Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
84 Cards in this Set
- Front
- Back
Diaphyseal lesion |
HALFEE - Histiocytoma - Adamantinoma - leukemia - FD - EG - Ewings |
|
Epiphyseal lesion in adults |
- chondroblastoma - GCT - clear cell chondrosarcoma - infection - telangiectatic osteosarcoma |
|
UBC V ABC on XR |
ABC - eccentric (v central) - width > physis |
|
Osteochondroma Transformation risk |
hereditary multiple osteochondromatosis is unknown, but may be 25-30% compared to approximately 1% for a solitary osteochondromas. The risk of malignant degeneration increases as the number and size of the osteochondromas increases. |
|
Osteochondroma Transformation risk |
1. Growth after maturity 2. Hot bone scan (can be from overlying bursa) 3. Increased thickness of cartilage cap on CT- > 1-3 cm (Enneking) 4. Pain 5. Pathological fracture 6. Disappearance of calcification - More common with central lesions - In general, a sessile lesion is more likely to degenerate into sarcoma than an exostosis. |
|
Osteosarcoma - Rosen in vivo response |
Dictates outcome some OS have P-Glycoproteins pump- remove chemo from the cell Grade 1 = no cell death, Grade 2 = Partial <90%, Grade 3 = Necrosis >90%, Grade 4 = Complete necrosis Grade 1 & 2 - < 50% survival Grade 3 & 4 - > 75% long term survival in OS and MFH |
|
Bloods test for Sarcoma / Mets / Unknown lesion |
FBC
LFT (Alk phos) Ca, PO4, Alk Phos ESR / CRP TFT PSA Serum and urine electrophoresis BJ urine LDH - lymphoma blood film (leukaemia) UE (MM and pre chemo) Urate (gout common with malignancy) |
|
ABC |
reactive heamorrhagic tissue arising in bone. Blood filled spaces seperated by fibrous tissue. Metaphysis long bone. (Prox hum, femur, tib) Posterior elements in vert. Teenagers. NHx # is rare, Usually resolve with skeletal maturity. XR eccentric, expansile, cortical thinning. Fluid fluid of MRI. Histo: blood, haemosiderin laden macro. GC. Rx observe, Op mx (Curretage BG, plate) prox femur, spine, recurrent #. Highest reccurent rate in those with open physis. If spine / pelvis considered embolisation. |
|
Adamantinoma |
Low grade Malignant 20yo. 90% in diaphysis tibia. Soap bubble appearance, eccentric, expansile, little periosteal reaction. Closely resembles FD and is varient of Ossifying fibroma. NHx metastasis 20%. WLE. |
|
Benign Fibrous Histiocytoma |
Older patient. Lytic lesion with sclerotic rim. Benign foam cells, lipid filled. Curettage and BG. |
|
Chondroblastoma |
Adolescents NHx benign, locally aggressive. Can have pul mets. Need CT chest. Epiphysis knee / hip. Painful, can cause LLD or angular deformity. Eccentric, well defined lucency, thin rim. Stippled calcification. may have periosteal reaction. Difficult to Rx due to position of joint. Curettage and BG/PMMA. Radiofreq ablation. WLE with joint replacement. |
|
Chondromyxoid fibroma |
Benign neoplasm cartilage origin. Myxoid cartilage. Very rare 20yo. Upper tibia, metaphysis. usually LL. Tender and buldge. Eccentric meta, sclerotic margin, local expansion but cortex intact. characteristic buttress of periosteal new bone. Cant tell difference from ABC. Curettage, BG 40% recurrence. |
|
Eosinophilic Granuloma |
AKA langerhans cell histiocytosis. Non neoplastic. infiltration by histocytic cells (monocytes / macro lineage). cell of origin is lanerhans. Unsure origin. 4-7yo. Variable presentation. Back pain from spine lesion. Affects any bone. Diaphyseal - thin endo scalloping. Vertebra plana, skull. Rule out HSC BS. NHx self limiting, tissue is replaced by bone. HSC chemotherapy. |
|
Eosinophilic Granuloma sub groups |
E-H-L
|
|
Fibrous cortical defect |
AKA NOF. Hamartomatous defect in metaphyseal cortex, skeletal immature adolescents. <2cm FCD >2cm NOF Defect in cortex long bone. 35% kids. Most common cause of pathological #. NHx self limiting usually ossify by adult. Femur / tibia. Eccentric, metaphysis, slight expansion sclerotic margin. Fibroblast whorling, multinucleated GC. Serial observation. Op if > 1/2 bone, Curettage and BG. If fracture - heals in normal time. |
|
Fibrous dysplasia |
Developmental Hamartoma areas of bone fail to mature normally, will remain indefinitely, poorly mineralised bone. Can be associated with endocrinopathy. Femur, tibia, skull. NHx remains relative unchanged through out life. Malignant transformation monostotic 0.4%, polyostotic 4% (OS/CS/FS). Polystotic - usually presents as kid, pain (#), limp and deformity. XR ground glass appearance, angular deformity. Coxa vara, Shepherds crook deformity, Sabre tibia. BS looking for other sites. Pathology Chinese letter. Dont operate unless deformity. Morcellised BG is resorbed. Bisphos relieves pain. Prox femur. Stabilise prevent worsening. When mature valgising osteotomy. Activation mutation GS alpha, chromo 20. leads to a sustained activation of adenylate cyclase cAMP. |
|
McCune Albrights syndrome |
Triad Fibrous dysplasia Cafe-au-lait spots (Coast of maine) Precocious puberty. |
|
GCT |
Benign wide spectum behaviour (can behave in malignant fashion 2% metastasizes to lung). 20yos, after maturity. Epiphysis - Knee, DR, sacrum, vert bodies. Dull ache, effusions. Well defined lesion, extending into subchondral bone. No sclerotic rim. can destroy cortex and extend into ST. Mutlinucleated GC, background fibrous tissue. Curettage and PMMA (recurrence 15%) or WLE and allograft/arthroplasty. medical Bisphos disomaz. |
|
Haemangioma |
Hamartomatous proliferation of vascular tissue. Capillary or Cavernous. Can be in any tissue. Ache, limb heaviness, tender mass. XR may have small calcified phleboliths. MRI bright. Management ST embolization, resection. Intraosseous. commonest sites spine and skull. Spine honeycomb appearance. |
|
Haemangioma Associations |
|
|
Metaphyseal enchondroma |
metaphsis of cortex long bones. Prox humerus. Difficult to DDx from chondrosarcoma. NHx doesnt ossify, remains as immature cartilage. No malignant potential. |
|
Unicameral bone cyst |
Solitary cavity contain clear fluid. Metaphysis in kids, adjacent to physis in kids. ? due to secondary venous obstruction / hypertension. Prox metaphysis Humerus 67%, femur 15%. Can occur in calcanous. Present with pathological #. XR near physis, well defined, central, thinned cortex, thin internal septa. Fallen leaf sign. NHx become latent resolve in adulthood, may resolve post #. 15% heal after #. Will heal but on average # 4 times. Observe, inject HLCA, curettage BG, cyst drain, ORIF. Humeral # Rx in sling. Prox femur Traction, paediatric hip screw and bone graft < 15yo. IMN>15yo. |
|
Bone infarct |
Divers, Sickle cell, long term steroid MFH may arise from long term bone infarcts. |
|
Enchondroma |
Benign intramedullary cartilage. Remnants of cartilage from epiphyseal growth mechanism which failed to under go enchondral ossification.
Young adults. Stop growing in adults. Malignant transformation. Never in children, never in hands and feet. BS and histology not helpful. Start near physis become diaphyseal with growth. Can have periosteal chondroma. Stippled calcificaition, no periosteal reaction, no scalloping. > 6cm rarely benign. Difficult to distinguish low grade chondrosar and enchondroma. Histo hyaline cart. Management observe. Clinical, and XR. Hand # - let heal then Curettage and BG. |
|
Olliers |
Enchondromas symmetrically distributed through an extremity. Usually unilateral and monostotic. Not heritable. Often associated with growth deformity LLD, Bowing wrist and elbow. Malignant transformation 25% @ 40yos. |
|
Maffuccis syndrome |
Multiple enchondroma, Random distributed. Associated with hemangiomas. 100% risk malignant transformation. long latent phase 30yrs. Associated with other tumours / visceral carcinoma. Skeletal deformity. Short tubular bones, hands and feet. LLD, Bowing forarms, Varus/valgus legs. Mx osteotomy to correct angulation, guided growth. Lifetime surveillance. |
|
Enostosis |
Bone island. Hamartomatous lesion. Mature cortical bone in midst of normal cancellous bone. Sharp, cortical density, round/oval, smooth, narrow zone. usually < 1cm. Osteopoikilosis multiple, AD, periarticular. Extremelt rare malignant transformation. |
|
Melorheostosis |
1:1000000, from child hood. 50% dvp symptoms by 20. Abnormality in sensory nerve of sclerotome. Pain, stiffness, progressive deformity. LLD, contractures, Spinal stenosis. XR Sclerotic lesion cortical hyperostosis (dripping wax). NHx slowly progressive, symptoms may require treatment. |
|
Osteochondroma |
Outgrowth of benign cartilage from bone. ? defect in perichondral ring la croix. NHx Stops growing when physis close. Malignant transformation. Low grade CS < 1%. Suspicious features. Grow after maturity, hot BS, C Cap > 2cm, pain, pathological #, disappearance of calcification. Knee, prox humerus. Pain, tenderness, decreased ROM, Compression Nerve. XR adjacent physis, away from jt, coritcal and medullary continuous with normal bone, may have calcified cap. MRI C cap and where NV bundle lies. DDx juxtacortical OS/CS, periosteal chondroma, osteoma. Management. Excise if, painful compressing, restore ROM, suspicious lesion, central (high risk). |
|
Multiple hereditary exostosis |
AD variable penetrance. Mildy short, nerve compressions (CPN). XR Coxa Valga, brevis. Genu valgum, ankle valgus (Fib short, wedge shape tibial epip). Forearm (Ulna short R dowing, ulna dev wrist, RH dislocation) Excision symptomatic or suspicious lesions. Guided growth or deformity correction if severe. Malignant transformation. 10% overall CS>OS. Better prognosis than primary CS. Danger areas more central. |
|
Nora's |
Bizarre parosteal osteochondromatous proliferation. Hand/feet 20-30's. Grows rapidly aggressive on imaging. Mildly painful, incr size over mths. XR on surface bone, well defined, wide base. Not contigous with medulla or cortex no cartilage. NHx lesion is benign. WLE limits local recurrence (50%). |
|
Osteoblastoma |
young boys. 30% spine posterior elements. (scoliosis) Long bones 25%. (limp) Pain less severe than OO, not relieved by aspirin. XR spine- sclerotic or loss pedicle, enlagement. L bone- meta-diaphyseal, faintly radiolucent, thin reactive rim, maybe expansile. CT stippled ossification. BS hot OO < 2cm. NHx can be locally aggressive (distruction, ST extension). Not self limiting therefore need surgery. Mx extended curettage, WLE, radiofreq. |
|
Osteoid osteoma |
Benign, bone forming, small nidus surround by wide zone mature bone. 5-25yrs old. Though to be glomus tumour of bone. Pain secondary to prostaglandin. intracoritcal position. femur, tibia at end diaphysis, posterior spine elements. Pain, intense, unrelenting (tooth ache) night. relieved by aspirin. worse by alcohol. NHx resolution with time. XR sharp round, < 1cm, homogenously dense centre. Cortical fusiform, central nidus, mimics stress #. DDx infection, stress #, Parosteal OS, chondroblastoma. Non op -NSAIDs Op En bloc resection, Burr down tech, Radio freq ablation 6mins 90 deg. |
|
Osteoma |
Benign harmartomatous bone forming lesion arising from surface of bone. Dense bone (like cortical) which arises from the surface of bones formed by intra membranous ossification. Skull mandible. Shafts of long bone (TIbia) |
|
Chondrosarcoma |
Malignant cartilage tumour. Primary (de novo), secondary (osteochondroma/ enchondroma). Diagnostic dilemma diff low grade from enchondroma (sapmling errors) Varients
XR endosteal scalloping hallmark CS. May have cortical thickening and expansion. Pain in benign cartilage tumour must assume malignant. Grade 1 - 3. Mx WLE. Highly resistant to chemo and radio. Exceptions in Dediff (chemo), mesen (C & R). Low grade 90% 5y, high grade <10% 5yr. Mets grade 2 15-40%, 3 75%. |
|
Osteosarcoma |
Malignant spindle cell sarc of bone. Malignant cells produce osteoid. Most aggressive and high grade. Bimodel, teenagers (75%) elderly (paget/ radiotherapy). If under 13yo prob ewings on OS. Classic central (high grade), parosteal, periosteal Metaphysis Distal femur, prox tibia, pro hum. Pain, often activity related, night. 10% mets on presentation. XR meta, cortical destruction, osteoid, wide zone, codman, ST involvement. MRI local extent and planing and entire bone (skip lesion). BS other lesions. CT chest (mets) ALP/LDH worse prognosis if incr. 70% survial overall, 90% limb sparing surgery. 12% local recurrence. (use Radn if + margin) If you survive 2 yr you are likely going to make it. |
|
Secondary causes OS |
Paget's previous radiotherapy OM Fibrous Dysplasia Chondrosarcomatous dedifferentiation |
|
Lichenstein pathological classification OS |
Osteoblastic -50% prominent osteoid Chrondoblastic - prominent cartilage Fibroblastic - Prominent fibrous tissue look like fibro sarc. Telangiectatic - worst prog, pools RBC/ giant cells. Can be mistaken for GCT. Giant cell rich OS - older pts, simialr MFH Small cell OS - Similar appearance to Ewings, respond to chemo like PNET. |
|
OS algorithm |
1. Accurate clinical staging, local (cross sectional imaging - CT / MRI), systemic (bone scan & CT chest / abdomen, biopsy 2. Neoadjuvant chemotherapy 3. Restage- locally and systemic (MRI / CT Chest) 4. Wide resection 5. Post operative chemotherapy +/- radiotherapy if positive margins |
|
OS chemo |
Treats micro mets, allow limb salvage. Rosen in vivo response dictates outcome. Some OS have P-Glycoproteins pump to remove chemo from cell. Partial < 90% kill, Necrosis > 90% kill, complete necrosis. Predict survival. 2 cycles pre op MACI (MTX, Adriamcin, Cisplatin, Ifosphamide). surgery 2 wks after finished (3mth from start). Goal recestion with 5 cm margin. |
|
Parosteal OS |
20-40yo females. Low grade. Slow growth. Most common in posteromedial distal femur. Painless block to back of knee. May look like osteochondroma. Broad base from cortex, less dense than bone. String sign thin radiolucent line bw lesion cortex CT scan. Attached to cortex growing into ST. WLE 80% cure with surgery alone. |
|
Periosteal OS |
V rare, 15-25. Diaphysis of long bone. typically anterior prox tibia. NHx Higher grade (Peri is a very bad boy). Classically shows cartilage. XR punched out lesion, in saucer shaped defect in cortex. Mx WLE, with neoadjuvant and adjuvant chemo. |
|
Ewings |
70% long term survival. Small round cells of uncertain histogenesis. ? neuroectoderm. translocation 11,22. usually second decade 5-30yo. Pain then swelling. Fever, LOW, malaise. XR Diffuse permeative destruction, ext in ST. Codmans, onion skinning, sunburst. Elevated ESR LDH poor prognosis. CT chest, MRI, Bone scan (10% have multiple bone at presentation) Treatment Algorithm similar to OS. Chemo VAAC (Vincristine, actinomycin, adriamycin, Cisplatin) loooking for >95% kill. Survival Mets at diagnosis 40% 5yr, no mets 60%. 5% local recurrence with surgery. |
|
Myloma |
Proliferation of single clone of plasma cells. 50-60yo. Heavy chain (IgG most common, light chains kappa and lamda = Bence Jones proteins) Highly differentiated B cells. Usually bone marrow of entire skeleton involved. Bone pain, fatigue, fever, night sweats. Anaemia, ESR > 100, Bence jones in urine. Serum and urine electrophoresis. XR punched out lytic lesion. widely disseminated = soap bubble appearance. No sclerotic rim. Diffuse osteopenia, Vertebrae plana. Bone scan 25% neg. Skeletal survey. Bone marrow biopsy. sheets plasma cell no stroma. Plasmocytoma - 70% go onto MM. 30% cured by en bloc resection and DXRT. MM - Chemo and Radiotherapy. Surgical stabilisation of pathologic #. MM is very aggressive with early death. |
|
Metastatic disease |
Avoid pathologic #, improve survival, easier to fix 80% malignancies to bone PBL (prostate, breast lung). Kidney, thyroid, GIT 20%. Lytic- lung ,kid, breast, thyroid, GI, neuroblast Mixed - breast, prostate, lung, bladder Blastic - Prostate, breast, bladder, GI. Bone scan is good screen. Dont forget to XR whole bone. Mortality post # lung 100% at 6 mths breast 50% at 6 mths. Mean survival metastatic disease. 50% 6mth. 30% 1yr. |
|
Metastatic prophylaxis |
Principles Need to live longer than recovery. Reconstruct so can FWB Address all areas of bone DXRT post op. Other: Healing is slower than normal bone. DXRT > 14days post op doesnt cause non union. if large lesion >75% augment with PMMA. renal cell = embolise. Chemo can incr infection and blood loss. Healing of pathological fracture without fixation very poor 70% non union. |
|
Metastatic Paeds |
Leukemia Neuroblastoma (Tumour of sympathetic nervous system) Wilms Bone scan |
|
Enneking questions |
Where is it? What is it doing to the bone? expansion, zone What is bone doing to it? periosteal, reactive rim. Any other clues? ST, matrix, bone forming. |
|
Stage local and Systemically |
To accurately define the extent of disease, prior to proceeding with biopsy and definitive treatment. |
|
Biopsy |
To determine Benign or Malignant To determine specific cell type To determine grade Provide representative sample without compromising definitive Rx. To be done at treating hosp (5x compication) Have pathologist on stand by. Traverse single muscle/compartment, which will be removed for WLE. Stay away from NV bundle. Direct approach without going through muscle if possible. Do not go thru NV interval. |
|
Staging Malignant |
1A Low Grade Intra-compartmental 1B Low Grade Extra-compartmental 2A High Grade Intra-compartmental 2B High Grade Extra-compartmental 3 Metastasis |
|
Compartment |
anatomically confining space will resist tumour spread beyond its boundaries. Intra compartment. Intra-osseous, intra fascial compartments, superficial to deep fascia, par-osseous Extra compartment, pelvis, popliteal fossa, axilla, cubital fossa |
|
Staging Benign |
Stage 1 Benign inactive (NOF) Stage 2 Benign active (ABC) Stage 3 Benign aggressive (GCT) |
|
Margins |
Intralesional - within lesion, tumour remains Marginal - within reactive zone Wide - intra compartment and outside reactive zone (Cuff of normal tissue) Radical - Extra compartment. removal of all compartment. Skin < 5cm Wide, >5cm radical. |
|
Limb Salvage |
must have same survival rates must not delay adjuvant treatment reconstruction should be enduring with minimal complications function should approach that achieved by amputation CI: PIN LEG patho #, infection, NV bundle, LLD >8cm, Extensive msucle loss, Good biopsy. |
|
Liposarcoma |
Rarely arise from Lipoma S-100 + almost always subfascial. Painless enlarging mass. 1/2 met to lungs, 1/2 met to non lung sites. Difficult to diff liposarcoma V atypical lipoma. Get sampling errors. Well diif, myxoid, round cell, pleomorphic, de diff WLE. DXRT |
|
Malignant fibrous Histiocytoma |
Pleomorphic spindle cells, storiform pattern. primary malignant bone tumor similar to OS, but has no osteoid. 25% secondary to either bone infarct, pagets, radiation (worse prognosis). Metaphysis, lytic destruciton no bone production. NHx Agressive usually high grade. Fast growing lump, minimal symptoms. Chemo, WLE, Chemo. 50% recurrence, 50% survival 5 yrs. |
|
Clear cell Sarcoma |
Small, arise in conjuction with tendons and aponeuroses. F&A 50% 20-40yrs. Translocation 12:22 Young male lump in foot Clear cell sarcoma or synovial sarcoma. Met lymph and blood. |
|
Others |
Leimyosarcoma - from smooth muscle Fibrosarcoma - Malignant spindle cell. Difficult to diff low grade from fibromatosis. Epithelioid Sarcoma - 50% forarm/wrist often misdiagnosed as ganglion (if not in typical place for gan then be suspicious). |
|
Neurofibrosarcoma |
Malignant schwannoma. Arise from peripheral nerves. 50% have NF. 10% life risk if have NF. Painful enlarging mass. Often presents with neurological symptoms. MRI cannot tell diff between Neurofibroma and one that has transformed to sarcoma. NHx most high grade 5yr 50% survival. Mets to lung and bone. Solitary neruosarcomas have better porg than those associated with NF1. |
|
Rhabdomyosarcoma |
Malignant tumour of striated muscle. Most common malignant ST tumour in children < 15yo. Embryonal, Alveolar, Botryoid, Pleomorphic. Mx Neoadjuvant chemo (**unusal for STS) WLE DXRT. |
|
Synovial sarcoma |
From synovial cells but not found in joints. 20-30yo. Can met to lymph. Classical mineralisation seen on XR. Most common sarcoma of foot. All considered high grade. Translocation X:18 Pre op DXRT the WLE. 70% 5yr. |
|
Origins of sarcoma |
Adipose / LS Fibrous / FS Fibrohistiocytic / MFH Muscle / Leiomyosarcoma / Rhabdosarcoma Synovial / Synovial Sarcoma Nerve / neurofibrosarcoma Bone / Cartilage - Extraskeletal OS & CS Vascular / haemangioendothelioma / angiosarc Other. |
|
Benign soft tissue lesions |
vascular (hemangioma, AVM, lymphangioma, glomus) neurogenic (NF, schwannoma) muscular (leiomyoma) fibroblastic (desmoid tumour, fibromatosis) fat (lipoma) simple cyst PVNS MO |
|
Lipoma Arborescens |
Proliferative synovial condition centre is a lipoma Knee. MRI = synovial proliferation Arthroscopic debridement |
|
PVNS |
Pigmented Villo-Nodular Synovitis Benign inflam process arising from synovial tissue, contains significant amounts hemosiderin Diffuse or localised. Major joints, knee, hip, shoulder. NHx process is progressive, cause destruction cartilage and SC bone resulting in degenrative Arthritis. can cause cystic erosions. MRI characteristic T1, T2 (dark) except if had resent bleed into it) Rx synovectomy open / arthroscopic. |
|
Synovial chondromatosis |
Chondroid metaplasia of synovium. Predilection for large joints. Knee, hip, elbow, shoulder. Mesenchymal cells in joint capsule become chondroblasts instead of fibroblasts form nest of cartilage. Grow and break off float into jt. Arthroscopy early to prevent secondary degeneration. |
|
0- 5 yr |
Malignant Leukemia, metastatic neuroblastoma, metastatic rhabdomyosarcoma Benign OM, osteofibrous dysplasia |
|
10-25 yr |
Malignant OS, Ewings, leukemia Benign EG, OM, Enchondroma, FD |
|
40-80 yr |
Malignant Metastatic disease, myeloma, lymphoma, CS,MFH, pagets sarcoma, radn sarcoma Benign Hyperparathyroidism, pagets, enchondroma, bone infart. |
|
Spinal tumors |
Anterior GCT, Hemangioma, EG, Mets, chordoma, MM Posterior ABC, OO, OB. |
|
Tumours of Neural tissue |
|
|
Tumour questions on Hx (for lump) |
Pain
Systemic features
|
|
Zone of transition |
Geographic Permative Moth eaten Periosteal reaction Onion skinning Start burst Codman |
|
Tumor suppressor gene Rb |
Retinoblatoma, Osteosarcoma. P16INK4a - familial melanoma, Chondrosarcoma, osteosarcoma melanoma. EXT1/2 MHE - Osteochondromas, CS NF1 - sarcoma. |
|
Chromosomal alterations (cytogentics) |
Ewings, PNET - 11;22 EWS, FLI1 Synovial sarcoma X:18 SYT, SSX Clear cell 12;22 EWS,ATF1 |
|
Histology words |
Pleomorphic Polychromatic Mitotic figures. Osteoid pink. look for thin seams of it = malignant osteoid. Cartilage is purple/ blue. cells wide apart. |
|
Parosteal osteoma |
30/40yo. uniform radio dense with broad base, no cortical or medullary invasion. Histo has mature lamellar bone with intact haversian system. |
|
Periosteal chondroma |
Hyaline cartilage on surface of bone. Slow growing no potential of malignancy classic well defined surface lesion create saucerised defect in underlying cortex. edges of lesion have mature buttress (rim) of bone. calcification is variable. |
|
Subungual exotosis |
arise from beneath nail in distal phalanx. Thought to be post traumatic lesions. |
|
CMF |
Chondromyxoid fibroma. benign contain chondroid, fibrous and myxoid tissue. 10-20yo can be older. Thought to arise from remnant of growth plate. Proximal tibia. Meta, eccentric lucent, thinning and expansion of surrounding bone. Sharpe scalloped rim. Shark bite. Look like cartilage on Histo. Curettage BG. Local recurrence rate 10-20%. |
|
Hand and feet soft tissue sarcomas |
Hand - Epithelioid sarcoma Feet - Synovial sarcoma |
|
Biomechanics of lesions |
|
|
Sensativitiy to radation |
Very - myeloma, lymphoma Moderate - breast, lung, bowel, prostateResistant - thyroid, kidney, melanoma |