Msk: Bone Tumors

Front 1

what are some x-ray findings of benign bone tumors?

Back 1

well-defined
surrounding rim of bone
not broken through the cortex
narrow ZONE OF TRANSITION b/w lesion and normal bone

Front 2

what are some x-ray findings of malignant bone tumors?

Back 2

poorly-defined margins
no rim of mature bone
extension through cortex
subperiosteal immature bone
broad/undefinable zone of transition

Front 3

name a bone forming benign bone tumor

Back 3

osteoid osteoma

Front 4

name a bone forming malignant bone tumor

Back 4

osteogenic sarcoma

Front 5

name 2 cartilage forming benign bone tumors

Back 5

osteochondroma (exostosis)
enchondroma

Front 6

what a cartilage forming malignant bone tumor

Back 6

chondrosarcoma

Front 7

name 3 non-bone-forming, non-cartilage forming benign bone tumors

Back 7

giant cell tumor
non-ossifying fibroma
simple bone cyst

Front 8

name 3 non-bone-forming, non-cartilage forming malignant bone tumors

Back 8

Ewing's sarcoma
Multiple myeloma
Metastatic carcinoma

Front 9

intense pain at rest and excellent relief w/ aspirin/NSAIDs, etc -->

Back 9

osteoid osteoma

Front 10

young or old: osteoid osteoma

Back 10

young

Front 11

what are some x-ray findings of osteoid osteoma

Back 11

benign cortical reaction
no periostitis
radiolucent nidus

Front 12

what are the histopath findings of osteoid osteoma?

Back 12

immature trabeculae
no atypia/mitotic figures
fibrovascular tissue

Front 13

what are some x-ray findings of osteosarcoma?

Back 13

"Sunburst pattern"
soft tissue extension
ill-defined borders on imaging

Front 14

describe a typical presentation of osteosarcoma

Back 14

22 yo M
pain at night
pain at rest
growing soft tissue mass

Front 15

describe the histopath of osteosarcoma

Back 15

atypical cells producing osteoid

Front 16

what are some x-ray findings of osteochondroma?

Back 16

continuity w/ marrow
usually grows away from metaphysis

Front 17

what are some x-ray findings of parosteal osteosarcoma?

Back 17

"Stuck on" (no continuity w/ marrow)

Front 18

describe the histopath of osteochondroma

Back 18

looks like a growth plate
stops growing at skeletal maturity

Front 19

describe the x-ray of a distal femur enchondroma

Back 19

central
no cortical breakthrough
cartillage matrix
no soft-tissue extension
always incidentally noted

Front 20

describe the histopath of enchondroma

Back 20

"bland"
no or very little atypia
not very cellular

Front 21

T or F: With most enchondromas, you don't have any symptoms.

Back 21

True except in the hand where you see fractures, lysis, etc.

Front 22

what are some imaging findings of chondrosarcoma?

Back 22

stippled pattern suggestive of cartilage
lytic changes
cortical involvement

Front 23

describe the histopath of chondrosarcoma

Back 23

more cellular than enchondroma
considerable atypia

Front 24

describe the x-ray of simple (unicameral) bone cysts

Back 24

well-circumscribed
central (not eccentric)
no matrix mineralization
cyst not wider than nearest physis

Front 25

what is the most common location of simple bone cysts

Back 25

proximal humerus
proximal femur

Front 26

describe the histopath of simple cysts

Back 26

bland stoma
no atypia

Front 27

describe the x-ray of a non-ossifying fibroma

Back 27

sharp borders
no periosteal reaction
eccentric
lobular/septated
metaphyseal
often incidental

Front 28

describe the x-ray of giant cell tumor

Back 28

extends to subchondral surface
radiolucent
no matrix calcification
no reactive sclerosis or periosteal reaction
narrow zone of transition

Front 29

describe the histopath of giant cell tumor

Back 29

giant cells look identical to stromal cells
no atypia

Front 30

describe the x-ray of Ewing's sarcoma

Back 30

diaphyseal or metadiaphyseal
often mixed lytic/blastic
permeative pattern
periosteal reaction/periosteal new bone
broad zone of transition

Front 31

extensive bone destruction with large soft-tissue mass -->

Back 31

Ewing sarcoma

Front 32

describe the histopath of Ewing Sarcoma

Back 32

Small, round blue cell tumor
anaplastic

Front 33

what translocation is assoc w/ Ewing Sarcoma?

Back 33

t(11,22)

Front 34

describe the x-ray of multiple myeloma

Back 34

radiolucent lesion
often multifocal
"punched out" appearance
no matrix
often well-circumscribed

Front 35

what imaging study is done to look for MM lesions?

Back 35

skeletal survey (not a bone scan!)

Front 36

what labs do you order if you think MM is on the ddx?

Back 36

CBC, electrolytes, SPEP/UPEP

Front 37

what carcinomas typically met to bone?

Back 37

PBKTL (Lead Kettle)
Prostate
Breast
Kidney
Thyroid
Lung

Front 38

what's the ddx for a new bony lesion in a pt > 50 yo?

Back 38

metastatic disease
myeloma
lymphoma

Front 39

atraumatic lesser trochanter avulsions --> you think...

Back 39

tumors!

Front 40

what is a benign deep soft tissue tumor?

Back 40

lipoma

Front 41

name two malignant deep soft tissue tumors

Back 41

malignant fibrous histiocytoma (pleomorphic sarcoma)
synovial cell sarcoma

Front 42

what are some clinical features of deep soft tissue tumors?

Back 42

deep to deep fascia
often painless
in thigh or gluteal area may be immense
greater than 5 cm is usually malignant (except for lipoma)

Front 43

don't assume a soft tissue mass is a __

Back 43

hematoma

Front 44

what do you do if somebody has a soft tissue mass on physical exam?

Back 44

get plain films of it!

Front 45

intralesional calcifications on x-ray of deep soft tissue tumor -->

Back 45

synovial sarcoma

Front 46

T or F: pain is a common feature of malignant tumors of bone

Back 46

TRUE

Front 47

deep aching pain is typically assoc w/ __ tumors

Back 47

malignant bone tumors

Front 48

Onion skin appearance -->

Back 48

Ewing's sarcoma

Front 49

soft tissue sarcoma of the limbs in kids -->

Back 49

rhabdomyosarcoma

Front 50

where are giant cell tumors?

Back 50

in the epiphysis

Front 51

what are some diaphyseal bone tumors?

Back 51

osteoid osteoma
Ewing's sarcoma
Mets
Myeloma