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NYCC Bone & Joint

Benign Tumors

MC Benign tumor of the extremities Osteochondroma
50% of all benign bone tumors Osteochondroma
MC age/gender of OSTEOCHONDROMA? <20, male
Symptoms of an OSTEOCHONDROMA? Painless, hard mass; stalk may fracture Usually asymptomatic (often unreported)
If an OSTEOCHONDROMA becomes malignant what is it called? Chondrosarcoma
What are the indications to remove an OSTEOCHONDROMA? >5cm, painful Cartilage cap should be <1cm...if >3cm at risk for chondrosarc
Where are OSTEOCHONDROMAS often found? Metaphysis Femur, humerus, tibia, pelvis, ribs, scap
What imaging findings will present with an OSTEOCHONDROMA? SESSILE: Cartilage cap (uncommon) Lucent when en face (wide, broad metaphysis) PEDUNCULATED (coat hanger or cauliflower like) - calcified cap; projects away from joint Lucent when en face Often found at LUSCHKA's TUBERCLE (on scap)
What % of HME transform into malignancy? 5-25% to chondrosarc
What age to people present with HME? 2-10yrs it is discovered
What symptoms will patients present with if they have HME? Multiple painless osteochondromas, often bilateral
What are the MC locations of HME? Knee, ankle, shoulder, wrist, MADELUNG'S DEFORMITY
What would HME appear like on radiograph? "Brahma Bull" appearance on greater trochanter of femur (very wide metaphysis)
2 types of hemangiomas? And locations for each? Which is the most common? Cavernous [skull and spine- lower T, upper L] & Capillary [ribs, pelvis, long bones] cavernous is MC 75%
What is the MC benign tumor of the spine? HEMANGIOMA
Age/gender of patients with HEMANGIOMAS? Female >40
Symptoms associated with HEMANGIOMAs Asymptomatic; rare expansion causes neurological findings; paravertebral swelling
DDX for HEMANGIOMA type lesions? Pagets, Osteoporosis, Hemangioma
What part of the spine is often affected by HEMANGIOMAs? vertebral body (10-15% in arch)
Radiographic/MRI/CT findings for HEMANGIOMAs Corduroy cloth; sand dollar (sunburst, spoke-wheel); polka dot appearance on CT Paravertebral swelling Bright on both T1 & T2 weighted images DT high fat content
ST Hemangioma is AKA? Where are they found? Phleboliths; pelvic brim
Symptoms of an OSTEOMA? Asymptomatic. Will have blocked sinuses --> sinusitis
Diagnostic criteria for an OSTEOMA? Hemartoma = normal cells in normal location just more of them
Common locations of OSTEOMAS Sinus, mandible, skull, tibia
Radiographic finding of OSTEOMA Osteosclerotic - arrises from surface of bone
What is the triad for GARDNER'S SYNDROME? 1) Multiple osteomas; 2) Premalignant colon polyps; 3) Soft tissue fibromas
Another name for Bone Island? Enostoma/Enostosis
ENOSTOMAS can be found in what age groups? and what are the symptoms? any age, asymptomatic
Hemartoma can be associated with what two benign tumors? osteoma & enostoma
Common locations for ENOSTOMAS? Epiphysis & metaphysis; medullary space; pelvis (esp ilium); proximal femur.
Radiographic findings for Ensotomas? Usually solitary round or oval radiodensity with RADIATING BRUSH BORDER. Occasionally warm on bone scan b/c can be growing.
Giant Bone Island measures what? >2cm
DDX BI with Osteblastic Mets Pain # of Lesions Bone Scan Age Change in Size BI: Pain = none; OM = yes BI: # = Solitary; OM; multiple BI: BS = can be warm; OM = hot BI: Age = any; OM = >45 BI: Size chg = occasionally; OM = yes
Age/gender for OSTEOID OSTEOMA 10-25 Male
Symptoms of OSTEOID OSTEOMA Severe pain, worse at night (incr prostaglandins) relieved by aspirin. May get painful scoliosis if in spine.
What side of the scoliosis is OSTEOID OSTEOMA on? Concave side
DDX for OSTEOID OSTEOMA-like tumor 1) Brodie's Abscess 2) Osteoblastoma 3) Stress fx
MC Locations of OSTEOID OSTEOMAS Metaphysis, Diaphysis; Femur & Tibia (50%); 10% spine (posterior elements)
Radiographic findings of an OSTEOID OSTEOMA Central radiolucent nidus (<1cm); sclerotic border w/ central calcified fleck; solid periosteal bone reaction; cortical based – thickened. HOT bone scan (double density sign)
Preferred type of imaging to dx OSTEOID OSTEOMA? CT
MC benign tumor of hand and foot? Enchondroma
Created by: mrw2013
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