Cysts And Tumors - Lady Khin

Front 1

Solitary (Unicameral Bone Cysts)

Back 1

-unknown etio, at distal ends of long bones, M:F 3:1
-sx: pain/swelling, maybe fracture
-contains amorphous protein like material and is lined by fibrous tis, giant cells, hemosiderin, macros
-curettage and insert of bone chips

Front 2

Aneurysmal Bone Cyst

Back 2

-uncommon expansive legion, large, long bones & vert of young ppl
-rapid inc in size, IMITATES malig
-cut surface of lesion--> spongy appearance w/ cytic spaces
-Hist: large vasc channels w/ walls of cell fibrous tissue, no endo lining

Front 3

Osteoma

Back 3

-benign, skull and facial bones, frontal sinus, M> F
1. Multiple osteomas in assoc w/
2. intestinal polyposis and
3. soft tissue tumors (Gardner synd)

Front 4

Osteoid Osteoma

Back 4

-benign, M:F = 3:1, lower extremities
-*intense pain in the legs especially at night
-central radiolucent area (nidus) surrounded by sclerotic bone
-nidus-->vasc tissue w/ osteoblasts

Front 5

Osteoblastoma (Giant Osteoid Osteoma)

Back 5

-uncommon, not painful, aggressive
-M=F, predom verte and long bones
-well-circ lesion surrounded by sclerotic bone, sim to osteoid osteoma but larger (>2 cm)
*repeated local recur after removal

Front 6

Osteosarcoma ("Osteogenic" Sarcoma):
General

Back 6

-most com primary malig bone tumor (excluding mult myeloma)
-10-20 y/o, M>F
-in older ppl, related to underlying bone disease
-any metaphyseal area of long bone, but most commonly lower femur, upper tip or fibula, humerus

Front 7

Osteosarcoma ("Osteogenic" Sarcoma):

Etiology

Back 7

-unknown, predisp bone disorders
-assoc w/ mut of tumor sup genes
-2/3 show mut in RB gene, 40% of pts w/ reinoblastoma develop osteosarcomas
-also mut in p53 gene

Front 8

Osteosarcoma ("Osteogenic" Sarcoma):

Morphology

Back 8

-80-90% arise in medullary cavity
-destroys both medulla and cortex
-malig stroma with bizarre pleomorph cells w/ hyperchromatic irreg nuclei
-areas of necrosis, islands of cartilage

Front 9

Osteosarcoma ("Osteogenic" Sarcoma):

Highly vascular type

Back 9

-telangiectatic osteosarcoma

Front 10

Osteosarcoma ("Osteogenic" Sarcoma):

Clinical

Back 10

-pain, swelling, limited ROM
-rapid growth--> enlarg of limb and fracture
*-Codman's triangle, bone destruct w/ penetration of cortex w/ superiosteal elevation
-"Sun ray" appearance on X-Ray

Front 11

Osteosarcoma ("Osteogenic" Sarcoma):

Prognosis

Back 11

-surgery along = 20% 5 year survival
-w/ radiation and chemo--> 60% 5 yr
-prog is better in predominantly fibroblastic or chondroblastic types

Front 12

Osteosarcoma ("Osteogenic" Sarcoma):

Spread

Back 12

-predominantly by blood stream to lings
-matastasis to lung present in more than 90% of fatal

Front 13

Juxtacortical Osteosarcoma

Back 13

-rare variant of osteosarcoma
-occurs on periosteal surface of bone, esp lower end of femur*
-*more common in FEMALES
-low-grad lesions w/ good prognosis (5 yr survival >80%)

Front 14

Chondroma and Enchondroma

Back 14

-benign cartilaginous tumors
-usually small bones of hands/feet
-chondroma --> periosteal
-enchondroma--> inside of bone
-from remnants of epiphyseal cart left behind in medullary cavities
-mult endchondromas have high risk of malig transformation***

Front 15

Ollier Disease (Enchondromatosis)

Back 15

-non-hered disorder w/ mult enchondromas in metaphysis and diaphysis of various bones

Front 16

Maffucci Syndrome

Back 16

-familial multiple form associated w/ hemangiomas in skin and viscera

Front 17

Chrondroma and Enchondroma:

Clinical/Morph

Back 17

-asympt, sometimes bony deformity, pain, fracture, recurrent
-lesions as confluent mass of hyaline cartilage w/ lobulated surfaces
-micro: cart appears mod cellular w/ few binucleate cells, no mitotics

Front 18

Chondromyxoid Fibroma

Back 18

-uncom benign tumor, metaphyses of long bones about knee, M>F
-fibrous myxoid and chondroid tissues
-swelling and clinical pain
-mistaken for chondrosarcomas

Front 19

Chondroblastoma (Codman Tumor):

Back 19

-benign, but aggressive, M 20s
-local pain, stiff, limited ROM
-prolif chondroblasts admized w/ fibrous stroma and chondroid material
-foci of multinuc giant cells
-*rare cases have metast to lung

Front 20

Chondrosarcoma:

Overview

Back 20

-malig, may be primary (75%) or originate in chondromas (secondary)
-slow growing, translucent in nature
-1/2 as often as osteosarcoma M>
-assoc w/ trisomy 7, high grade assoc w/ rearrange of chromo 17

Front 21

Central Chondrosarcoma

Back 21

-medullary cavity of pelvis, ribs, long bones, may penetrate cortex
-necrosis, cystic changes, hemorrhage
-cortex of bone and trabecular spaces of marrow are infiltrated
-middle aged men

Front 22

Peripheral Chondrosarcoma

Back 22

-less common, outside of bone from CARTILAGINOUS CAP of and osteochondroma
-pelvis, femur, verte, sacrum, humorus, rarely distal

Front 23

Slow Growth Chondrosarcoma

Back 23

-expansion causes pain and local sx
-compression of lumbosacral plexus--> paraplegia

Front 24

Juxtacortical Chondrosarcoma

Back 24

-least common variety
-like central chondrosarcoma, has pre-dilection for middle age men
-end of long bones most commonly affected

Front 25

Chondrosarcoma:

Morphology

Back 25

-lobulated, translucent mass, areas of necrosis and calcification
-micro: islands of immature cart showing anaplasia, graded 1 to 3

Front 26

What makes certain chondrosarcomas difficult to differentiate from other masses?

Back 26

-well diff chondrosarcoma (grade 1) may be difficult to diff from chondromas
-chondrosarcoma w/ ossification may be difficult to diff from chondroblastic type of osteosarcoma

Front 27

Chondrosarcoma:

Clinical Presentations

Back 27

-local swelling and pain
-X-ray shows cortical bone destruct
-"snowstorm" appearance
-metastasis by blood stream (late feature seen w/ higher grade tumors) to lungs, liver, kidney, brain

Front 28

Metastatic Tumors of Bone

Back 28

-more com than prim tumors of bone
-males - bronchus and prostrate
-females - breast
-osteolytic -> radiolucency w/ ragged margins
-osteoblastic -> new bone formation
-back pain > than pathologic fract

Front 29

Ewing Sarcoma

Back 29

-rare malig tumor of neuroectoderm O in medullary cavities of long bones
-children and young adults M:F, 2:1

Front 30

Ewing Sarcoma:

Clinical

Back 30

-pain, tenderness, palpable mass--> destructive lesion --> breaks thru cortex, elevates periosteum--> new layers of bone--> onion skinning and sunburnt pattern***
-assoc w/ reciprocal translocation t(11;22)

Front 31

Ewing Sarcoma:

Morphology

Back 31

-fleshy gray-wite, infiltrate cortex and into adjacent soft tissues
-micro: sheets of small uniform hyperchromatic round cells w/ little cytoplasm and virtually no stroma
-abundant glycogen

Front 32

Ewing Sarcoma:

Spread and Prognosis

Back 32

-local--> destruction of bone
-early blood spread and pulmonary metastates common
-prognosis: highly malig and fatal
-w/ modern tx --> 5 yrs survival 40-75%

Front 33

Giant Cell Tumor of Bone (Osteoclastoma):

General Information

Back 33

-end of long bones, 20-40yrs, F > M
- >50% occur about the knees
-most are benign, 25-50% recur locally, ~10% develop metastases
-large, lytic, distinct SOAP BUBBLE APPEARANCE***

Front 34

Giant Cell Tumor of Bone (Osteoclastoma):

Morphology

Back 34

-Mac: multiple hemor cystic cavities enclosed in a thine shell of new bone formation**
-micro: spindle-cells among multinuc giant cells, neoplastic cell is the spindled stromal cell