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184 Cards in this Set
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SECTION 4: ORTHOPAEDIC ONCOLOGY AND SYSTEMIC DISEASE
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SECTION 4: ORTHOPAEDIC ONCOLOGY AND SYSTEMIC DISEASE
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36. Overview of Orthopaedic Oncology and Systemic Disease
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36. Overview of Orthopaedic Oncology and Systemic Disease
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The most common site of metastases from bone and soft-tissue sarcomas is the _____________ __________.
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pulmonary system
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The most common low-grade bone sarcomas are __________, _____________, ________ and _______________.
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Chondrosarcoma, parosteal osteosarcoma, adamantinoma, and chordoma.
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The most common high-grade sarcomas are _____________, ____________, and ____________ ___________ ______________________.
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Osteosarcoma, Ewing sarcoma, and malignant fibrous histiocytoma.
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The order of importance of prognostic factors in bone tumor staging is _________________, ___________, ___________________ and _______________.
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The order of importance of prognostic factors in bone tumor staging is presence of metastases, discontinuous tumor, grade, and size.
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A high rate of false-negative results occur with technetium Tc 99m bone scanning in what disease?
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A high rate of false-negative results occur with technetium Tc 99m bone scanning in multiple myeloma.
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The order of importance of prognostic factors in soft-tissue tumor staging is _________________, _______________, ___________ and ____________.
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The order of importance of prognostic factors in soft-tissue tumor staging is presence of metastases, grade, size, and depth.
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The ___________________ gene is the tumor suppressor gene associated with osteosarcoma.
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The retinoblastoma gene is the tumor suppressor gene associated with osteosarcoma.
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EXT1/EXT2 are the tumor suppressor genes associated with __________ _____________.
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EXT1/EXT2 are the tumor suppressor genes associated with multiple exostoses.
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_____________ and ____________________ have a characteristic chromosomal translocation t(11;22).
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Ewing sarcoma and primitive neuroectodermal tumor (PNET) have a characteristic chromosomal translocation t(11;22).
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Synovial sarcoma has a characteristic chromosomal translocation ____________.
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Synovial sarcoma has a characteristic chromosomal translocation t(X;18).
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37. Principles of Treatment of Musculoskeletal Tumors
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37. Principles of Treatment of Musculoskeletal Tumors
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Chemotherapy drugs induce ______________________.
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Chemotherapy drugs induce programmed cell death (apoptosis).
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Radiation therapy induces DNA damage by the creation of ________ _________.
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Radiation therapy induces DNA damage by the creation of free radicals.
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Aspiration and injection is used for selected benign bone lesions— __________ __________ _________ of the humerus (methylprednisolone, bone marrow, or synthetic graft) and __________ __________ (methylprednisolone).
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Aspiration and injection is used for selected benign bone lesions—unicameral bone cyst of the humerus (methylprednisolone, bone marrow, or synthetic graft) and eosiniphilic granuloma (methylprednisolone).
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Curettage and methylmethacrylate or bone graft for reconstruction is used for most benign bone tumors — _____________, _______________, ________________, and ________________ of the proximal femur.
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Curettage and methylmethacrylate or bone graft for reconstruction is used for most benign bone tumors—giant cell tumor, chondroblastoma, osteoblastoma, chondromyxoid fibroma, and unicameral bone cyst of the proximal femur.
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Wide surgical margins alone are used for sarcomas without effective adjuvant therapy — ___________________, ______________, _______________ ______________.
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Wide surgical margins alone are used for sarcomas without effective adjuvant therapy—chondrosarcoma, adamantinoma, parosteal osteosarcoma.
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The major benefit of chemotherapy in osteosarcoma and Ewing sarcoma is to reduce the risk of ____________ ___________________.
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The major benefit of chemotherapy in osteosarcoma and Ewing sarcoma is to reduce the risk of pulmonary metastases.
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Radiation can be used as the definitive method for local control of primary lymphoma of bone, solitary plasmacytoma, hemangioendothelioma of bone, and Ewing sarcoma.
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Radiation can be used as the definitive method for local control of primary lymphoma of bone, solitary plasmacytoma, hemangioendothelioma of bone, and Ewing sarcoma.
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Simple excision is chosen for most benign soft-tissue tumors, with the exception of _____________ ___________ (requires wide margins).
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Simple excision is chosen for most benign soft-tissue tumors, with the exception of desmoid tumor (requires wide margins).
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Preoperative irradiation for soft-tissue sarcomas results in less fibrosis but a higher risk of early _________ _______________ compared to postoperative irradiation.
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Preoperative irradiation for soft-tissue sarcomas results in less fibrosis but a higher risk of early wound complications compared to postoperative irradiation.
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Amputation surgery criteria: (1) an adequate surgical margin cannot be achieved, (2) the morbidity is not acceptable, (3) the resulting limb will not be functional, (4) tumor growth continues after preoperative chemotherapy or irradiation, (5) the tumor involves major _________________ _____________.
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Amputation surgery criteria: (1) an adequate surgical margin cannot be achieved, (2) the morbidity is not acceptable, (3) the resulting limb will not be functional, (4) tumor growth continues after preoperative chemotherapy or irradiation, (5) the tumor involves major neurovascular bundles.
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38. Benign Bone Tumors and Reactive Lesions
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38. Benign Bone Tumors and Reactive Lesions
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Bone
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Bone
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Osteoid osteoma has a radiolucent __________ with surrounding ________.
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Osteoid osteoma has a radiolucent nidus with surrounding sclerosis.
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The bone scan is always intensely __________ in an osteoid osteoma.
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The bone scan is always intensely positive in an osteoid osteoma.
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Thin-cut CT scans most often identify the nidus and make the diagnosis of osteoid osteoma.
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Thin-cut CT scans most often identify the nidus and make the diagnosis of osteoid osteoma.
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The ___________ ____________ is the most common location for an osteoid osteoma.
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The proximal femur is the most common location for an osteoid osteoma.
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Osteoid osteoma is the most common cause of a painful __________ in a young patient.
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Osteoid osteoma is the most common cause of a painful scoliosis in a young patient.
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_____ is the current standard of care to treat osteoid osteoma.
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RFA is the current standard of care to treat osteoid osteoma.
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An osteoid osteoma can be differentiated from an osteoblastoma by its smaller ____ and less aggressive ______, although the histologic appearance is _____
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An osteoid osteoma can be differentiated from an osteoblastoma by its smaller size and less aggressive behavior, although the histologic appearance is similar.
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Osteoblastoma is a large radiolucent lesion that occurs most commonly in the posterior elements of the spine.
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Osteoblastoma is a large radiolucent lesion that occurs most commonly in the posterior elements of the spine.
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Parosteal osteoma must be differentiated from parosteal _____________
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Parosteal osteoma must be differentiated from parosteal osteosarcoma.
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A bone island is an inactive lesion most commonly found in the _______ and ______ ________
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A bone island is an inactive lesion most commonly found in the pelvis and proximal femur.
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Cartilage
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Cartilage
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Enchondromas are usually asymptomatic; a painful presentation is usually due to __________
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Enchondromas are usually asymptomatic; a painful presentation is usually due to an unrelated condition.
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The clinical presentation and radiographic appearance are more important than the histologic appearance in differentiating enchondroma from _____-grade _____________.
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The clinical presentation and radiographic appearance are more important than the histologic appearance in differentiating enchondroma from low-grade chondrosarcoma.
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Patients with either _______ disease or _________ syndrome have an increased risk for malignant transformation of an enchondroma to a low-grade chondrosarcoma.
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Patients with either Ollier disease or Maffucci syndrome have an increased risk for malignant transformation of an enchondroma to a low-grade chondrosarcoma.
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A _________ ________ is a surface lesion that creates a saucerized defect in the underlying cortex.
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A periosteal chondroma is a surface lesion that creates a saucerized defect in the underlying cortex.
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The medullary cavity of the underlying bone is continuous with the _______ of an osteochondroma.
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The medullary cavity of the underlying bone is continuous with the stalk of an osteochondroma.
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Secondary chondrosarcomas arising from osteochondromas are _______ grade and occur more often in patients with ___________ lesions.
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Secondary chondrosarcomas arising from osteochondromas are low grade and occur more often in patients with multiple lesions.
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EXT1, EXT2, and EXT3 are genetic loci commonly mutated in patients with _______ _______ _____________.
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EXT1, EXT2, and EXT3 are genetic loci commonly mutated in patients with multiple hereditary exostoses.
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Chondroblastoma most commonly occurs in the _________ and __________ of long bones.
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Chondroblastoma most commonly occurs in the epiphyses and apophyses of long bones.
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Chondroblastoma rarely metastasizes to the ________ .
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Chondroblastoma rarely metastasizes to the lung.
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__________ ___________ is a lucent, eccentric lesion with a sclerotic, scalloped rim seen in long bones, pelvis, and hands/feet.
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Chondromyxoid fibroma is a lucent, eccentric lesion with a sclerotic, scalloped rim seen in long bones, pelvis, and hands/feet.
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Fibrous/Histiocytic
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Fibrous/Histiocytic
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Nonossifying fibromas are usually incidental findings that spontaneously _________ and should be ___________.
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Nonossifying fibromas are usually incidental findings that spontaneously regress and should be observed.
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Nonossifying fibromas are developmental abnormalities that occur in ___% of children.
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Nonossifying fibromas are developmental abnormalities that occur in 30% of children.
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Nonossifying fibromas occur as scalloped lytic lesions with a __________ border within the _________.
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Nonossifying fibromas occur as scalloped lytic lesions with a sclerotic border within the metaphysis.
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Fibrous dysplasia is a long lesion in a long bone with a _________ __________ appearance.
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Fibrous dysplasia is a long lesion in a long bone with a ground glass appearance.
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The histologic appearance of fibrous dysplasia is woven bone shaped like “___________ _______” or “______ ________” in a cellular, fibrous stroma.
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The histologic appearance of fibrous dysplasia is woven bone shaped like “Chinese letters” or “alphabet soup” in a cellular, fibrous stroma.
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Polyostotic fibrous dysplasia occurs in ________-__________ syndrome along with precocious puberty and _______-_____-_____ spots.
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Polyostotic fibrous dysplasia occurs in McCune-Albright syndrome along with precocious puberty and café-au-lait spots.
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Osteofibrous dysplasia affects children in the first decade, with a predilection for the anterior cortex of the _____.
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Osteofibrous dysplasia affects children in the first decade, with a predilection for the anterior cortex of the tibia.
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The histologic appearance of osteofibrous dysplasia is a cellular, fibrous stroma with prominent osteoblastic rimming around the woven bone, which differentiates it from ________ ___________.
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The histologic appearance of osteofibrous dysplasia is a cellular, fibrous stroma with prominent osteoblastic rimming around the woven bone, which differentiates it from fibrous dysplasia.
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Langerhans cell histiocytosis is the great mimicker; think of it with ______ lesions in children.
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Langerhans cell histiocytosis is the great mimicker; think of it with lytic lesions in children.
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In Langerhans cell histiocytosis, the histiocyte (not the eosinophil) is the tumor cell and stains with ______.
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In Langerhans cell histiocytosis, the histiocyte (not the eosinophil) is the tumor cell and stains with CD1A.
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Cystic/Miscellaneous
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Cystic/Miscellaneous
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UBCs are centrally located in the ___________ and appear to move to the diaphysis.
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UBCs are centrally located in the metaphysis and appear to move to the diaphysis.
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UBCs present with a pathologic fracture—rare ________ ______ sign on radiographs.
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UBCs present with a pathologic fracture—rare fallen leaf sign on radiographs.
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Treat UBCs with an _________ _______ _________.
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Treat UBCs with an intralesional steroid injection.
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ABCs are destructive, expansile, ______-filled ______.
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ABCs are destructive, expansile, blood-filled cysts.
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ABCs occur around the knee, pelvis, and posterior elements of the ______.
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ABCs occur around the knee, pelvis, and posterior elements of the spine.
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At least ___% of the time, ABCs are secondary to an underlying primary bone tumor.
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At least 30% of the time, ABCs are secondary to an underlying primary bone tumor.
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Giant cell tumors are epiphyseal or apophyseal and extend into the ________ and _________ bone.
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Giant cell tumors are epiphyseal or apophyseal and extend into the metaphysis and subchondral bone.
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The _________ ________ cell is the neoplastic cell in giant cell tumor.
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The mononuclear stromal cell is the neoplastic cell in giant cell tumor.
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The treatment of giant cell tumor is careful _______ with a large _______ window (low local recurrence rate of __% to __%).
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The treatment of giant cell tumor is careful curettage with a large cortical window (low local recurrence rate of 5% to 15%).
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Giant cell tumor metastasizes to the lung in __% of patients.
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Giant cell tumor metastasizes to the lung in 2% of patients.
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39. Malignant Bone Tumors
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39. Malignant Bone Tumors
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Osteosarcoma and Malignant Fibrous Histiocytoma
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Osteosarcoma and Malignant Fibrous Histiocytoma
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_____________ is the most common malignant bone tumor in children.
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Osteosarcoma is the most common malignant bone tumor in children.
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Osteosarcoma classically occurs in the _______________ of long bones and presents with _________ ____.
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Osteosarcoma classically occurs in the metaphysis of long bones and presents with progressive pain.
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Osteosarcoma has a radiographic appearance of bone destruction and bone formation starting in the _________ _____.
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Osteosarcoma has a radiographic appearance of bone destruction and bone formation starting in the medullary canal.
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The _____________ _______ cells are malignant in osteosarcoma.
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The osteoblastic stromal cells are malignant in osteosarcoma.
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The 5-year survival of patients with osteosarcoma is __% to __%.
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The 5-year survival of patients with osteosarcoma is 65% to 70%.
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________ and ________ osteosarcomas occur on the surface of the bone.
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Parosteal and periosteal osteosarcomas occur on the surface of the bone.
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Parosteal osteosarcoma is a low-grade lesion that appears _______ histologically and is treated with _____ ________ ________ alone.
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Parosteal osteosarcoma is a low-grade lesion that appears fibrous histologically and is treated with wide surgical resection alone.
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Periosteal osteosarcoma is an intermediate-grade lesion that appears __________ and is treated with __________ and _________ ________.
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Periosteal osteosarcoma is an intermediate-grade lesion that appears cartilaginous and is treated with chemotherapy and surgical resection.
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Telangiectatic osteosarcoma can be confused with an ___________ _____ ______.
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Telangiectatic osteosarcoma can be confused with an aneurysmal bone cyst.
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Malignant fibrous histiocytoma of bone presents and is treated like ____________ but no ________ is noted histologically.
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Malignant fibrous histiocytoma of bone presents and is treated like osteosarcoma but no osteoid is noted histologically.
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Chondrosarcoma
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Chondrosarcoma
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Chondrosarcoma occurs de novo or secondary to an _______________ or ________________.
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Chondrosarcoma occurs de novo or secondary to an enchondroma or osteochondroma.
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Chondrosarcoma occurs in adults, whereas __________ and ________ _________ occur primarily in children.
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Chondrosarcoma occurs in adults, whereas osteosarcoma and Ewing sarcoma occur primarily in children.
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The ________ is the most common location for chondrosarcoma.
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The pelvis is the most common location for chondrosarcoma.
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Pelvic chondrosarcomas require _________ resection regardless of grade.
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Pelvic chondrosarcomas require wide resection regardless of grade.
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Chemotherapy is used only in the ________ and ______________ chondrosarcoma variants.
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Chemotherapy is used only in the dedifferentiated and mesenchymal chondrosarcoma variants.
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Tumor grade is a major _____________ factor for chondrosarcoma.
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Tumor grade is a major prognostic factor for chondrosarcoma.
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Grade 1 chondrosarcomas rarely metastasize and have a >___% survival.
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Grade 1 chondrosarcomas rarely metastasize and have a >90% survival.
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The survival for patients with dedifferentiated chondrosarcoma is the _______ of all bone sarcomas (__%).
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The survival for patients with dedifferentiated chondrosarcoma is the lowest of all bone sarcomas (10%).
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Clear cell chondrosarcoma has a radiographic appearance similar to ______________.
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Clear cell chondrosarcoma has a radiographic appearance similar to chondroblastoma.
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_________ is not used in the treatment of chondrosarcoma.
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Radiation is not used in the treatment of chondrosarcoma.
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Ewing Sarcoma/PNET
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Ewing Sarcoma/PNET
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Ewing sarcoma is one of a group of small round ______ cell tumors not distinguishable based on histology alone.
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Ewing sarcoma is one of a group of small round blue cell tumors not distinguishable based on histology alone.
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Ewing sarcoma is the _______ most common malignant bone tumor in children.
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Ewing sarcoma is the second most common malignant bone tumor in children.
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Ewing sarcoma is found most commonly in the _______ of ______ bones as well as in the ________.
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Ewing sarcoma is found most commonly in the diaphysis of long bones as well as in the pelvis.
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No matrix is produced by the tumor cells, so the radiographs are purely ______.
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No matrix is produced by the tumor cells, so the radiographs are purely lytic.
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There may be extensive ____________ reaction and a large _____-_______ mass.
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There may be extensive periosteal reaction and a large soft-tissue mass.
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Ewing sarcoma is ______-positive and has the __:__ chromosomal translocation.
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Ewing sarcoma is CD99-positive and has the 11:22 chromosomal translocation.
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Ewing sarcoma is radiation-__________, but surgery is used more commonly for local control unless the patient has metastatic disease.
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Ewing sarcoma is radiation-sensitive, but surgery is used more commonly for local control unless the patient has metastatic disease.
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Ewing sarcoma requires ___________ chemotherapy
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Ewing sarcoma requires multiagent chemotherapy
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Ewing sarcoma can metastasize to the _______, _______, and _____ ________.
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Ewing sarcoma can metastasize to the lungs, bone, and bone marrow.
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The 5-year survival rate of patients with isolated extremity Ewing sarcoma is __% to __%.
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The 5-year survival rate of patients with isolated extremity Ewing sarcoma is 65% to 70%.
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Chordoma and Adamantinoma
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Chordoma and Adamantinoma
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Chordoma occurs exclusively in the _______ ___, although many lesions should be considered in the differential of a destructive ______ lesion.
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Chordoma occurs exclusively in the spinal axis, although many lesions should be considered in the differential of a destructive sacral lesion.
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Chordoma occurs in adults and has a ___________ course; misdiagnosis is common.
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Chordoma occurs in adults and has a prolonged course; misdiagnosis is common.
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_______ _________ often do not identify sacral destruction from chordoma—cross-sectional imaging is required.
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Plain radiographs often do not identify sacral destruction from chordoma—cross-sectional imaging is required.
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CT scan of a chordoma shows ___________ areas within the tumor.
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CT scan of a chordoma shows calcified areas within the tumor.
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Chordoma consists of ___________ cells on histologic examination.
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Chordoma consists of physaliferous cells on histologic examination.
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Surgical cure of chordoma requires a _________ resection—possibly removing nerve roots, bowel, bladder, etc.
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Surgical cure of chordoma requires a wide resection—possibly removing nerve roots, bowel, bladder, etc.
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Radiation can be used in an adjunct fashion for chordoma, but _________ has no role.
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Radiation can be used in an adjunct fashion for chordoma, but chemotherapy has no role.
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Adamantinoma occurs primarily in the ______ _________ and has a _____ ________ radiographic appearance.
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Adamantinoma occurs primarily in the tibial diaphysis and has a soap bubble radiographic appearance.
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Adamantinoma consists of nests of __________ cells in a ______ stroma and is _______-positive.
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Adamantinoma consists of nests of epithelial cells in a fibrous stroma and is keratin-positive.
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Adamantinoma requires a ______ surgical resection for cure.
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Adamantinoma requires a wide surgical resection for cure.
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Multiple Myeloma and Lymphoma
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Multiple Myeloma and Lymphoma
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Multiple myeloma is the ________ common primary malignant bone tumor.
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Multiple myeloma is the most common primary malignant bone tumor.
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Myeloma often presents with _____________, ______________ anemia.
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Myeloma often presents with normochromic, normocytic anemia.
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Myeloma presents radiographically with multiple _________-___ _____ lesions.
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Myeloma presents radiographically with multiple punched-out lytic lesions.
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Myeloma is typically “____” on bone scan.
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Myeloma is typically “cold” on bone scan.
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Myeloma is composed of sheets of _______ cells.
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Myeloma is composed of sheets of plasma cells.
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Myeloma is treated with ____________, _____________, and possibly autologous stem cell transplant.
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Myeloma is treated with chemotherapy, bisphosphonates, and possibly autologous stem cell transplant.
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Lymphoma affecting bone is usually ____-_________ __-cell subtype.
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Lymphoma affecting bone is usually non-Hodgkin B-cell subtype.
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Subtle radiographic ______ _____________ with extensive marrow and soft-tissue involvement is typical.
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Subtle radiographic bone destruction with extensive marrow and soft-tissue involvement is typical.
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Lymphoma cells are ______+ on immunohistochemistry staining.
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Lymphoma cells are CD20+ on immunohistochemistry staining.
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___-____ lymphoma is treated with chemotherapy and radiation and rarely requires surgery.
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B-cell lymphoma is treated with chemotherapy and radiation and rarely requires surgery.
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Secondary Lesions
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Secondary Lesions
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Secondary lesions can be benign (secondary ABC or giant cell tumor) but are most commonly ___________.
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Secondary lesions can be benign (secondary ABC or giant cell tumor) but are most commonly sarcomas.
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Secondary sarcomas arise in areas of Paget disease, prior radiation, or previous lesions (bone infarcts, fibrous dysplasia).
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Secondary sarcomas arise in areas of Paget disease, prior radiation, or previous lesions (bone infarcts, fibrous dysplasia).
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New onset pain in the site of a previous lesion or site of radiation is suspicious for a _________ ______.
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New onset pain in the site of a previous lesion or site of radiation is suspicious for a secondary lesion.
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Radiographic appearance of a secondary sarcoma is an ____________, __________ bone tumor.
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Radiographic appearance of a secondary sarcoma is an aggressive, destructive bone tumor.
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Histologic appearance is of a ______-______ sarcoma (osteosarcoma, MFH, fibrosarcoma, chondrosarcoma).
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Histologic appearance is of a high-grade sarcoma (osteosarcoma, MFH, fibrosarcoma, chondrosarcoma).
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Secondary sarcomas have a uniformly poor prognosis; treatment is with _______________ and _________.
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Secondary sarcomas have a uniformly poor prognosis; treatment is with chemotherapy and surgery.
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MFH of bone can arise in a prior ________ and has a poor prognosis.
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MFH of bone can arise in a prior infarct and has a poor prognosis.
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Fewer than __% of fibrous dysplasia lesions undergo malignant change to ____ or ______________.
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Fewer than 1% of fibrous dysplasia lesions undergo malignant change to MFH or osteosarcoma.
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Secondary ________ ______ __________ can arise in long-standing osteomyelitis with a draining sinus tract.
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Secondary squamous cell carcinoma can arise in long-standing osteomyelitis with a draining sinus tract.
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Secondary chondrosarcomas can occur in prior ___________ or _______________ (more commonly in patients with Ollier, Maffucci, or multiple hereditary osteochondromas).
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Secondary chondrosarcomas can occur in prior enchondromas or osteochondromas (more commonly in patients with Ollier, Maffucci, or multiple hereditary osteochondromas).
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40. Benign Soft-Tissue Tumors and Reactive Lesions
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40. Benign Soft-Tissue Tumors and Reactive Lesions
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Lipomas should image the same as ____ on all MRI sequences.
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Lipomas should image the same as fat on all MRI sequences.
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______________ ____________ or other ________ malformations are best treated nonsurgically.
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Intramuscular hemangiomas or other vascular malformations are best treated nonsurgically.
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NF1 involves an abnormal chromosome ___, and __% of patients will develop malignant transformation of a lesion.
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NF1 involves an abnormal chromosome 17, and 5% of patients will develop malignant transformation of a lesion.
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Neurilemomas have ______ A (_______) and ______ B (________) areas on histology.
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Neurilemomas have Antoni A (cellular) and Antoni B (myxoid) areas on histology.
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Desmoid tumors are one of the few benign soft-tissue lesions to require a ______ _________.
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Desmoid tumors are one of the few benign soft-tissue lesions to require a wide resection.
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____________ is often part of the treatment regimen for recurrent desmoid tumors.
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Radiation is often part of the treatment regimen for recurrent desmoid tumors.
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Elastofibromas commonly occur between the ________ and chest wall; they stain with _________.
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Elastofibromas commonly occur between the scapula and chest wall; they stain with elastin.
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Glomus tumors usually occur in a __________ location.
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Glomus tumors usually occur in a subungual location.
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41. Malignant Soft-Tissue Tumors
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41. Malignant Soft-Tissue Tumors
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Soft-tissue sarcomas are usually categorized as indeterminate lesions on MRI (_____ intensity on T1-weighted images and _____ intensity on T2-weighted images) and require a biopsy for definitive diagnosis.
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Soft-tissue sarcomas are usually categorized as indeterminate lesions on MRI (low intensity on T1-weighted images and high intensity on T2-weighted images) and require a biopsy for definitive diagnosis.
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Liposarcomas (other than low-grade well-differentiated subtypes) do not have any resemblance to ___ on MRI studies.
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Liposarcomas (other than low-grade well-differentiated subtypes) do not have any resemblance to fat on MRI studies.
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Myxoid liposarcoma has a classic ___;___ chromosomal translocation.
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Myxoid liposarcoma has a classic 12;16 chromosomal translocation.
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Synovial sarcoma has a classic ___;___ chromosomal translocation.
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Synovial sarcoma has a classic X;18 chromosomal translocation.
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____________ sarcoma is the most common soft-tissue sarcoma found in the hand/wrist.
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Epithelioid sarcoma is the most common soft-tissue sarcoma found in the hand/wrist.
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Common sarcomas that metastasize to regional lymph nodes include ______________, _________ sarcoma, _______ ____ sarcoma, and ________ sarcoma.
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Common sarcomas that metastasize to regional lymph nodes include rhabdomyosarcoma, synovial sarcoma, clear cell sarcoma, and epithelioid sarcoma.
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Chemotherapy has not been shown to have a proven benefit in the treatment of most soft-tissue sarcomas (exceptions from this chapter include ___________________ and ___________ sarcoma).
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Chemotherapy has not been shown to have a proven benefit in the treatment of most soft-tissue sarcomas (exceptions from this chapter include rhabdomyosarcoma and synovial sarcoma).
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Patients with a history of NF1 have a ___% chance of malignant degeneration of a neurofibroma to an _____.
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Patients with a history of NF1 have a 5% chance of malignant degeneration of a neurofibroma to an MPNST.
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Most high-grade soft-tissue sarcomas are treated with _________ and ______ surgical resection.
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Most high-grade soft-tissue sarcomas are treated with radiation and wide surgical resection.
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Compared with postoperative radiation, preoperative radiation allows a _____ dose, but _______ complications are increased.
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Compared with postoperative radiation, preoperative radiation allows a lower dose, but wound complications are increased.
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42. Miscellaneous Lesions
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42. Miscellaneous Lesions
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________________ is characterized by nodular, heavily mineralized bone on the surface of bones and in the soft tissues, which gives a “dripping candle wax” appearance on radiographs.
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Melorheostosis is characterized by nodular, heavily mineralized bone on the surface of bones and in the soft tissues, which gives a “dripping candle wax” appearance on radiographs.
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Massive _______________ is purely lytic resorption of large segments of bone.
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Massive osteolysis is purely lytic resorption of large segments of bone.
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Radiographic findings for Gaucher disease include __________ __________ deformity (widened metaphyses).
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Radiographic findings for Gaucher disease include Erlenmeyer flask deformity (widened metaphyses).
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Gaucher disease is caused by a deficiency of the enzyme ___________________ (acid β-glucosidase, lysosomal enzyme); treatment consists of _______________ replacement.
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Gaucher disease is caused by a deficiency of the enzyme glucocerebrosidase (acid β-glucosidase, lysosomal enzyme); treatment consists of enzyme replacement.
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Imaging findings for stress fractures — radiographs: __________ ____ bone formation; T1-weighted MRI: ______ marrow except for ____ signal linear areas; T2-weighted MRI: _____ signal in the _________ _______ and on the periosteal surface.
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Imaging findings for stress fractures—radiographs: periosteal new bone formation; T1-weighted MRI: normal marrow except for low signal linear areas; T2-weighted MRI: high signal in the medullary cavity and on the periosteal surface.
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Neuropathic arthropathy—remember the common locations by disease state: syringomyelia—______ and ______; syphilis—_____; and diabetes—________ and _______.
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Neuropathic arthropathy—remember the common locations by disease state: syringomyelia—shoulder and elbow; syphilis—knee; and diabetes—foot and ankle.
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Radiographic findings for neuropathic arthropathy include _____________, ____________, and _____________ of the joint.
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Radiographic findings for neuropathic arthropathy include fragmentation, subluxation, and dissolution of the joint.
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Hemophilic arthropathy—remember the factor deficiencies (hemophilia A—factor ____, hemophilia B—factor ___), and remember the key radiographic findings (knee—squaring of the __________ ________ pole and _________ _________).
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Hemophilic arthropathy—remember the factor deficiencies (hemophilia A—factor VIII, hemophilia B—factor IX), and remember the key radiographic findings (knee—squaring of the inferior patellar pole and femoral condyles).
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43. Metastatic Bone Disease
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43. Metastatic Bone Disease
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The most common primary sites that metastasize to bone are _______, ________, _____, ______, and ________.
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The most common primary sites that metastasize to bone are breast, prostate, lung, renal, and thyroid.
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Careful history, physical examination, and radiographic staging will identify ___% of primary lesions; biopsy is needed when the __________ lesion has not been identified.
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Careful history, physical examination, and radiographic staging will identify 85% of primary lesions; biopsy is needed when the primary lesion has not been identified.
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The most common diagnosis of a lytic, destructive lesion in a patient older than age ____ years is bone metastasis.
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The most common diagnosis of a lytic, destructive lesion in a patient older than age 40 years is bone metastasis.
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The histology of metastatic bone disease is ________ cells in a _________ stroma.
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The histology of metastatic bone disease is epithelial cells in a fibrous stroma.
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Breast carcinoma cells secrete ________, which signals osteoblasts to release _______, which causes _____________ activation and _______ resorption.
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Breast carcinoma cells secrete PTHrP, which signals osteoblasts to release RANKL, which causes osteoclast activation and bone resorption.
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Osteolytic lesions have a greater likelihood of pathologic fracture than __________ lesions.
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Osteolytic lesions have a greater likelihood of pathologic fracture than osteoblastic lesions.
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____________ cause osteoclast apoptosis by inhibiting protein prenylation and act via the ____________ pathway.
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Bisphosphonates cause osteoclast apoptosis by inhibiting protein prenylation and act via the mevalonate pathway.
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_______ ______ radiation is helpful for pain control and important in maintaining local control postoperatively.
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External beam radiation is helpful for pain control and important in maintaining local control postoperatively.
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Pathologic femoral neck lesions require _______ ________, not for situ fixation.
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Pathologic femoral neck lesions require prosthetic replacement, not for situ fixation.
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_____ ____________ fixation is used for diaphyseal impending or actual fractures (femoral rods must extend into the femoral neck).
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Locked intramedullary fixation is used for diaphyseal impending or actual fractures (femoral rods must extend into the femoral neck).
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44. Metabolic Bone and Inflammatory Joint Disease
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44. Metabolic Bone and Inflammatory Joint Disease
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________________ is a rare disorder characterized by a failure of osteoclastic resorption with resultant dense bone with no medullary cavity (prone to fracture).
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Osteopetrosis is a rare disorder characterized by a failure of osteoclastic resorption with resultant dense bone with no medullary cavity (prone to fracture).
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__________ ______________ is a paraneoplastic syndrome characterized by renal phosphate wasting and can be caused by a variety of bone and soft-tissue tumors (osteoblastoma, nonossifying fibroma, and phosphaturic mesenchymal tumor).
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Oncologic osteomalacia is a paraneoplastic syndrome characterized by renal phosphate wasting and can be caused by a variety of bone and soft-tissue tumors (osteoblastoma, nonossifying fibroma, and phosphaturic mesenchymal tumor).
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___________ may occur as a complication of breast cancer, multiple myeloma, and lymphoma.
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Hypercalcemia may occur as a complication of breast cancer, multiple myeloma, and lymphoma.
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________ disease is a remodeling disease characterized by disordered bone formation; it is treated with bisphosphonates.
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Paget disease is a remodeling disease characterized by disordered bone formation; it is treated with bisphosphonates.
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_________ ______ is a systemic inflammatory disorder characterized by morning stiffness and joint pain; ___% of patients are positive for rheumatoid factor.
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Rheumatoid arthritis is a systemic inflammatory disorder characterized by morning stiffness and joint pain; 90% of patients are positive for rheumatoid factor.
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__________ ________ is an inflammatory disorder of the spine and sacroiliac joints characterized by HLA-B27 positivity; it is treated with anti-TNF therapy.
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Ankylosing spondylitis is an inflammatory disorder of the spine and sacroiliac joints characterized by HLA-B27 positivity; it is treated with anti-TNF therapy.
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Gout is a metabolic disorder caused by uric acid crystals in the synovium resulting in ___________ erosions.
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Gout is a metabolic disorder caused by uric acid crystals in the synovium resulting in periarticular erosions.
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Osteoporosis is characterized by low bone mass (>_____ SDs below the mean) and an increased risk of fracture.
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Osteoporosis is characterized by low bone mass (>2.5 SDs below the mean) and an increased risk of fracture.
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