Tumors Flashcards
1
Q
Presentation of tumors and tumor like lesions of the bone?
What should eval include?
A
both benign and malignant:
- persistent skeletal pain and swelling, mil discomfort
- limited of motion
- spontaneous fx
- night pain (malignant)
- proceed w/ clinical, radiographic, lab and bx exam
- anyone over 40:
think mets: prostate, breast
2
Q
Diff tumors of the bone?
A
osteoblastic CT tumors:
- osteoid osteoma: pain usually relieved by aspirin
- osteosarcoma: resection and chemo
Cartilage tumors:
- enchondromas
- chondromyxoid fibromas
- chondrosarcomas
bone tumors:
- giant cell: 50% are benign
- chondroblastomas: almost always benign
- ewing’s sarcoma: 50% mortality rate in spite of chemo, rad and surgery
3
Q
What are sxs that pt to malignant tumor of the bone?
Xray findings - that pt to malignancy?
PE findings?
A
- night pain, constant pain, unusual sxs, no improvement w/ conservative management, or general sxs such as fever, malaise, weakness
- if over 40, weakness: MM
- xray findings: lytic or blastic bone changes, soft tissue calcification or periosteal reaction
- PE: unexplained mass, especially in the thigh
4
Q
Eval of pts w/ suspected tumor of the bone?
A
- PE and xrays for most
- possible bone scan, CT, MRI, CXR/CT for more high risk lesions
- consider:
lab tests (CBC, Ca, Phosphorous, alk phos - bone breakdown) - consults/referral oncologist, path
5
Q
How should a bx be done?
A
- ideal if performed by surgeon (one who knows what he/she is doing)
- longitudinal and stay in 1 compartment
- consult to plan incision
6
Q
Tx of bone tumor?
A
- clearly benign: observation vs excision/curettage
- possibly malignant: consider referral to regional cancer center having teams of pathologists, radiologists, surgeons and oncologists and radiation therapists
7
Q
Classification of tumors?
A
- bony vs soft tissue
- benign vs malignant
- primary vs mets
8
Q
Prognosis of malignant bone tumors?
A
- prognosis greatly improved in recent yrs w/ dedicated referral centers, pre-op chemo, limb sparing procedures
9
Q
Common characteristics of osteosarcoma? Imaging?
A
- 2nd MC primary bone tumor after myeloma
- high risk mets
- 20% of all bone sarcomas
- 2nd decade (10-20yo)
- male=female
- appendicular (50% knee - clicking, chronic pain in knee) - 90% in metaphysis of long bones (MC femur, tibia, humerus) - bone pain/jt swelling, palpable soft tissue mass
- MC mets lungs (usually COD)
- XRs mixed lytic/sclerotic w/ cortical destruction (Codman’s triangle - ossification of raised periosteum, “star burst” periosteal rxn)
- MRI
management: limb sparing resection (if not neovascular), amputation (if neovascular), Chemo as adjuvant tx
10
Q
Characteristics of Ewing’s Sarcoma?
A
- highly anaplastic
- small round cell tumor in sheets
- MC in males 5-35y, femur and pelvis MC location
- bone pain, +/- palpable mass, may have jt swelling, +/- fever
- Dx:
- newer lab tests to differentiate
- long bone diaphyses, lytic, moth-eaten, indistinct margins, “onion skin”**
- really aggressive
- management: chemo, surgery, and rad
- survival rates now 80-90% w/ pre-op chemo (vs 20%)
11
Q
Soft tissue tumors - why are they challneging? Diff types and modes of resection?
A
- challenging: hx rarely helpful, xrays usually negative
- small (less than 5 cm) superificial cystic lesions usually benign/observed
- large deep solid tumors: studies/bx
- type of resection: intralesional, marginal, wide and radical
12
Q
Classes and staging of soft tissue tumors?
A
class based on apparent differentiation:
- fibrous: Dupuytren’s, desmoid
- lipomatous: lipoma, liposarcoma
- smooth muscle, striated muscle, vascular, synovial, neuro
- staging: tumor grade, location, extension, mets
13
Q
MC cuase of bone destruction in an adult? Most common areas?
A
- Mets: breast, lung, prostate, kidney, all common, go to bone
- spine, ribs, pelvis, proximal limb girdles MC
- initial presentation may be to orthopedist w/ pain (low back and thoracic pain)
14
Q
What are common pitfalls of dx bone tumors?
A
- assume metastatic, not recognizing that a fx is pathologic, inadequate w/u, planning, fixation, not knowing when to refer
- tx: fx risk, fxn, palliation, other
15
Q
What are some common benign bone tumors?
A
- osteochondroma
- osteoid osteoma
- bone cyst
- nonossifying fibroma
16
Q
Characteristics of an osteochondroma? Management?
A
- MC (35-50%) of benign and about 15% of all primary bone tumors
- not true neoplasms
- knee/proximal humerus - 2:1 males
- 10-20y
- begins in childhood and grows until skeletal maturity (if it doesn’t stop - be concerned it is something else) , may precede chondrosarcomas
- mostly mechanical problems/compression, space occupying
- often pedunculated, grows away from growth plate, and involves medullary tissue, pelvis is MC site of malignant transformation
- CT/MRI if unclear
- surgery: completely excise cartilage and perichondrium
17
Q
Osteoid osteoma characteristics? Imaging, tx?
A
- benign
- nidus: well demarcated, bone forming, up to 1 cm, approx 10% of benign bone tumors and 2-3% of all primary bone tumors
- 2nd and 3rd decades: Male to female 3:1
- long bones: lower extremity, cortex, posterior elements lumbar spine
- dull/sharp pain, worse at night, better w/ aspirin/NSAIDs
Imaging- XR/CT
- En bloc resection (CT, XR) w/ lymph drainage
- percutaneous radiofrequency ablation
18
Q
Characteristics of unicameral bone cyst? Tx?
A
- ages 5-15, boys 3:1 over girls
- 50-60% prox humerus
- not true cyst
- central radiolucent lesion metaphyseal side of growth plate, long bones
- MRI if unclear
- curretage/graft: 20% to 45% recurrence
- needle aspiration and several steroid injections at 2 month intervals - 10% recurrence
19
Q
What is FCD-NOF (fibrous cortical defect/non ossifying fibroma)?
A
- common in childhood
- approx 5% of benign primary tumors
- non-neoplastic
- metaphysis of long bones (knee)
- occurs in first 2 decades
- oval elongated radiolucent, well marginated
- if weakening bone then curettage/graft
- prone to fx: if fx immobilize, observe, sometimes lesions will heal
20
Q
What is critical in bone tumor care?
A
- early detection/tx/referral can be critical
