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Bone Tumors
Bone Tumors and Tumor-Like Lesions
| Question | Answer |
|---|---|
| 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
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