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28 Cards in this Set

  • Front
  • Back

primary (meaning not from metastasis) bone tumors occur in what age group


#1 bone tumor

osteochondroma; the most common bone tumors are benign

top 2 most common sarcomas

#1 is osteosarcoma, #2 is ewing sarcoma

what about if you are under 5?

most are metastases

what about 20-40?

very few bone tumors occur; most common is giant cell tumor of bone, lymphoma, fibrosarcoma/MFH

what about over 40?

#1 tumor in bone is from metastasis; #1 primary bone tumor is plasma cell myeloma; #1 bone sarcoma is chondrosarcoma

primary bone tumor sites

bone forming tumors= metaphyses, knee, proximal humerus; bone marrow derived tumors/other= diaphysis, pelvis

on x ray what does a benign bone tumor look like

it is surrounded by cortex so either a little white spot surrounded by cortex (osteoid osteoma) or an entirely radioluscent area surrounded by cortex (giant cell tumor)

on x ray what does an aggressive/malignant bone tumor look like

either 'hair standing on end' with codman's triangle (lifting of the cortex) (osteosarcoma) or total destruction with maybe some attempt at onion skinning around the area of annihilation (ewing BUT could also be a nasty infection so be carful (t(11;22))

when you see a solitary bone lesion what is your differential?

neoplasm, OSTEOMYELITIS, cysts, focal dysplasias, metabolic diseases, infarcts

what are the bone forming tumors

osteoma (often on the skull), OSTEOID OSTEOMA (PAIN SYNDROME), osteoblastoma (less pain), OSTEOSARCOMA

osteoid osteoma: age range, where does it arise, symptoms, what does it look like on x ray, differential, treatment

AGE 2-25; cortex of long bones (tibia/femur most common, vertebral column); SEVERE LOCAL PAIN THAT IS WORSE AT NIGHT AND RELIEVED BY ASA/NSAIDS, OCCASIONAL OTHER SYMPTOM COMPLEXES; x ray shows lesional 'nidus' (central radiodensity surrounded by cortex) of immature small bone spicules with cellular bone, <2cm, surrounded by reactive cortical bone; DIFFERENTIAL= INFECTION; treatment= excision

conventional osteosarcoma: age, where does it arise, what does it look like on x ray, treatment, prognosis

HIGH GRADE INTRAMEDULLARY MALIGNANT TUMOR 90% OF OSTEOSARCOMAS; AGE 5-25 CLASSICAL (75% OF CASES); OCCURS IN AREAS OF GREATEST METAPHYSIS (bone making tumor) (so distal femur, proximal tibia, and proximal humerus) AND >50% AROUND THE KNEE; older pts can have it in the flat and long bones; AGGRESSIVE CHANGES ON X RAY; TREATMENT= ADJUVANT (PRE SURGICAL) CHEMO, THEN SURGERY; M0 (NO METASTASIS) 65% LONG TERM SURVIVAL, M1 25% BUT STILL LONG TERM BEFORE RELAPSE; like the metastasize to the lung

osteosarcoma: association

hereditary retinoblastomas (Rb mutation) (germ cell mutation); 100x relative risk for osteosarcoma in their eyes

osteosarcoma: how do you make the dx

radiograph is pretty telling; take a tissue sample and see osteoid (organic bonematrix) made by malignant cells; 'lace' like pattern of osteoid

secondary osteosarcomas: what age, what are they secondary to, prognosis

small peak agter age 50; polyostotic PAGET disease of bone; 60-90% OF OS AFTER AGE 60 BUT STILL VERY RARE; can occur as a result of radiated bone, this is the most common secondary sarcoma in radiated children but very rare; dismal prognosis

osteochondroma/exostosis: what are they, what do they look like

#1 EXCISED BONE LESION; cartilage formation persists in METAPHYSEAL EXOSTOSIS= single (common, NOT familial), multiple (not sommon, familial autosomal domiant 'dysplastic' syndrome, this one can go on to malignancy (chondrosarcoma)); most stop growing at puberty; these are the bones growing out of bones that have connecting marrow spaces

enchondroma: what are they, what do they look like


multiple enchondromatosis: what is it called, is it familial, can it go malignant

OLLIER SYNDROME; NOT FMAILIAL; 30% malignant change (most low grade chondrosarcomas)

chondroblastoma: age, where is it, what does it look like

rare, unique, ADOLESCENT; EPIPHYSES AND APOPHYSES; WELL CIRCUMSCRIBED; chicken wire calcification of cells with poor cartilage formation and lots of giant cells; local joint problems; recur rarely; aka giant cell tumor

chondrosarcoma: age, where is it found, treatment, what is it, how is it graded

#1 BONE SARCOMA >40 Y/O; primary most common; secondary in enchondromas, rare in other preexisting lesions; MOST COMMON IN AXIAL SKELETON/PROXIMAL EXTREMITIES; MANY LOW GRADE LUCKILY; TREATMENT IS SURGICAL; CELLULAR CARTILAGE PERMEATING BONE (how do we tell this apart from endochondroma? histology of the cells); GRADED BY CELLULARITY AND NUCLEAR ATYPIA

ewing sarcoma: age, what does it look like, where is it found, where does it metastasize to, what does it mimic, treatment

#2 PRIMARY SARCOMA IN BONE IN CHILDREN; PERMATIVE lesion with layered periosteal reaction ('ONION SKINNED'); DIAPHYSIS of long bones, PELVIS; >70% less than age 20; mets to lungs, bone, bone marrow; MAY MIMIC INFECTION; treat with surgery and chemo; round blue cell tumor of childhood (kinda like neuroblastoma)

ewing sarcoma: differential

PNETS (peripheral neuroendocrine tumors), other round cell tumors of childhood, OSTEOMYELITITS, eosinophilic granuloma

ewing versis PNETs

both have same translocations T(11;22); call PNET if neural differentiation (rosettes, etc) on microscopy; they may be the exact same thing just acting in different ways

fibrous/fibrohistiocytic lesions: benign versus malignant

benign= non ossifying fibroma/fibrous cortical defects, common defects, beware pathological fracture, fibrous dysplasia; malignant= fibrosarcoma/malignant fibrous histiocytoma (pleomorphic sarcoma), side age/site range, histologically graded, reported in preexisting lesions (infarcts, radiation)

giant cell tumor of bone: age, where is it, what is it

most age 20-40; ENDS OF LONG BONES (epiphyses) 50% knee, SACRUM, vertebral processes; sheets of multinucleated giant cells (like osteoclasts) in plump spindle cell stroma; LOCAL RECURRENCE COMMON, RARE METASTASIS

plasma cell myeloma: age, where is it seen, patterns of growth, diagnosis

#1 primary bone (marrow) tumor >40 y/o; sites= axial skeleton, proximal long bones; patterns= focal lytic (radiolucent) tumorous mass, generalized osteoporosis pattern; diagnosis= SEP/IEP and biopsy; likes the skull too (aka multiple myeloma)

metastatic tumors to bone: labs, where do they come from, what do they look like

over age 40 it is the #1 tumor affecting bone; kids have metastasis from round cell tumors outside bone commonly <5 y/o; variable x ray patterns; RARE below elbows or knees; COMMON IN VERTEBRAL BODIES; elevated alkaline phosphatase (AP) (bone remodeling); HYPERCALCEMIA from bone resorption via PGs, ILs, PTHrP form tumor; most multiple; prostate cancer usually causes BLASTIC lesions; breast cancer usually causes mixed LYTIC/BLASTIC lesions; lung usually causes small cell tumors; classic solitary lytic bone metastases are from the thyroid or renal cell carcinoma