Tumors/Pathology Lists > Goldstein List > Flashcards

Goldstein List Flashcards

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1
Q
  1. Tumour incidence in orthopaedic surgery (highest → lowest) (5)
A
  • Metastatic disease
  • Benign soft tissue
  • Benign bone
  • Malignant soft tissue
  • Malignant bone
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2
Q
  1. Bone tumour presenting complaints (4)
A
  • Soft tissue mass
  • Incidental finding
  • Painless bony mass
  • Painful bone lesion
  • Pathologic fracture
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3
Q
  1. Enneking classification of malignant bone tumors (5)
A
  • IA: low grade, intracompartmental
  • IB: low grade, extracompartmental
  • IIA: high grade, intracompartmental
  • IIB: high grade, extracompartmental
  • III: metastatic
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4
Q
  1. Enneking classification of benign bone tumors (3)
A
  • 1: latent
  • 2: active
  • 3: aggressive
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5
Q
  1. AJCC staging of bone sarcomas (4)
A
  • Stage I: low grade
    o A: < 8 cm
    o B: > 8 cm
  • Stage II: high grade
    o A: < 8 cm
    o B: > 8 cm
  • Stage III: “skip metastases” in the same bone
  • Stage IV: distant metastases
    o A: pulmonary
    o B: non-pulmonary (including other bones
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6
Q
  1. AJCC soft tissue sarcoma staging (4)
A
  • Stage I: low grade
  • Stage II: high grade
  • Stage III: high grade, deep, large (T2b)
  • Stage IV: metastatic
    o T:
     1 - ≤ 5 cm
     2 - > 5 cm
     a – superficial
     b – deep
    o N: nodal involvement
    o M: distant metastasis
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7
Q
  1. Most common metastatic tumors to bone (5)
A
  • Breast
  • Lung
  • Thyroid
  • Prostate
  • Renal cell
  • (B.L.T. with Pickle on Rye)
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8
Q
  1. Principles of biopsy (9)
A
  • Longitudinal incision
  • in line with definitive resection
  • Approach soft tissue mass or weakened bone
  • Avoid N/V structures
  • Don’t raise flaps
  • Through muscle
  • Avoid joints, growth plates and neurovascular structures
  • Frozen section to confirm lesional tissue
  • Meticulous hemostasis
  • Drain as needed distal and in-line with wound
    Bonus: oval window in bone if needed.
    Send tissue for culture if infection is on the differential

Never biopsy a fracture (pathology mimics osteosarcoma)

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9
Q
  1. Tumour suppressor syndromes (6)
A
  • Familial melanoma (p161NK4a – melanoma, osteosarcoma and chondrosarcoma)
  • Familial adenomatous polyposis (APC – colonic adenomas and desmoids tumours)
  • Hereditary retinoblastoma (RB – retinoblastoma and osteosarcoma)
  • Li-Fraumeni syndrome (p53 – osteosarcomas and breast cancer)
  • Multiple hereditary exostosis (EXT1/2 – osteochondromas and chondrosarcomas)
  • Neurofibromatosis (neurofibromin – neurofibromas and sarcomas)
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10
Q
  1. Findings of McCune Albright syndrome (4)
A
  • Polyostotic fibrous dysplasia
  • Cafe-au-lait spots (“Coast of Maine”)
  • Precocious puberty
  • Endocrine abnormalities
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11
Q
  1. Diagnostic criteria for Neurofibromatosis Type 1 (Von Recklinghausen’s disease) – requires 2 of 7 cardinal features (7)
A
  • > 6 cafe-au-lait spots (“Coast of California” 15 mm in adults/5 mm in kids)
  • ≥ 2 Lisch nodules (#2)
  • Axillary freckling (Crowe’s sign)
  • ≥ 2 neurofibromas or 1 plexiform neurofibroma
  • Optic glioma
  • a distinctive osseous lesion such as sphenoid dysplasia or thinning of long bone cortex with or without pseudarthrosis.
  • First degree relative with NF-1 as per these criteria
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12
Q
  1. Steps involved in the metastatic cascade (7)
A
  • Proliferation
  • Angiogenesis
  • Detachment
  • Dissemination
  • Adherence
  • Extravasation
  • Proliferation
  • (P.A.D.D.A.E.P.)
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13
Q
  1. Signs of hypercalcemia (10)
A
  • Early (5)
    o Polyuria
    o Polydypsia
    o Anorexia
    o Weakness
    o Fatigue
  • Late (5)
    o Nausea/vomiting
    o Psychiatric problems
    o Vision problems
    o Cardiac abnormalities
    o Coma
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14
Q
  1. Multiple Bone lesion
A

Malignant
-Metastatic
-Multiple myeloma
Benign
-Familial osteochondromatosis
-Ollier’s (multiple enchondromas)
-Maffucci’s (enchondromas and hemangiomas)
-fibrous dysplasia (McCune-Albright)
-EG
Non-Tumor
-multifocal osteomyelitis
-Paget’s

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15
Q
  1. Epiphyseal lesions (3 + others)
A
  • Chondroblastoma
  • GCT
  • Clear cell chondrosarcoma (MALIGNANT)– NEED TO RULE THIS OUT IN AN ADULT!
  • Telangiectatic osteosarcoma
  • Infection (Brodie’s abscess)
  • EG
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16
Q
  1. Metaphyseal lesions (8)
A
  • Malignant (4)
    o Malignant fibrous histiocytoma
    o Osteosarcoma
    o Chondrosarcoma
    o Metastases
  • Benign (4)
    o Osteochondroma
    o NOF
    o ABC
    o UBC
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17
Q
  1. Diaphyseal lesions
A
  • Adamantinoma
  • Eosinophilic granuloma
  • Infection/Fracture/Callus
  • Osteoid osteoma/Osteoblastoma
  • Ewing’s sarcoma
  • Myeloma/lymphoma/fibrous dysplasia
  • (A.E.I.O.U. and sometimes Y.)
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18
Q
  1. Lesions with circumferential bone involvement (3)
A
  • Infection
  • Lymphoma
  • Ewing’s sarcoma
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19
Q
  1. Surface bone lesions (5)
A
  • Parosteal osteosarcoma
  • Periosteal osteosarcoma
  • Periosteal chondroma
  • Myositis ossificans
  • Sessile osteochondroma
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20
Q
  1. Cortically-based lesions (3)
A
  • Adamantinoma
  • Chondromyxoid fibroma
  • Non-ossifying fibroma
  • Osteofibrous dysplasia
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21
Q
  1. Flat bone tumours (5)
A
  • Hemangioma
  • Fibrous dysplasia
  • Chondrosarcoma
  • Ewing’s sarcoma
  • Metastases
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22
Q
  1. Lesions of the vertebral body (9)
A
  • Infection
  • GCT
  • Hemangioma
  • Metastases
  • Multiple myeloma/plasmacytoma
  • Lymphoma
  • Chondrosarcoma
  • Osteosarcoma
  • Ewing’s
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23
Q
  1. Lesions of the posterior elements of the vertebra (3)
A
  • Aneurismal bone cyst
  • Osteoid osteoma
  • Osteoblastoma

Note: Anterior spine = mets, myeloma, neurofibroma, hemangioma, GCT, EG, TB infection

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24
Q
  1. Benign latent lesions (6)
A
  • Enchondroma
  • Eosinophilic granuloma
  • Infection
  • Non-ossifying fibroma
  • Osteochondroma
  • Unicameral bone cyst
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25
25. Benign aggressive lesions (5/6)
- Osteoblastoma - Chondroblastoma - Aneurysmal bone cyst* - Giant cell tumour - Chondromyxoid fibroma *think about telangiectatic osteosarcoma
26
26. “Bubbly” lesions in the pediatric tibia
- Adamantinoma - Fibrous dysplasia - Osteofibrous dysplasia - NOF
27
27. Malignant-looking lesions in peds:
- Osteosarcoma - Ewing’s - Infection - EG - Leukemia
28
28. Sacral tumours (5)
- Metastases - Aneurysmal bone cyst - Chordoma - Giant cell tumour - Ewing’s
29
29. Lesions on both sides of a joint (8)
- Hemophilia - Infection - Pannus (inflammatory arthropathy – RA) - PVNS - CPPD (pseudogout) - Arthritis - Tuberculosis - Synovial chondromatosis - (H.I.P.P. C.A.T.S.)
30
30. Tibial lesions in kids with a benign osteoblastic periosteal response (3)
- Stress fracture - Osteoid osteoma - Infection
31
31. Pediatric malignant-looking lesions (6)
- Osteosarcoma - Ewing’s sarcoma - Hematologic malignancy (leukemia/lymphoma) - Metastases (rhabdomyosarcoma/Wilm’s tumor/neuroblastoma/retinoblastoma) - Infection - Eosinophilic granuloma
32
32. Bone-forming tumours (4)
- Osteoid osteoma - Osteoblastoma - Osteoma - Osteosarcoma
33
33. Cartilage-forming tumours (6)
- Enchondroma - Osteochondroma - Chondroblastoma - Chondromyxoid fibroma - Periosteal chondroma - Chondrosarcoma
34
34. Fibrous tumors of bone (5)
- Non-ossifying fibroma - Fibrous dysplasia - Osteofibrous dysplasia - Fibrosarcoma - Malignant fibrous histiocytoma of bone
35
35. Vascular lesions of bone (3)
- Hemangioma - Hemangioendothelioma - Angiosarcoma of bone
36
36. Lytic lesions with coarse trabeculae (5)
- Aneurysmal bone cyst - Hemangioma - Sarcoidosis - Paget’s disease - Fibrous dysplasia
37
37. Small round blue cell tumours (8)
- Ewing’s sarcoma/PNET - Leukemia - Lymphoma - Metastatic neuroblastoma/retinoblastoma/Wilm’s - Multiple myeloma - Rhabdomyosarcoma - Hepatoblastoma - Desmoplastic round cell tumour
38
37. Small round blue cell tumours by age
By age: <5: leukemia, neuroblastoma 5-10: EG 5-30: Ewing’s >50: Multiple myeloma
39
38. Lytic lesions of bone in patients > 40 years old (7)
- Metastatic disease - Myeloma - Lymphoma - Infection - GCT - Hyperparathyroidism - Primary bone tumors
40
39. Lesions associated with secondary ABC (6)
- Chondroblastoma (30%) - Osteoblastoma (25%) - Non-ossifying fibroma - Fibrous dysplasia - GCT - CMF
41
40. Lesions causing mineralization of soft tissue (9)
- ***Benign*** o Lipoma o Hemangioma o Myositis ossificans o Synovial chondromatosis o Pseudogout (CPPD) o Calcific tendonitis - ***Malignant*** o Synovial sarcoma o Liposarcoma o Angiosarcoma
42
41. Diseases that can present with multiple soft tissue masses (5)
- Neurofibromatosis - Hemangiomas (Mafucci’s) - Myxomas (Mazabraud’s) - Lymphoma - Liposarcoma
43
42. Deep soft tissue tumors (7)
- Benign (4) o Lipoma o Hemangioma o Myxoma o Peripheral nerve sheath tumour - Benign aggressive (2) o Fibromatosis o Hemangiopericytoma - Malignant (1) o Soft tissue sarcoma - (4,2,1)
44
43. Soft tissue sarcomas that metastasize to lymph nodes (5)
- Synovial sarcoma - Clear cell sarcoma (melanoma of soft parts) - Angiosarcoma - Rhabdomyosarcoma - Epithelioid sarcoma - (S.C.A.R.E.)
45
44. Soft tissue tumors that are bright on STIR
- Schwannoma - Cysts - Myxoid liposarcoma
46
45. Types of oncologic surgical margins (4)
- Intralesional - Marginal - Wide - Radical
47
46. Tumour reconstruction options (4)
- Endoprosthesis - Osteoarticular/intercalary allografts - Allograft-prosthetic composites - Vascularized fibular autograft
48
47. Indications for excision of an osteochondroma (6)
- Soft tissue inflammation - Frequent traumatic injury - Cosmetic abnormality - Causing deformity - Nerve/vascular irritation - Concern for malignant transformation
49
48. Risk factors for malignant transformation of an osteochondroma (6)
- Multiple lesions - Proximal lesions - Recurrent lesions - Growth after skeletal maturity - Painful lesions - Cartilage cap > 2 cm thick
50
49. Principles of osteochondroma excision (4)
- Extensile incision to visualize entire base - Do not disturb the cartilage cap - Amputate lesion at base of stalk - Don’t take too much cortical bone to prevent fracture
51
50. Indications for amputation in musculoskeletal oncology (5)
- Negative margins cannot be achieved with limb salvage - Morbidity of limb salvage too high - Limb salvage will not give adequate function - Tumor unresponsive to neoadjuvant chemo/radiation - Involvement of a major neurovascular bundle
52
51. Osteosarcoma chemotherapy (4)
- Doxorubicin - Methotrexate - Adriamycin - Cis-platinum - Ifosfamide - (M.A.C.I.)
53
52. Ewing’s sarcoma chemotherapy (4)
- Cyclophosphamide - Adriamycin - Vincristine - Dactinomycin - (C.A.Ve.D)
54
53. Soft tissue sarcomas that respond to chemotherapy (5)
- Synovial sarcoma - Ewing’s/PNET - Angiosarcoma - Rhabdomyosarcoma - Extraskeletal Osteosarcoma - (S.E.A.R.O.)
55
54. Complications of radiation therapy (7)
- Growth arrest - Joint contractures - Fibrosis - Fracture (osteopenia) - Radiation dermatitis - Wound healing problems - Secondary malignancy
56
55. Principles of surgical treatment of metastatic disease (7)
- Careful patient selection - Address all areas of weakened bone - Immediate stability of constructs - Adequate durability of constructs - Preoperative embolization for vascular tumours - Cement for bone defects - Cemented arthroplasty components
57
56. Advantages of prophylactic stabilization of metastatic lesions (6)
- Decreased morbidity - Decreased Perioperative pain - Shorter OR - Faster recovery - Shorter hospital stay - Ability to co-ordinate care with oncology team
58
57. Components of Mirel’s Criteria for prophylactic stabilization of long-bone metastases (4)
- Pain (mild, moderate, mechanical) - Appearance (blastic, mixed, lytic) - Shaft involvement (< 1/3, 1/3-2/3, > 2/3) - Site (UE, LE, peritrochanteric) - (P.A.S.S.)
59
58. Indications for resection and megaprosthetic replacement for subtrochanteric metastases (5)
- Periarticular destruction precluding internal fixation - Displaced pathologic fracture - Radio-resistant lesion - Solitary lesion - Salvage of failed internal fixation
60
59. Poor prognostic factors for Ewing’s sarcoma (6)
- Location (spine/pelvis) - Elevated LDH - Size > 100 cm3 - < 90% necrosis with neoadjuvant chemotherapy - Metastatic disease at presentation - Non-pulmonary metastases
61
60. Poor prognostic factors for osteosarcoma (6)
- Higher stage (#1) - Elevated LDH - Elevated alkaline phosphatase - < 90% necrosis with neoadjuvant chemotherapy - Pelvic location - Secondary tumour (radiation, Paget’s)
62
61. Prognostic factors for soft tissue sarcoma (6)
- Grade (#1) - Metastases - Size of tumor (> 5 cm) - Depth of tumor (subfascial) - Location of tumor (axial) - Histopathologic subtype (“bad actors” – same ones that go to lymph nodes and Ewing’s)
63
62. Risk factors for malignant transformation of enchondroma (5)
- Large - Lytic with bone expansion - Cortical thinning - Painful - Soft tissue mass
64
63. Signs predictive of chondrosarcoma vs. enchondroma (7)
- Large size - Axial location (pelvis) - Older patient - Multiple lesions - Hot on bone scan - Pain (especially at night) - Local recurrence
65
64. Indications for biopsy of an enchondroma (4)
- Change in size - Pain - Permeative lysis - Endosteal erosion
66
65. Risk factors for local recurrence of ABC after surgical treatment (5)
- Young age - Open physes - Stage (Campanacci staging system I-V) - Type of surgical removal - Resulting margin
67
66. Campanacci staging of aneurysmal bone cysts (5)
- Type I: central cyst with intact bone profile - Type II: central cyst with enlarged bone - Type III: eccentric cyst with minimal bone expansion - Type IV: subperiosteal cyst with superficial cortical erosion - Type V: cortical destruction with cyst expansion into the soft tissues
68
67. Campanacci staging of giant cell tumors (3)
- Stage I: benign latent lesion with normal bone morphology - Stage II: benign active lesion with cortical expansion - Stage III: benign aggressive lesion with cortical disruption
69
68. XR findings of Telangiectatic osteosarcoma (6)
- Expansile lesion - Metaphysis/epiphysis (epicentre is the metaphysis) - Geographic lysis - Wide zone of transition - Osteoid matrix - Internal septations and fluid-fluid levels
70
69. Glomus triad:
a. Pain b. Cold intolerance c. Purple d. Xray shows dorsal shelled out lesion
71
70. Rad Sensitive Tumours:
a. Myeloma b. Lymphoma c. Leukemia d. Breast e. Prostate f. Lung
72
71. Rad Resistant:
a. Thyroid b. Renal c. GI d. Melonoma
73
72. Synovial Tumors (3):
a. PVNS b. lipoma arborescens c. synovial chondromatosis d. also need to consider synovial sarcoma
74
73. Common translocations:
a. 11:22 – Ewing’s b. 9:22 – Chondrosarcoma c. X:18 – Synovial sarcoma d. 12:22 – clear cell sarcoma e. 12:16 – myxoid liposarcoma
75
75. Surface lesions:
a. parosteal osteosarcoma b. myositis ossificans c. ?periosteal sarcoma
76
76. Metastatic pattern with lymph nodes spread: “SCARE”
a. Synovial sarcoma b. Clear cell sarcoma c. Angiosarcoma d. Rhabdomyosarcoma e. Epithelial sarcoma
77
77. “Classic locations”
a. Chordoma – sacrum b. Enchondroma – phalanges c. Chondrosarcoma – pelvis
78
78. Standard chemotherapy regimen for bone sarcoma (4 – MACI):
a. Methotrexate b. Adriamycin/doxorubicin c. Cisplastin d. Iphopsphamide
79
79. Standard chemotherapy regimen for soft tissue sarcomas (2):
a. Adriamycin/doxorubicin b. Iphosphamide
80
Epiphyseal lesions:
clear cell chondrosarcoma, GCT, chondroblastoma
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