Tx/Prognosis of Tumors Exam 3

Question 1

Giant cell tumor

prognosis

Answer 1

• 80% benign
• 20% malignant
• txt: surgical curettage w/ liquid nitrogen freezing, bone packing or grafting.
• recurrence rate of 12-50%
• 5 yr survival for mal. Lesions 10%

Question 2

Simple/solitary/unicameral bone cyst

prognosis

Answer 2

• spontaneous regression in some
• surgical curettage and bone chip, recurrence rate of 30-40%
• most effective txt is the injection of steroids

Question 3

Osteoblastoma

prognosis

Answer 3

-surgical curettage and bone ship therapy with possible recurrence at 50%

• radiation therapy may be used for some lesions especially in the spine
• small lesions are treated by excision or curettage
• recurrence rate of ~5%
• spinal lesions often undergo radiation

Question 4

Osteoid osteoma

prognosis

Answer 4

• complete surgical excision of the nidus (reactive bone sclerosis regresses subsequently)
• little chance of recurrence
• vertebral body lesions may be irritated

Question 5

Enchondroma

prognosis

Answer 5

• usually req no treatment
• symptomatic lesion in long bones may req surgical curettage and bone chips
• malignant degeneration in long bones ~15-20%

Question 6

Hemangiomas

prognosis

Answer 6

• usually req no treatment
• symptomatic spinal lesion may undergo decompression surgery
• symptomatic skull lesion often treated with en bloc excision

Question 7

Chondroblastoma

prognosis

Answer 7

• surgical curettage and packing with bone chips
• local recurrence rate of ~20%
• resection in an expendable area

Question 8

Fibrous cortical defect

prognosis

Answer 8

-no treatment necessary as these lesions tend to spontaneously regress over a 2-5 yr period

Question 9

Nonossifying fibroma

prognosis

Answer 9

• no txt rendered as these lesions spontaneously regress with age in most cases
• lg lesions >8 cm may req curettage and bone packing to prohibit fx

Question 10

Paget’s disease

prognosis

Answer 10

Possible complication

• peripheral nerve compression
• brainstem compression & spinal stenosis
• hearing loss, blindness, facial palsey
• hyperemia of overlying skin
• “banana fx” in long bones
• pathological fx
• high output cardiac failure
• DJD
• malignant transformation

Question 11

Fibrous dysplasia

prognosis

Answer 11

Possible complication

• leg length discrepancy
• shepard’s crook and sabre shin deformities
• CN compromise
• protusio acetabuli
• proptosis
• pseudoarthrosis of the tibia in infancy
• malignant transromation .5-1%
• pathologic fx

Question 12

Fibrosarcoma

prognosis

Answer 12

-late metastasis to lung and lymph nodes*
Txt of choice is to amputate with jt disarticulation
-5 year survival is ~30%

Question 13

Chordoma

prognosis

Answer 13

• resection for sacral area lesions
• radiation fro clival and vertebral lesions
• almost 100% recurrence despite surgery
• 5 yrs survival ~8.5% for sacral lesions
• 3 yr survival for skull & vertebral lesion

Question 14

Multiple Myeloma

prognosis

Answer 14

• txt is often palliative
• chemotherapy, radiotherapy
• hydration & ambulation
• 5yr survival 20%

Question 15

Osteosarcoma

prognosis

Answer 15

-amputation only: 20% 5-year survival, 15% develop skeletal mets; 75% fatal in

Question 16

Chondrosarcoma

prognosis

Answer 16

• local excision
• segmental resection
• amputation
• 90% survival after early surgery

Question 17

Ewing’s Sarcoma

prognosis

Answer 17

• metastasis to: lung, bone, regional lymph nodes in 11-30% at time of dx, in 40-45% within 2 yrs of diagnosis
• tx: amputation, radiation, chemotherapy with 60-75% 5 year survival