Term
Bone tumors: An abnormal growth of bone that may be noncancerous (benign) or cancerous (malignant)
There are primary tumors, which originate in bone; and, secondary tumors, which originate elsewhere |
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Definition
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Term
| __ bone tumors are more common. Most are painless and ___. |
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Definition
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Term
| 3 types of benign bone tumors: |
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Definition
1. Osteoma- from bone
2. Chondroma- from cartilage
3. Osteochondroma- bone and cartilage, most common |
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Term
| Most common type of benign bone tumor: |
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Definition
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Term
| Signs and symptoms of bone tumors: |
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Definition
- pain (not usually with benign)
- swelling/mass
- redness at site
- fever
- weight loss, decreased appetite
- fatigue
- paralysis
- incontinence
- symptoms related to nerve compression (tingling, numbness, etc.) |
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Term
| Methods of dx bone tumors: |
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Definition
X-rays
CT scans
MRI
Bone scan
Biopsy
Bone marrow
aspiration/biopsy (eg. Ewing Sarcoma) |
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Term
| The x-rays cannot always tell you what kind of tumor it is, CTs are better at seeing the tumor |
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Definition
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Term
| Malignant tumors will show up __ on bone scans. |
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Definition
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Term
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Definition
- Removal of tumor
- Amputation
- Radiation
- Chemotherapy
- Stem cell transplant
- Rehab/physical therapy
- Support groups |
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Term
Many of the tumors present similar on radiographs
Difficult to differentiate each tumor, so the need for special tests help in diagnosis |
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Definition
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Term
| Osteochondromas are benign capped __ outgrowth connected to bone by a stalk, called ___. If there is no stalk, it is called __. These occur in __ bones most commonly at __ and along __ __. |
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Definition
- capped cartilage outgrowth
- pedunculated
- sessile
- long bones
- joints
- growth plates |
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Term
| Osteochondromas are most common at what two sites? |
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Definition
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Term
| These tumors will grow in a child/adolescent and stop growing during maturity: |
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Definition
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Term
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Definition
| Osteocartilaginous exostosis |
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Term
Osteochondromas:
Periodic radiographs
If grows enough to cause mechanical symptoms of muscle, tendon, or other tissues it can be excised
Can compress vessels (rare) and change vascularity
Can compress nerves causing paresthesias
It makes up 35% of benign bone tumors and 9% of all bone tumors
No way to prevent osteochondroma |
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Definition
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Term
| Is there a way to prevent osteochondromas? |
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Definition
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Term
| Osteochondromas are __% inherited and __% random. |
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Definition
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Term
| see slides 13-15 of bone tumors lecture for xrays of osteochondromas |
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Definition
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Term
| Chief complaint that brings patients in with osteochondromas? |
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Definition
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Term
| Surgery indications for osteochondromas: |
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Definition
- pain with activity
- nerve or blood supply pressure
- large cartilage cap |
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Term
| If surgical removal of an osteochondroma is performed, it should be removed at the level of __ __. |
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Definition
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Term
Be familar with this but don't memorize:
Multiple osteochondromatosis is also called multiple osteocartilaginous exostosis, multiple hereditary exostosis (MHE), familial osteochondromatosis, multiple hereditary osteochondromatosis, or diaphyseal aclasia. |
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Definition
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Term
| Osteoid osteomas arise from __ and are highly __ especially in the __. This is a smaller version of an ___. These are less than __cm in diameter. |
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Definition
- osteoblasts
- highly vascularized
- nidus
- osteoblastoma
- less than 1.5 cm in diameter |
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Term
| Osteoid osteomas are most common in __ in the __ , __ __, and __ bones. These tumors cause severe pain at __. |
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Definition
- males
- vertebrae, long bones, and facial bones
- night |
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Term
| Tumor that is most common in males in the vertebrae, long bones, or facial bones? |
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Definition
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Term
| Tumor that is most common in males in the vertebrae, long bones, or facial bones? These cause severe pain at night. |
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Definition
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Term
| X-ray of an osteoid osteoma would show a __ surrounded by __ __. |
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Definition
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Term
| Pt comes in with severe night time bone pain, his x-ray shows a vertebral nidus surrouned by sclerotic bone. Whats going on? |
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Definition
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Term
| Osteoid osteoma pain increases through the day and is worse at night. It is releived with small doses of __. Radiographs may reveal the lesion, but a __ __ is needed to isolate the nidus. These tumors are bone scan __. |
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Definition
- ASA
- CT scan
- bone scan positive |
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Term
| questions to ask if thinking osteoid osteoma? |
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Definition
- fever?
- night pain relieved wth aSA? |
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Term
| see slides 20 and 21 for osteoid osteoma films |
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Definition
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Term
| ___ look like osteoid osteomas but are bigger (between __ and __ cm). Some have features similar to malignant osteosarcomas. Since its larger may cause neuro spine issues. More common in ___. |
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Definition
- Osteoblastoma
- 2-6 cm
- males |
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Term
| Osteoblastomas are most common in males younger than ___ years. These may be associated with __ and are most common in the __ and __ bones. |
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Definition
- younger than 30 years old
- scoliosis
- verebrae
- long bones |
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Term
| Osteoblastoma pain is NOT as severe ast osteoid osteoma pain. Osteoblastoma pain is usually present for __ __, worse at night, and NOT relieved with __. |
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Definition
- several months
- night
- NOT relieved with ASA |
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Term
| Is osteoblastoma or osteoid osteoma more severe pain? Which one is relieved with ASA? |
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Definition
osteoid osteoma more severe pain and relieved wiht ASA
osteoblastoma pain less severe, NOT relieved with ASA |
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Term
| With osteoblastomas, radiographs are important, but a __ is needed to identify lesion edges. MRI NOT needed but can look at __ __ invasion. __ is for definitive diagnosis. Treatment is __ __ __. |
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Definition
- CT- identify lesion edges
- MRI NOT needed- can look at soft tissue invasion
- Biopsy is definitive dx
- complete surgical excision |
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Term
| see slides 25 and 26 of bone tumors ppt for osteoblastoma films |
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Definition
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Term
| Giant cell tumors are __ tumors that destruct __ bone, while the __ remains undisturbed. |
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Definition
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Term
| Giant cell tumors are hard to treat and may recur. They sometimes ___ (even though benign) about __ years after appearance of primary lesion. Sometimes the lung lesions will regress, remain stable, grow slowly, or rapidly grow. |
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Definition
- metastasize
- 3-5 years |
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Term
| Giant cell tumors are more common in __ during the __ decade of life. |
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Definition
- females
- 3rd decade of life (20s) |
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Term
| Soap-bubble appearance on x-ray indicates a __ __ __. |
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Definition
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Term
| Describe the borders of a giant cell tumor? |
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Definition
| - sharp non sclerotic well defined borders |
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Term
| Most common presenting symptom with Giant cell tumor: |
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Definition
| pain (but may also have swelling and decreased ROM) |
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Term
| 50% of giant cell tumors are in the __. |
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Definition
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Term
| Usual locations of giant cell tumors: |
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Definition
- proximal tibia
- distal femur
- proximal humerus
- distal radius |
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Term
| lytic/lucent lesion on epiphysis that usually extends into joint: |
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Definition
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Term
| giant cell tumors may be asymptomatic until a __ __ occurs. |
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Definition
pathologic fracture
If there is a pathologic fracture, let it heal first before treating the tumor. |
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Term
| Surgery for symptomatic giant cell tumors: |
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Definition
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Term
| Any time there is a tumor in the body, it can have several effects on the body…once it starts to have effects, consider excision |
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Definition
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Term
| Giant cell tumors that cannot be excised should get __ therapy. There is concern that these tumors become __ (malignant). |
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Definition
- radiation
- sarcomas (malignant) |
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Term
| With giant cell tumors there is __ destruction but no __ destruction. |
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Definition
- cortical destruction
- NO periosteal destruction |
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Term
| see slides 32 and 33 for giant cell tumors |
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Definition
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Term
| An Enchondroma is a tumor that affects the __ that lines the inside of __. These are __ lesions usually containing __ __ __, except in the phalanges. |
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Definition
- cartilage that lines the inside of bones
- lytic
- calcified chondroid matrix |
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Term
| Bones most often affected by enchondroma: |
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Definition
- miniature long bones of hands and feet
- may also involve femur, humerus, tibia |
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Term
| Enchondromas occur at any age but are most common b/w ages __ and __. Are these more common in males or females? |
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Definition
- 10 and 20 years old
- equal b/w males and females |
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Term
| These tumors are usually asymptomatic and dx is usually incidental or if a fracture occurs through the growth: |
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Definition
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Term
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Definition
- excision> curettage> bone graft
- may not need to excise, follow with xrays b/c can become malignant later |
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Term
| Lucent lesion with chondroid calcifications: |
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Definition
Enchondroma
(very benign but to make pt feel better follow with xrays) |
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Term
| slides 37-39 of bone tumor ppt for films of enchondromas |
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Definition
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Term
| Most benign tumors do NOT require tmt, if they do its just resection. |
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Definition
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Term
| 4 types of malignant bone tumors: |
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Definition
- Osteosarcoma
- Chondrosarcoma
- Fibrosarcoma
- Ewing's Sarcoma
(SARCOMA= MALIGNANT) |
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Term
| Most common malignant bone tumors: |
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Definition
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Term
| Osteosarcomas are the most common malignant bone tumors, these are aggressive. They are of __ origin. |
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Definition
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Term
| 8th most common cause of cancer in children: |
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Definition
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Term
Notes say she won't ask stats, but just in case
Osteosarcoma:
20% of all bone cancers
68% survival rate
90% are located in the metaphysis |
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Definition
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Term
| 4 most common locations for osteosarcoma (from 1 most common to 4 least common). |
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Definition
1. Femur
2. Tibia
3. Humerus
4. Skull, jaw, pelvis |
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Term
| 2 most common age groups for osteosarcoma: |
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Definition
- first peak b/w ages 15 and 30
- second peak in elderly |
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Term
| Osteosarcomas more common in males or females? |
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Definition
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Term
| Elderly with osteosarcoma usually have a hx of __, __ __, or __. |
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Definition
- Paget's
- medullary infarct
- irradiation |
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Term
| First symptom of Osteosarcoma: |
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Definition
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Term
| Osteosarcoma do NOT preserve the periosteum like giant cell tumors do. |
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Definition
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Term
osteosarcomas:
- __ end of humerus
- __ end of tibia
- __ end of femur |
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Definition
- upper end of humerus
- upper end of tibia
- lower end of femur |
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Term
| 3 descriptions of osteosarcomas: |
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Definition
1. fir-tree
2. moth-eaten
3. sun-burst |
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Term
| osteosarcomas tend to recur. |
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Definition
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Term
| Pts with these tumors tend to be misdiagnosed with cysts/muscle problesm and sent to PT without x-rays. DO NOT DO THIS. What bone tumor does this occur with? |
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Definition
Osteosarcomas
DO NOT DO THIS
KNOW THIS |
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Term
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Definition
- x-ray
- CT scan and biopsy for definitive dx |
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Term
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Definition
Treatment goal is limb salvation
Resection and chemotherapy
The more tumor necrosis seen during surgery the worse the prognosis
Despite treatment it has the lowest survival rates for the pediatric cancer patient |
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Term
| cancer with lowest survival rate for pediatric cancer pt? |
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Definition
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Term
| Densely sclerotic lesion at proximal tibia in a child (see slide 51 of bone tumors) makes you think: |
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Definition
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Term
| Densely sclerotic lesion at proximal tibia in a child (see slide 51 of bone tumors) makes you think: |
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Definition
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Term
| Chondrosarcomas occur mostly in __. They form in the __. More common in __ __. Most common in __ and __ bones and __ and __ of arms and legs. Some grow slow and some grow fast. Early dx is __ or __ from minor trauma. |
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Definition
- adults
- cartilage
- older adults
- pelvic and shoulder bones
- metaphysseal and diaphyseal of arms and legs
- incidental or fracture from minor trauma |
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Term
| What two tumors may lead to secondary chondrosarcoma? |
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Definition
| - endochondroma and osteochondroma> secondary chondrosarcoma |
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Term
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Definition
| - excsision and limb salvation |
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Term
| Chondrosarcomas most commonly mets to the __, so follow up is important. |
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Definition
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Term
| chondrosarcomas more common in males or females? |
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Definition
| slightly more common in males 1.5:1 |
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Term
| Fusiform lucent defect with scalloping of inner cortex and periosteal reaction on radiographs: |
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Definition
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Term
| Fibrosarcomas are made from fibrous connective tissue and are characterized by proliferating __. Thes are more common in __ ages _ to __. These involve the __ and overlying __ and long and flat bones. Most commonly in __ and __. |
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Definition
- fibroblasts
- males ages 30-40
- periosteum and overlying muscle
- knee and femur |
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Term
| A secondary fibrosarcoma arises from a __ __ of __ and has a __ prognosis. These to mets to the __. |
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Definition
- prior lesion of radiation
- poor prognosis
- mets to the lungs |
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Term
| Fibrosarcomas affect the __ extremities the most, especially the __ and __. |
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Definition
lower
tibia and fibular
(KNOW- green in notes) |
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Term
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Definition
- excision of tumor and preserve tissue
- pre and post surgery radiation
- follow up for min of 5 years with xrays at site and lungs
- 60% recurrence rate, but with radiation chance is 25% |
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Term
| Ewing Sarcoma is a __ __ __ tumor found in bone and soft tissue. Most common in __ __. |
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Definition
- malignant round cell tumor
- male teenagers
KNOW THIS |
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Term
| 2nd most common malignant tumor in children in adolescents: |
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Definition
EWING SARCOMA
TEST KNOW THIS |
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Term
| Ewing sarcoma is difficult to classify b/c its __ and __ in origin. |
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Definition
| mesodermal and ectodermal |
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Term
| Ewing Sarcoma common locations: |
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Definition
- pelvis
- femur
- ribs
- clavicle
- growth plates |
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Term
EwinMesoderm is the outer layer of the early embryo and forms bone, cartilage, muscle, connective tissue, middle layer of the skin, glands, reproductive, GU, and vascular systems
Ectoderm is the outer layer of the early embryo and differentiates to form the nervous system, tooth enamel, and epidermisg Sarcoma: |
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Definition
| sure hope we don't need to know that... |
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Term
| Ewing Sarcoma is due to __ __ that occurs __ birth for no reason, it is NOT __. Peaks b/w ages __ and __. |
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Definition
- chromosomal exchange
- after birth
- NOT inherited
- 10 and 20 |
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Term
| Ewings sarcoma is mc in diaphysis of femur, then tibia, then humerus |
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Definition
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Term
| Presentation of Ewings Sarcoma (KNOW THIS): |
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Definition
extreme bone pain
30% present with mets (usually lungs, bone and/or bone marrow, sometimes CNS and lymph nodes) |
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Term
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Definition
Treatment is excision, radiation, chemotherapy, limb salvage/amputation
may do stem cell transplant
physical therapy |
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Term
Ewing sarcoma 5 year survival rate is 70-80% with chemotherapy
Long term survival is 10% |
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Definition
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Term
| Permeative lytic lesion with periosteal reaction (onion skin): |
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Definition
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Term
| Ewing sarcoma shows __ on xrays/MRIs. |
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Definition
SAUTERIZATION (KNOW THIS TEST)
slides 71-73 of bone tumor ppt for picts |
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Term
Tumors that derive from cartilage – known as chondromas
Tumors that derive from bone – blastomas
Tumors that derive from connective tissue – fibromas
Many of the bone tumors are difficult to differentiate from other bone tumors
Most tumors are benign |
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Definition
Most important treatment is preservation of tissues and limb salvage; and, in some cases (malignancies) increasing survival rates
Bone tumors can occur in any age group
Ewing Sarcoma occurs more frequently in children and adolescents and has a high mortality rate |
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