Bone Tumors and Tumor-Like Lesions
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
thamrick800
Popular Medical sets