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Bone Tumors

Bone Tumors and Tumor-Like Lesions

Approach to diagnosis of Bone Tumors and Tumor-Like Lesions ? * Age, pain/no pain, imaging (zone of transition = see if malig. or benign), and histology
4 Categories of Bone Lesions ? * Bone forming tumors -- Cartilage forming tumors -- Fibrous and fibro-osseus tumors -- Miscellaneous tumors
IMAGING STRATEGY OF BONE LESIONS ? * Plain film radiograph is ALWAYS the first step ...... * MRI important for local staging and preoperative planning ..... * CT scan useful in identifying tumor matrix ..... * PEP Scan = metastatic bone cancer
4 Bone Forming Tumors ? * Osteoma -- Osteoid osteoma -- Osteoblastoma -- Osteosarcoma
Osteoma basics ? * benign tumor that arise on or inside the skull .... * Cx insignificant unless it is obstructing something
OSTEOMA X-Ray ? * smooth, dense, well circumscribed , usu under 2cm.... * see Sclerotic focus
Osteoid Osteoma ? * less than 2 cm, usu involves femur and tibia, Severe nocturnal pain relieved by aspirin, usu in ppl under 25 y/o
Osteoid Blastoma ? (super RARE) * larger than 2 cm, usu involves spine,Pain is dull, achy and unresponsive to aspirin
Morphology of Osteoid osteoma and Osteoblastoma ? * same histo .... * The mass is made up of hemorrhagic ..... * in OO, we see a Nidus gritty tan tissue ..... * bone prominently rimmed by Osteoblasts
Osteoid Osteoma/Osteoblastoma imaging ? * bone scan is best to differentiate between the two, also it resembles osteomyelitis .... * on X-ray can look like TB or Aneurysm Bone Cyst
Osteosarcoma basics ? * malignant mesenchymal tumor in which the cancerous cells produce bone matrix -- Most common primary malignant tumor of bone
Osteosarcoma age and usu places it develops ? * 75% in younger than 20 years and 25% in the elderly who get it due to an underlying condition (2ndary osteosarcoma)..... * arrise in the metaphyseal region of the long bone and almost 50% in the knee
Most common osteosarcoma subtype ? * metaphysis, primary (in younger kids), solitary, intramedullary and poorly differentiated
Morphology of Osteosarcoma ? * tan-white tumor fills most of the medullary cavity of the metaphysis and diaphysis ....... * see both cortical and periosteal involvement
Clinical Features of Osteosarcoma ? * Painful, progressively enlarging mass that is aggressive and spreads, and usu to the lungs ..... * if mets to lung = 20% survival and 60-70% without
Osteosarcoma Imaging ? * osteomyelitis mimics this ..... * see classical Sunburst pattern ..... * Zone of transition- best to Dx malignancy/benign..... * usu in Long Bones ...... *see lytic lesions on X-Ray
Osteosarcoma Summary ? * Seen in the second decade of life -- presents in physically active teens, misDx as sports injury -- see sunburst pattern on film -- CT of chest may show lung mets -- biopsy needed for Dx -- often limb salvage done at time of biospy --chemo started after
Benign Bone Forming Tumors Summary ? * Osteoid osteoma (10-20 yrs): go away with maturity ane bone pain is lowered with salicylates (aspirin) ....... * Osteoma (any age): on face/skull ....... * Osteoblastoma(10-20yrs): located in vertebrae, and need spinal stability and surgery
Cartilage Forming Tumors ? * Osteochondroma -- Chondromas -- Chondroblastoma -- Chondromyxoid fibroma -- Chondrosarcoma
Osteochondroma basics ? * Known as Exostosis and is the and is the Most common benign bone tumor seen in ppl in 20's .... * usu in men and usu solitary
Osteochondroma bones involved ? * Develop only in bones of endochondral origin and arise from the metaphysis near the growth plate of long tubular bones, occasionally from bones of the pelvis, scapula and ribs.... * Rare, but 1% Can transform into chondrosarcoma
If there are multiple nodules in Osteochondroma ? * they have Multiple hereditary exostosis syndrome
Morphology of Osteochondroma ? * Bone marrow and cortical surface are in continuity with the mass has a cartilaginous cap ...... * see no columnar organization, but see more Hypertrophic Zone
Chondromas basics ? * Benign tumors of hyaline cartilage that occur in bones of enchondral origin ........ * get in 20s- 40's
When chondromas arise in the medullary cavity ? * enchondromas
When chondromas arise On surface of the bone ? * subperiosteal or juxtacortical chondroma
Chondroma locations they usu take place at ? * favored sites are tubular bones of hands and feet – usu. on the knuckles
Chondromas Cx Sx and other things it can cause ? * usu no pain, but can have it ...... * Ollier disease = multiple enchondromas ....... * Maffuci syndrome = Enchondromatosis and soft tissue hemangioma
Morphology of Enchondroma ? * Well-circumscribed nodules of cytologically benign hyaline cartilage that are blue/gray.... * location is helpful to Dx
ENCHONDROMA imaging ? * looks like bone infarct on XRay.... * see calcification in phalanges ..... * looks like Chondrosarcoma too, which is painful bones and aggressive
Chondroblastoma basics, locations, and morpho ? * Rare benign tumor in teens ..... * see in knee/epiphysis, and become painful and restrict joint mvt ..... * morpho: Tumor is composed of sheets of compact polyhedral chondroblasts
Chondromyxoid fibroma basics ? * Rarest of cartilage tumors ...... * mistaken for osteosarcoma usu..... * see in teens- 20's.... * CxSx: dull, achy, localized pain
Chondrosarcoma basics and CxSx? * produces neoplastic cartilage and in 2nd decade (40's) ....... * Present as painful, progressively enlarging masses....... * see in ribs , pelvis, and shoulder
Morphology of Chondrosarcoma ? * lobules of hyaline and myxoid cartilage permeating throughout the medullary cavity .....----.....grows through the cortex and forms a relatively well-circumscribed soft tissue mass
Chondrosarcoma imaging ? * over 40, see snowflake pattern, and in shoulder/pelvis
Osteochondroma management ? * if solitary, watch and wait..... * Surgery if needed due to pain.... *usu resolves itself after growth ends
Fibrous and Fibro-Osseus tumors ? * Fibrous cortical defect and non-ossifying fibroma --- Fibrous Dysplasia --- Fibrosarcoma Variants
Fibrous Cortical Defect and Non-Ossifying Fibroma basics ? * Fibrous cortical defects = Small (0.5cm) and arise eccentrically in the metaphysis of the distal femur and proximal tibia...... * Non-ossifying fibromas = grow to 5 or 6 cm and in adolescence instead of kids
Non ossifying Fibroma/Fibrous Cortical Defect imaging ? * Most common bone lesion seen by radiologist ...... * usu see bilat lesions ..... * under 30 with no pain ...... * See Thin sclerotic scalloped border
Fibrous Dysplasia basics/morpho ? * No pain....... * All components of normal bone are present but do not differentiate into their mature structures ...... * Buzzword = Chinese Character look..... * grossly well circumscribed , intramedullary and tan white and gritty
Three clinical patterns of Fibrous Dysplasia = ? * Monostotic -70% = seen in one bone only and found accidentally ........ * Polyostotic -27% = multiple bones, see recurrent fractures ........ * McCune-Albright syndrome – 3% = see Poly. + skin pigmentation and precocious puberty in girls usu
Fibrosarcoma variants basics and imaging ? * covered later in Mod.12 ----- * see floating particle in XRay
Malignant Fibrous Bone Tumor basics ? * in Fibrosarcoma and in lonf/flat bones ...... * we see Painful mass with localized swelling and +/- overlying erythema ..... * usu see in elderly though
Miscellaneous Bone Tumors (4) ? * Ewing sarcoma/PNET --- Giant –Cell tumor --- Aneurysmal bone cyst --- Metastatic disease
Ewing Sarcoma/PNET seen in who, CxSx and where? * Second most common bone sarcoma in children (average age 10-15 y/o) ........ * see in femur ....... * CxSx: Painful, enlarging mass some with fever, leukocytosis, inc. ESR and anemia
Ewing Sarcoma/PNET is from ? * get from Chromosomal translocation of (11;22)
Ewing Sarcoma/PNET histo ? * see round cells with scant cytoplasm that appears clear due to glycogen.... *onion peel looking lesion = buzzword
Giant Cell tumor (GCT) basics ? * Aka Osteoclastoma ....... * see in 20 -40 yr olds ........ * both epiphyses and metaphyses involved ...... * Sx almost like arthritis...... * See Necrosis, hemorrhage, and osteoclasts in histo.
GCT imaging ? * ends of bones and epiphysis must be closed
Aneurysmal Bone Cyst basics ? * benign and in 2nd decade ages usu. ....... * see pain and swelling ...... * Develops in the mataphyses of long bones ...... *from translocation of 17p13
Aneurysmal Bone Cyst histo ? * Wall of cyst lined by giant cells… look for blood being surrounded ..... * can regress on its own
Metastatic Bone Disease basics ? * Most common form of skeletal malignancy ..... *ppl over 40..... * found via PET Scan.... * tmt = limb salvage and chemo
Metastatic lesion appearance on X-Ray ? * either Lytic-lucent, loss of bone matrix density --- or --- Blastic- dense, increased bony whiteness, usually slower growing
Mets that is Always lytic? * Renal
Similar to Ewing ? * Osteosarcoma - look at chart in this lec before test for commonalities and differences
Created by: thamrick800