Midterm

Question 1

Giants Cell Tumor:

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 1

• Appearance/ Special Features:
  Lytic. Subchondral Extension
• Symptoms:
  Most produce pain/Swelling
• DDX:
  Chondroblastoma

-Malignant Potential:
Quasimalignant (20% malig)

-Refer?:
Yes

Question 2

Osteochondroma

• Appearance/ Special Features:
• Symptoms:
• Malignant Potential:
• Refer?:

Answer 2

• Appearance/ Special Features:
  Exostosis. Cortex and Trabecular bone continuous with underlying bone.
• Symptoms:
  None

-Malignant Potential:
1* Solitary
20* Multiple

-Refer?:
No

Question 3

Hemangioma

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 3

• Appearance/ Special Features:
  Vertebrae: Vertical Striations
• Symptoms:
  None
• DDX:
  Pagets

-Malignant Potential:
None

-Refer?:
No

Question 4

Osteoma

• Appearance/ Special Features:
• Symptoms:
• Malignant Potential:
• Refer?:

Answer 4

• Appearance/ Special Features:
  Skull or sinus; opaque; surface
• Symptoms:
  None

-Malignant Potential:
None

-Refer?:
No

Question 5

Bone Island

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 5

• Appearance/ Special Features:
  Thorny/Brush border
• Symptoms:
  None

-Malignant Potential:
None

-Refer?:
No

Question 6

Osteoid Osteoma

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 6

• Appearance/ Special Features:
  Opaque with <1cm nidus
• Symptoms:
  Pain relieved by asprin
• DDX:
  Osteoblastoma, Brodie’s abscess

-Malignant Potential:
None

-Refer?:
Yes

Question 7

Osteoblastoma

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 7

• Appearance/ Special Features:
  Lytic, expansile in spine; variable sclerosis in other locations.
• Symptoms:
  Pain

- DDX:
Osteoid Osteoma (Bigger nidus= Osteoblastoma)

-Malignant Potential:
None

-Refer?:
Yes

Question 8

Enchondroma

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 8

• Appearance/ Special Features:
  Lytic; calcification in 50%; common in phalanx
• Symptoms:
  None
• DDX:
  Chondrosarcoma if lesion is larger and closer to spine.

-Malignant Potential:
1* solitary
25-50* multiple

-Refer?:
No

Question 9

Chondroblastoma

• Appearance/ Special Features:
• Symptoms:
• DDX:
• Malignant Potential:
• Refer?:

Answer 9

• Appearance/ Special Features:
  Epiphysis; calcification in 50%
• Symptoms:
  None
• DDX:
  GCT

-Malignant Potential:
None

-Refer?:
Yes

Question 10

FCD: NOF

• Appearance/ Special Features:
• Symptoms:
• Malignant Potential:
• Refer?:

Answer 10

• Appearance/ Special Features:
  Within cortex; eccentric, small, sclerotic margin
• Symptoms:
  None

-Malignant Potential:
None

-Refer?:
No

Question 11

Simple Bone Cyst

• Appearance/ Special Features:
• Symptoms:
• Malignant Potential:
• Refer?:

Answer 11

• Appearance/ Special Features:
  Lytic, Central
• Symptoms:
  None

-Malignant Potential:
None

-Refer?:
Yes

Question 12

Aneurysmal Bone Cyst

• Appearance/ Special Features:
• Symptoms:
• Malignant Potential:
• Refer?:

Answer 12

• Appearance/ Special Features:
  Expansile
• Symptoms:
  Pain

-Malignant Potential:
None

-Refer?:
Yes

Question 13

Painful lesion of posterior elements in younger patients

DDX:

Answer 13

Osteoid Osteoma (sclerotic)
Osteoblastoma (lytic)
Aneurysmal Bone Cyst (lytic)

Question 14

DDX for sclerotic tumor with nidus.

Answer 14

Oteoid Osteoma (<1cm Nidus)
Osteoblastoma (>2cm Nidus)

Question 15

(T/F) All blastomas are painful and require referral.

Answer 15

True

• Chondroblastoma
• Osteoblastoma

Question 16

DDX:

Lytic neoplasm of epiphysis

Answer 16

Giants Cell

Chondroblastoma

Question 17

How do you tell Giant Cell Tumors from Chondroblastomas.

Answer 17

Chondroblastoma

• Epiphysis before growth plate closes (young).
• May have sclerotic margin
• May have calcification

Giant Cell Tumor

• After growth plate closure (20-40)
• No calcification or sclerotic margin.
• Mostly in metaphysis, but extends into epiphysis.

Question 18

How do you differentiate between Giant Cell Tumor and Aneurysmal Bone Cyst.

Answer 18

Age mostly.
ABC= 5-20
Giant Cell= 20-40

Question 19

Benign Tumors that produce pain

Answer 19

Osteoid Osteoma
Osteoblastoma
Chondroblastoma
Aneurysmal Bone Cyst
GCT (quasimalignant)

Question 20

Benign Tumors that DONT produce pain

Answer 20

Osteochondroma
FCD/NOF
Simple Bone Cyst
Enchondroma
Hemangioma
Bone Island
Osteoma

Question 21

All benign tumors are <30 y.o except _

Answer 21

Hemangioma (>40)
Bone Island (Any)

Question 22

Which Benign Tumors do you refer out?

Answer 22

Osteoblastoma
Chondroblastoma
Osteoid Osteoma
Aneurysmal Bone Cyst
Simple Bone Cyst
GGT

Question 23

DDX Ivory Vertebra

Answer 23

Mets
Pagets
Lymphoma (least common)

Question 24

4 Most common Primary Malignancies of bone and their age groups

Answer 24

Multiple Myeloma (50-70)
Osteosarcoma (10-25)
Chondrosarcoma (40-60)
Ewings Sarcoma (10-25)

Question 25

DDX: Large, Geographic, Lytic lesion of proximal femoral metaphysis extending into diaphysis. A thin sclerotic margin seen at the proximal margin of the lesion. Refer?

Answer 25

Simple Bone Cyst Enchondroma NOF Fibrous Dysplasia Yes, refer incase of pathologic fx.

Question 26

Who do you refer to if there is a risk of a pathologic fracture in a solitary lesion?

Answer 26

Orthopedic surgeon.

Question 27

What are the benign lesions that are painful?

Answer 27

``` Chondroblastoma Osteoid osteoma Osteoblastoma Giant Cell Tumor Aneurysmal Bone Cyst ```

Question 28

What benign tumors do you refer out?

Answer 28

``` Chondroblastoma Osteoid osteoma Osteoblastoma Giant Cell Tumor Aneurysmal Bone Cyst Simple Bone Cyst ```

Question 29

Aggressive Signs

Answer 29

``` Cortical Destruction Moth eaten or permeative lytic Soft Tissue Mass Aggressive Periosteal response -Multiple Laters -Spiculated -Codman Triangle Large ```

Question 30

Painful Scoliosis DDX

Answer 30

Osteoid Osteoma ABC Osteoblastoma

Question 31

Primary Malignancy between the age 10-20 DDX

Answer 31

Osteosarcoma | Ewing Sarcoma

Question 32

Primary malignancy between the age of 20-35 DDX

Answer 32

Hodgkin Lymphoma

Question 33

Labs to look for primary malignancy

Answer 33

``` ESR Serum Calcium (lytic) Alkaline Phosphatase (blastic) ```

Question 34

Most common route for metastasis

Answer 34

Hematogenous (blood)

Question 35

Lab changes seen in Multiple Myeloma

Answer 35

``` Anemia Elevated ESR Serum Proteins Bence Jones proteins in urine Rouleaux formation ```

Question 36

What is the big risk with Solitary Plasmacytoma?

Answer 36

70% develop multiple myeloma within 5 years

Question 37

Mets: Age= Appearance= Location=

Answer 37

Age= 40+ Appearance= Multiple bones/lesions Location=Axial skeleton

Question 38

Multiple Myeloma Age/Location: Diagnositic Criteria:

Answer 38

Age/Location: Same as mets | Diagnositic Criteria: Proteins

Question 39

Plasmacytoma Solitary form of _ Age= Appearance=

Answer 39

Solitary form of Multiple Myeloma Age= Younger (not young) Appearance= Lytic, Bubbly, Expansile.

Question 40

Primary malignancy in young that mimics infection

Answer 40

Ewings sarcoma

Question 41

Treatment for Pagets?

Answer 41

Reduce bone resorption with calcitonin - Gives pain relief. Supportive braces

Question 42

Deformities seen with Pagets

Answer 42

``` Shepherds crook Sabre Shin Basilar Invagination Protrusio Acetabuli Leontiasis ossea Genu Varum ```

Question 43

Most common complication of Pagets

Answer 43

Pathologic Fracture

Question 44

``` Stages of Pagets Stage 1: Stage 2: Stage 3: Stage 4: ```

Answer 44

Stage 1: Osteolytic, destructive Stage 2: Combined, mixed Stage 3: Sclerotic, Ivory Stage 4: Malignant degeneration (coarsened trabeculae, thickened cortex, bone expansion.