Tumour

Front 1

Diaphyseal lesion

Back 1

HALFEE

- Histiocytoma

- Adamantinoma

- leukemia

- FD

- EG

- Ewings

Front 2

Epiphyseal lesion in adults

Back 2

- chondroblastoma

- GCT

- clear cell chondrosarcoma

- infection

- telangiectatic osteosarcoma

Front 3

UBC V ABC on XR

Back 3

ABC

- eccentric (v central)

- width > physis

Front 4

Osteochondroma Transformation risk

Back 4

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.

Front 5

Osteochondroma Transformation risk

Back 5

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.

Front 6

Osteosarcoma - Rosen in vivo response

Back 6

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

Front 7

Bloods test for Sarcoma / Mets / Unknown lesion

Back 7

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)

Front 8

ABC

Back 8

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.

Front 9

Adamantinoma

Back 9

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.

Front 10

Benign Fibrous Histiocytoma

Back 10

Older patient.

Lytic lesion with sclerotic rim.

Benign foam cells, lipid filled.

Curettage and BG.

Front 11

Chondroblastoma

Back 11

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.

Front 12

Chondromyxoid fibroma

Back 12

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.

Front 13

Eosinophilic Granuloma

Back 13

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.

Front 14

Eosinophilic Granuloma sub groups

Back 14

E-H-L

• EG 70% 5-20yo only osseous.
• Hand-Schuller-Christian (20%) Multiple EG, widespread with diabetes insipidus, exopthalmos, skull defect, large spleen, liver, skin lesions, pulm disease. 10% die.
• Letterer-Siwe disease (10%) < 1yo. Fulminant course all die.
  

Front 15

Fibrous cortical defect

Back 15

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.

Front 16

Fibrous dysplasia

Back 16

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.

Front 17

McCune Albrights syndrome

Back 17

Triad

Fibrous dysplasia

Cafe-au-lait spots (Coast of maine)

Precocious puberty.

Front 18

GCT

Back 18

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.

Front 19

Haemangioma

Back 19

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.

Front 20

Haemangioma Associations

Back 20

• Klippel Trenaunay Weber Syndrome - Hemihypertrophy secondary to angiogensis. usually unilateral.
  
• Maffucci syndrome
  
• Sturge - weber - Congenital, often facial malformations. Hemiatrophy, mental retardation.
  

Front 21

Metaphyseal enchondroma

Back 21

metaphsis of cortex long bones.

Prox humerus.

Difficult to DDx from chondrosarcoma.

NHx doesnt ossify, remains as immature cartilage. No malignant potential.

Front 22

Unicameral bone cyst

Back 22

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.

Front 23

Bone infarct

Back 23

Divers, Sickle cell, long term steroid

MFH may arise from long term bone infarcts.

Front 24

Enchondroma

Back 24

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.

Front 25

Olliers

Back 25

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.

Front 26

Maffuccis syndrome

Back 26

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.

Front 27

Enostosis

Back 27

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.

Front 28

Melorheostosis

Back 28

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.

Front 29

Osteochondroma

Back 29

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).

Front 30

Multiple hereditary exostosis

Back 30

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.

Front 31

Nora's

Back 31

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%).

Front 32

Osteoblastoma

Back 32

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.

Front 33

Osteoid osteoma

Back 33

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.

Front 34

Osteoma

Back 34

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)

Front 35

Chondrosarcoma

Back 35

Malignant cartilage tumour.

Primary (de novo), secondary (osteochondroma/ enchondroma).

Diagnostic dilemma diff low grade from enchondroma (sapmling errors)

Varients

• Dedifferentiated - very aggressive, most die <2yrs.
• Clear cell - epip young males (varient chondroblastoma), low grade, slow mets rare. WLE.
• Mesenchymal - rare , young, extra skeletal, high metastatic potential. Surgery and Chemo.

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%.

Front 36

Osteosarcoma

Back 36

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.

Front 37

Secondary causes OS

Back 37

Paget's

previous radiotherapy

OM

Fibrous Dysplasia

Chondrosarcomatous dedifferentiation

Front 38

Lichenstein pathological classification OS

Back 38

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.

Front 39

OS algorithm

Back 39

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

Front 40

OS chemo

Back 40

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.

Front 41

Parosteal OS

Back 41

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.

Front 42

Periosteal OS

Back 42

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.

Front 43

Ewings

Back 43

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.

Front 44

Myloma

Back 44

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.

Front 45

Metastatic disease

Back 45

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.

Front 46

Metastatic prophylaxis

Back 46

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.

Front 47

Metastatic Paeds

Back 47

Leukemia

Neuroblastoma (Tumour of sympathetic nervous system)

Wilms

Bone scan

Front 48

Enneking questions

Back 48

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.

Front 49

Stage local and Systemically

Back 49

To accurately define the extent of disease, prior to proceeding with biopsy and definitive treatment.

Front 50

Biopsy

Back 50

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.

Front 51

Staging Malignant

Back 51

1A Low Grade Intra-compartmental

1B Low Grade Extra-compartmental

2A High Grade Intra-compartmental

2B High Grade Extra-compartmental

3 Metastasis

Front 52

Compartment

Back 52

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

Front 53

Staging Benign

Back 53

Stage 1 Benign inactive (NOF)

Stage 2 Benign active (ABC)

Stage 3 Benign aggressive (GCT)

Front 54

Margins

Back 54

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.

Front 55

Limb Salvage

Back 55

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.

Front 56

Liposarcoma

Back 56

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

Front 57

Malignant fibrous Histiocytoma

Back 57

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.

Front 58

Clear cell Sarcoma

Back 58

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.

Front 59

Others

Back 59

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).

Front 60

Neurofibrosarcoma

Back 60

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.

Front 61

Rhabdomyosarcoma

Back 61

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.

Front 62

Synovial sarcoma

Back 62

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.

Front 63

Origins of sarcoma

Back 63

Adipose / LS

Fibrous / FS

Fibrohistiocytic / MFH

Muscle / Leiomyosarcoma / Rhabdosarcoma

Synovial / Synovial Sarcoma

Nerve / neurofibrosarcoma

Bone / Cartilage - Extraskeletal OS & CS

Vascular / haemangioendothelioma / angiosarc

Other.

Front 64

Benign soft tissue lesions

Back 64

vascular (hemangioma, AVM, lymphangioma, glomus)

neurogenic (NF, schwannoma)

muscular (leiomyoma)

fibroblastic (desmoid tumour, fibromatosis)

fat (lipoma)

simple cyst

PVNS

MO

Front 65

Lipoma Arborescens

Back 65

Proliferative synovial condition centre is a lipoma

Knee.

MRI = synovial proliferation

Arthroscopic debridement

Front 66

PVNS

Back 66

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.

Front 67

Synovial chondromatosis

Back 67

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.

Front 68

0- 5 yr

Back 68

Malignant

Leukemia, metastatic neuroblastoma, metastatic rhabdomyosarcoma

Benign

OM, osteofibrous dysplasia

Front 69

10-25 yr

Back 69

Malignant

OS, Ewings, leukemia

Benign

EG, OM, Enchondroma, FD

Front 70

40-80 yr

Back 70

Malignant

Metastatic disease, myeloma, lymphoma, CS,MFH, pagets sarcoma, radn sarcoma

Benign

Hyperparathyroidism, pagets, enchondroma, bone infart.

Front 71

Spinal tumors

Back 71

Anterior

GCT, Hemangioma, EG, Mets, chordoma, MM

Posterior

ABC, OO, OB.

Front 72

Tumours of Neural tissue

Back 72

• Neurilemoma (benign schwannoma) nerve sheath tumor, no sx except mass, tumour grows. MRI eccentric mass from peripheral nerve. Composed of Antoni A and B.
• Neurofibroma - single or multiple. superifical slow growing painless. 1/2 associated with NF. in major nerve can cause expansion in fusiform manner (tumour in nerve). histo = wavey. marginal excision often causes further loss of function. MRI target sign.
• Neurofibromatosis - AD, skeletal abnormalities. Malginant change occurs in 10%. Pain and enlarging = transformation.
• Neurofibrosarcoma - either de novo or in NF. High gradesarcoma.

Front 73

Tumour questions on Hx (for lump)

Back 73

Pain

• Deep like tooth ache
• intermittent progressing to all time?
• Increasing in intensity
• Night / unrelenting?
• NSAIDs opioids?
• 1-3mths high grade/6-24mths low grade.

Systemic features

• Fever
• LOW
• Malaise

Front 74

Zone of transition

Back 74

Geographic

Permative

Moth eaten

Periosteal reaction

Onion skinning

Start burst

Codman

Front 75

Tumor suppressor gene Rb

Back 75

Retinoblatoma, Osteosarcoma.

P16INK4a - familial melanoma, Chondrosarcoma, osteosarcoma melanoma.

EXT1/2 MHE - Osteochondromas, CS

NF1 - sarcoma.

Front 76

Chromosomal alterations (cytogentics)

Back 76

Ewings, PNET - 11;22 EWS, FLI1

Synovial sarcoma X:18 SYT, SSX

Clear cell 12;22 EWS,ATF1

Front 77

Histology words

Back 77

Pleomorphic

Polychromatic

Mitotic figures.

Osteoid pink. look for thin seams of it = malignant osteoid.

Cartilage is purple/ blue. cells wide apart.

Front 78

Parosteal osteoma

Back 78

30/40yo.

uniform radio dense with broad base, no cortical or medullary invasion.

Histo has mature lamellar bone with intact haversian system.

Front 79

Periosteal chondroma

Back 79

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.

Front 80

Subungual exotosis

Back 80

arise from beneath nail in distal phalanx.

Thought to be post traumatic lesions.

Front 81

CMF

Back 81

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%.

Front 82

Hand and feet soft tissue sarcomas

Back 82

Hand - Epithelioid sarcoma

Feet - Synovial sarcoma

Front 83

Biomechanics of lesions

Back 83

1. When length of longitudinal defect in bone exceeds 75% of its diameter there is a 90% reduction in torsion strength.
2. centred cortical defect 50% = 60% bending strength reduction.
3. eccentric cortical defect 50% = 90% bending strength reduction.

Front 84

Sensativitiy to radation

Back 84

Very - myeloma, lymphoma

Moderate - breast, lung, bowel, prostateResistant - thyroid, kidney, melanoma