Msk Tumors

Front 1

What kind of test should be ordered before any imaging?

Back 1

Plain X-Ray

Front 2

Painless, growing, firm malignancies are characteristic of?

Back 2

Soft Tissue malignancies

Front 3

Features of malignant bone tumors are?

Back 3

cortical destruction/endosteal erosion (causes pain,) surrounding soft tissue mass, periosteal reaction, ill-defined borders

Front 4

Which type of imaging best determines the extent of skeletal disease?

Back 4

Whole body scan (also checks for symmetry, north star sign.)

Front 5

Which type of imaging best screens for metastasis?

Back 5

Chest CT

Front 6

Which type of imaging best assesses bone destruction/

Back 6

CT of affected one (also assesses matrix calcification/ossification.)

Front 7

Which type of imaging best determines tissue type of the tumor, and indicates soft tissue involvement?

Back 7

MRI, also gives intramedullary extent, and the anatomic extent of the tumor spread in adjacent structures

Front 8

Which tumor has an etiology in a displaced nest of physeal cartilage?

Back 8

osteochondrosarcoma, benign

Front 9

Presentation of osteochondrosarcoma?

Back 9

1st-2nd decade, painless mass, occasional soft tissue irritation, AD hereditary form. Radiographic findings are a sessile or pedunculated mass, a cartilage cap, contiguous with medullary space. Histology shows benign cartilage growth in the bone, no cellular atypia or pleomorphism

Front 10

What is the treatment and prognosis of osteochondrosarcoma?

Back 10

Observation, but resection if it becomes bothersome. 1% chance for malignant degeneration

Front 11

Where does osteochondrosarcoma form in the skeleton?

Back 11

Femur, proximal tibia, proximal humerus, scapula

Front 12

Presentation and onset of enchondroma?

Back 12

Any age, an incidental finding on xray which shows stippled calcification, hot bone scan, expansion and scalloping in the hand lesions, benign cartilage on histology.

Front 13

Which diseases are associated with multiple enchondromas?

Back 13

Ollier's disease, and Maffucci's (+ multiple hemangiomas)

Front 14

What is the treatment and prognosis of enchondroma?

Back 14

Good prognosis, low risk of pathologic fx, treat with observation, curretage and bone graft if concerned for pathologic fx, resect all symptomatic lesions.

Front 15

What features of enchondromas indicate a pathologic fx?

Back 15

Pain, radiolucencies in lesion, endosteal scalloping, cortical disruption, sot tissue mass

Front 16

What is the presentation of a non ossifying fibroma?

Back 16

1st and 2nd decade, asymptomatic, occasional pathologic fx, eccentric, long lesion with sclerotic margin and a scalloped border on radiography.

Front 17

Histologic findings of a non-ossifying fibroma?

Back 17

spindle cells in a whorled pattern, scattered giant cells.

Front 18

Histologic and Radiographic presentation of Simple bone cyst

Back 18

Metaphyseal, cystic lesion, multiloculated, minimal expansion. On histology there is straw colored fluid, thin, fibrous membrane with giant cells.

Front 19

Which lesions have giant cells?

Back 19

Non-ossifying fibromas, simple bone cysts, giant cell tumors

Front 20

Where are simple bone cysts located?

Back 20

in 1st-2nd decade, 90% found in humerus and proximal femur, also proximal tibia and fibula.

Front 21

Tx for simple bone cyst?

Back 21

aspiration of fluid, steroid injections, bone marrow injections, curretage and bone grafting, allow fractures to heal before initiating treatment

Front 22

Presentation of osteoid osteoma?

Back 22

1st-3rd decades, male predominance, pain, night pain, worse with alcohol, relieved with NSAIDS, located mostly in long bones at/near cortex

Front 23

Histologic features of osteod osteoma?

Back 23

cherry red nidus, irregular woven bone in fibrovascular connective tissue

Front 24

24 y/o male with pain in long bones, worse at night, worse with alcohol, relieved by NSAIDS. Prognosis?

Back 24

osteoid osteoma, excellent, treat with NSAID suppression, curretage, radiofrequency ablation

Front 25

35 y/o female with pain and swelling. Histology shows sea of mononuclear cells with scattered multinucleated giant cells, and the nuclei in the giant cells are the same as the mononuclear cells. What is best treatment?

Back 25

This is a giant cell tumor, the most aggressive destructive benign lesion. Treat with curretage, crythotherapy, high speed burr. Resection and reconstruction may be necessary.

Front 26

Radiographic hallmarks of giant cell tumors?

Back 26

purely lytic, epiphyseal lesion, no surrounding sclerotic margin, aggressive appearance.

Front 27

Patient comes in with pain and swelling around the knee. X-ray shows metaphyseal lesion, and and the histology shows malignant spindle cells forming osteoid. What is the treatment?

Back 27

Intramedullary osteosarcoma, treat with surgery and chemotherapy

Front 28

Metadiaphyseal or diaphyseal destruction lesion of bone with a poorly marginated border and a permeative pattern and a prominent layered pattern of periosteal new bone formation, often with a soft tissue mass on plain xray.

Back 28

Most common presentation of Ewing's sarcoma.

Front 29

Translocation associated with Ewing's Sarcoma?

Back 29

11,22

Front 30

Presentation of Ewing's Sarcoma?

Back 30

Pain and localized swelling or mass in affected site, warm erythematous, low grade fever, increased ESR and LDH, anemia. Histology shows round blue nuclei sheets of ells, without discernable cytoplasm

Front 31

50 year old male presents with long duration of pain and swelling on a mass in the proximal humerus. Radiography shows variable calcification, cortical destruction, endosteal scalloping, soft tissue mass, and high T2 signal on MRI. What histological findings might be present?

Back 31

blue-gray cartilage, increased cellularity, binucleation of cells, and increased cellular atypia. This is chondrosarcoma. Treat wth low grade curretage if low grade and resection if high grade. chemo doesn't help.

Front 32

How does a lipoma(benign) look on imaging?

Back 32

Like subcuntaneous fat, whereas a malignant tumor will not.

Front 33

Brownish villonodular fronds in the affected joints?

Back 33

PVNS- proliferative synovial process

Front 34

Benign metaplasia of the synovial lining of the joint resulting in formation of multiple intra-articular cartilaginous bodies?

Back 34

Synovial chondromatosis

Front 35

What are the characteristics of soft tissue tumors?

Back 35

Malignant tumors are deep to fascia, have rapid growth, are fixed and firm.(ex MFH, Rhabdomyosarcoma.) Benign tumors are less than 5 cm, are superficial to fascia, mobile, and soft(ex lipoma, fibroma, hemangioma)

Front 36

What is the definition of malignancy?

Back 36

At least one cell escapes, travels to a distant site, survives, daughters neoplastic cells and induces new blood supply.

Front 37

Where are the most common sites of metastasis to bone?

Back 37

Vertebral bodies, axial more than appendicular, lumbar> thoracic> cervical > sacral. Proximal> distal.

Front 38

Which cancers have high incidence of metastasis to bone?

Back 38

Breast, prostate, thyroid, kidney, lung

Front 39

Histology of multiple myeloma?

Back 39

Cellular, round cell, abundant cytoplasm, eccentric nuclei with clumped chromatin (wagon wheel appearance)

Front 40

Clinical Presentation of Multiple Myeloma?

Back 40

CRAB: Pain with a pathologic fx, weight loss, fatigue, tenderness and mass, hypercalcemia, hypergammaglobulinemia, SPEP, UPEP. Radiography shows lytic bone lesions in the appendicular skeleton, no periosteal rxn, no sclerotic rim. treat with chemo.