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Huang's Orthopaedic Surgery > Tumour > Flashcards

Tumour Flashcards

(56 cards)

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0
Q

What lesion is improved with ibuprofen?

A

Osteoid osteoma

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1
Q

Describe Mirel’s criteria. What is it used for?

A 
Score for prophylactic fixation of pathological fractures
Score: 8 or more indicated prophylactic fixation
- Site
1: upper limb
2: lower limb
3: peritrochanteric
- Lesion: 
1: blastic
2: mixed
3: lytic
- Size of lesion:
1: 2/3
- Pain:
1: mild
2: moderate
3: severe
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2
Q

What is the clinical vignette of a patient with Osteoid osteoma?

A

Young patient with pain totally relieved by NSAIDs.
Pain worse at night
May spontaneously resolve in 2-4 years

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3
Q

What levels are increased in Osteoid osteoma?

A

Cox 1 & 2

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4
Q

Islands of epithelial cells in a spindle-cell stroma +/- nuclear atypia with mitotic figures

A

Adamantinoma

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6
Q

Loose, storiform fibrous background containing spicules of woven bony trabeculae that are lined with layers of osteoblasts

A

Osteofibrous dysplasia

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7
Q

What is typical of an osteoid osteoma radiograph?

A

A nidus of bone

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8
Q

Slowly enlarging, painless soft tissue mass. what are you worried about?

A

Soft-tissue sarcoma

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9
Q

A mutation in which gene causes multiple hereditary exostosis?

A

EXT1 & EXT2

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10
Q

“Stuck on” appearance:

A

parosteal osteosarcoma

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11
Q

A genetic abnormality in the cyclic AMP signaling pathway:

A

Fibrous dysplasia

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12
Q

Life expectancy of bone mets, from Best to Worst

A

The Pit Bulls Keep Laughing:

Thyroid, Prostate, Breast, Kidney, Lung

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13
Q

What percentage of Paget’s disease transforms into osteosarcoma?

A

1%

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14
Q

What are the 5 most common primary sites of metastatic bone lesions?

A

Thyroid, prostate, breast, kidney, lung

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15
Q

Prostate bony mets: Lytic of blastic?

A

Blastic

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16
Q

Name 3 lytic mets:

A

Renal, lung, thyroid

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17
Q

What are the requisite steps of bony metastasis?

A
  • Tumor cell intravasation (entry into blood vessels)
  • Avoidance of immune surveillance
  • Target tissue localization,
  • Induction of angiogenesis
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18
Q

What percentage of enchondromas transform into chondrosarcoma?

A

<1%

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19
Q

What sarcoma’s to go the LNs?

A 
RACES: (RACES to the LN)
Rhabdomyosarcoma
Angiosarcoma (vascular)
Clear cell sarcoma
Epithelioid sarcoma
Synovial  sarcoma
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20
Q

Is sending reamings a good option for biopsy? Why or why not?

A

No, because reamings could contaminate adjacent tissue (muscle, fat, additional compartments), risking successful limb salvage if bx comes back + for malignancy (b/c you’ve just spread it).
NO definitive treatment until biopsy is back.

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21
Q

What is the constellation of signs and symptoms of multiple myeloma?

A

CRAB

  • Calcinosis
  • Renal dysfunction (increased Cr)
  • Anemia
  • Bony (lytic) lesions
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22
Q

What are the tumor biopsy principles?

A
  • Longitudinal incision (allows for extension of incision during definitive management)
  • Do not expose neurovascular structures
  • Maintain meticulous hemostasis
  • Approach through affected compartment
  • Can biopsy adjacent soft tissue if its an extension of the bony tumor
  • Insert any drains in line with the wound
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23
Q

What tumors should be biopsied?

24
Q

What does post-operative radiation achieve?

Study These Flashcards
A

Pain reduction
Slowing of progression
Reduction in tumor burden

25
What laboratory test should be ordered in the setting of osteosarcoma?
ALP | - Can be increased 2-3x
26
What is the risk of malignant transformation of multiple hereditary exostosis (MHE)? What does it transform to?
5-10% risk of transformation to chondrosarcoma
27
What is Maffuci syndrome?
Variant of enchodroma: Multiple enchondromatosis Hemangioma/angioma Lymphangioma Visceral malignancy (brain - astrocytoma, GI) High risk of transformation to chondrosarcoma
28
What is the Enneking tumour staging system?
``` Benign: 1: Latent 2: Active 3: Aggressive Malignant: I: Low grade, no mets: - IA: intracompartmental - IB: extracompartmental II: High grade, no mets: - IIA: intracompartmental - IIB: extracompartmental III: Metastatic - IIIA: intracompartmental - IIIB: extracompartmental ```
29
What is the AJCC tumour staging system?
American Joint Committee on Cancer System
30
What works better on osteosarcoma? Radiation or chemotherapy?
Chemotherapy | - Osteosarcoma is highly resistant to radiation therapy
31
What are the absolute and relative contraindications for limb-salvage surgery?
- Inability to obtain a wide surgical margin - Neurovascular involvement - Pathologic fracture
32
What is the survival rate for non-metastatic and metastatic osteosarcoma?
10 year survival: Non-metastatic: 60-80% Metastatic: 20-30%
33
What effect of chemo has been reported to improve survival?
>90% tumor necrosis with neoadjuvant chemotherapy
34
What are the types of osteosarcoma?
``` Intramedullary: - Conventional: most common - Telangeictatic - Low grade - Small-cell Surface: - Parosteal - low-grade - Periosteal - intermediate grade - High-grade - high grade ```
35
Describe conventional osteosarcoma?
Intramedullary osteosarcoma Most common variant (80%) X-ray: Osteolytic and/or blastic bone lesion with cortical destruction Histo: - Malignant mesenchymal cells - Spindle to polyhedral shape - Pleomorphic nuclei and occasional mitotic figures - Evidence to bone or osteoid matrix Further divided into: - Osteoblastic, chondroblastic, fibroblastic, depending on matrix
36
Describe Telangiectatic osteosarcoma?
Intramedullary osteosarcoma Eccentric and osteolytic lesion expanding or disrupting the metaphyseal surface - Lesion may resemble an ABC as it contains multiple blood-filled sinusoids - High signal intensity on T2- weighted MRI Histo: - Multiple dilated hemorrhagic cavities, small amounts of osteoid and high grade osteosarcoma cells found within the septa
37
Describe low-grade intramedullary osteosarcoma
Intramedullary osteosarcoma - Unaggressive appearing lytic, mixed lytic/blastic or blastic process - Appears fibro-osseous - Varying amouts of septal ossification and sclerosis Histo: - Well-differentiated cells dispersed with women microtrabeculae of bone and fibrous stroma - Small amounts of osteoid, atypia and mitotic figures
38
Describe small-cell osteosarcoma
Intramedullary. Rare - Lytic areas with variable amounts of sclerosis - MRI: large circumferential soft-tissue mass Histo: - Small, round, malignant cells within an osteoid matrix
39
Describe parosteal osteosarcoma:
Surface osteosarcoma - Densely ossified and lobulated mass sparing IM cavity - Often posterior on femur Histo: - low-grade, well differentiated fibrous stroma with osseous components - "Pulled steel wool" pattern with presence of bony trabeculae with a parallel orientation
40
Describe periosteal osteosarcoma:
Surface juxtacortical tuour - More aggressive than parosteal - Lytic, radiolucent mass sparing IM cavity - Sunburst appearance common Histo: - Intermediate grade tumour containing cartilagenous matrix with areas of calcification - Small amounts of osteoid
41
Describe high grade osteosarcoma:
- Surface osteosarcoma with partial mineralization and tumour extension in surrounding ST Histo: - High grade spindle cells with atypia and varying amounts of osteoid
42
What is the common origin of the Ewing Sarcoma Family of Tumours?
Mesenchymal stem cells capable of differentiation into multiple lineages
43
Describe Ewing's Sarcoma
Ill-defined, mottled or focally moth-eaten destructive intramedullary lesion. Laminated or onionskin peristeal reaction. May have sunburst or codman's triangle
44
What are the differences between Osteosarcoma & Ewing's sarcoma?
Osteosarcoma: Metaphysis ES: diaphysis/metadiaphyseal Osteosarcoma: Codman's triangle/sunburst more common Both 2nd decade of life
45
What is the common genetic abnormality in Ewing's?
EWS-ETS (FLI1) fusion gene | 11;22 translocation
46
Describe the histopathology of de-differentiated chondrosarcoma:
Often not of the same type as the primary chondrsarcoma/osteochondroma (ie it's something else like osteosarcoma)
47
What part of the osteochondroma becomes malignant in secondary chondrosarcoma?
The cartilagenous cap
48
dDx for "Bubbly" or "Soap bubble" appearance on x-ray
aneurysmal bone cyst (ABC) non-ossifying fibrooma (NOF) unicameral bone cyst (UBC)
49
"metaphyseal eccentric "bubbly" lytic lesion surrounded by sclerotic rim"
Non-ossifying fibroma
50
What is MHE?
Multiple hereditary exostosis. Multiple osteochondromas | Maliganancy risk: 5-10% with MHE (vs. 1% with solitary osteochondroma)
51
EXT gene
multiple hereditary exostosis
52
What is the risk of malignancy for solitary osteochondroma & MHE
Risk of transformation into chondrosarc: 1% for solitary 5-10% for MHE
53
Ollier's & Maffuci:
Multiple enchondromas: Ollier's: multiple enchondromatosis. 30% malignancy Maffuci: 100% malignancy from enchondromatosis & angioMa and visceral malignancies (GIs)
54
What is the most malignant form of chondrosarcoma?
Dedifferentiated chondrosarcoma
55
What is the 10 year survival rate of dedifferentiated chondrosarcoma?
10% at 10 years - it is the most malignant form of chondrosarcoma
56
Risk factors for fracture in bone mets (not mirel's)
Resistant tumour Widespread disease Visceral involvement End stage disease

Huang's Orthopaedic Surgery (15 decks)

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