retroperitoneum and proximal extremities. What is it and what is the most likely cause?
- Malignant Fibrous Histiocytoma (MFH)
- as a result of radiotherapy
List the Osseous lesions
- Bone island
- Osteoma
- Osteoid osteoma
- Osteosarcoma
- Ewing’s sarcoma
What is a Bone Island/Enostosis composed of?
composed of compact bone within cancellous bone
What is Bone Island/Enostosis?
sclerotic lesion of no significance
What is the size of Bone Island/Enostosis?
size of a bone island is typically <1 cm
There is a patient diagnosed with a very common lesion located in the sinuses and cranial vault. There is a protruding mass of dense periosteal intramembranous bone on the surface of the host bone. What is the diagnosis?
Osteoma
If there are multiple osteoma, what should you consider?
Gardner syndrome
- familial adenopolyposis (FAP)
- multiple osteomas especially of the mandible, skull and long bones
- epidermal cysts
- fibromatoses
- desmoid tumours of mesentery and anterior abdominal wall
What is second most common primary bone tumor after multiple myeloma?
Osteosarcoma
malignant bone forming tumors
Osteosarcoma
A 12 year old male patient is found with a malignant knee bone tumor; there is also a lesion at the metaphysical region of the femur, tibia, and fibula. The patient was complaining of bone pain. You hear your preceptor say this type of tumor is the second most common type of primary bone tumor. What is the diagnosis?
Primary Osteosarcoma
A 70 year old patient, is found with a malignant bone tumor in the pelvis. The patient was complaining of bone pain. The X-rays show it is a mixed lytic and sclerotic lesions. There is periosteal reaction. You hear your preceptor say this type of tumor is the second most common type of primary bone tumor. What is the diagnosis?
Secondary osteosarcoma
A 70 year old patient, is found with a malignant bone tumor in the pelvis. The patient was complaining of bone pain. The X-rays show it is a mixed lytic and sclerotic lesions. There is periosteal reaction. You hear your preceptor say this type of tumor is the second most common type of primary bone tumor. What is this condition usually secondary to?
usually secondary to malignant degeneration of Paget disease, extensive bone infarcts, post-radiotherapy for other conditions, osteochondroma, and osteoblastoma
You see “Codman’s triangle” on an X-ray. What is your initial diagnosis?
Osteosarcoma
A patient is diagnosed with a subtype of osteosarcoma. Your preceptor tells you it arises from the outer layer of periosteum. How should this patient present in clinic?
A painless, slowly growing mass
A patient is diagnosed with a subtype of osteosarcoma. Your preceptor tells you it arises from the outer layer of periosteum. What is this?
Parosteal osteosarcoma
Where in the body does Parosteal osteosarcoma occur?
Metaphysis of the posterior aspect of the distal femur, then tibia, and the proximal humerus
second most common malignant primary bone tumor of childhood
Ewing’s sarcoma
A patient comes in complaining of pain and swelling; she also has a fever. Her ESR is also elevated. On X-ray, you see a lesion looking “moth eaten.” It is located on the diaphysis of the humerus. You discover there is also a large ST mass.
What is the diagnosis?
Ewing’s sarcoma
Which tumor has a typical onion skin periostitis?
Ewing’s sarcoma `
How are metastatic tumors evaluated?
a radionuclide bone scan or MRI
What area does “Osteoblastic” affect?
prostate
What type of tumors will have an “Osteolytic” density on X-ray?
renal, lung, thyroid
What type of tumor will have a “Mixed lytic and blastic” density on X-ray?
Breast
List the Metastatic Tumors
- Prostate
- Thyroid
- Breast
- Lung
- Skin (melanoma) (GI)
- Kidney
“P. T. Barnum Loves Small (good) Kids”
A 65 year old patient in the clinic has bowing, kyphosis, decreased ROM, her bone size is markedly increased. Her lab findings are as follows:
- elevated serum alkaline phosphatase
- elevated urinary hydroxyproline (collagen breakdown marker)
- increased urinary N-telopeptide, alpha-C-telopeptide, and deoxypyridinoline
- normal calcium levels
- elevated serum uric acid levels caused by the increased turnover of nucleic acids from high bone turnover.
Looking at the patients images is confusing to you because all of the bone seems to be involved; and there is noted trabecula.
What is the diagnosis?
Paget’s disease
What are some treatment options for stopping osteoclasts?
- Bisphosphonates
- Calcitonin
NO TERIPARATIDE
