What are the osteoblastic connective tissue tumors?
What are the cartilage tumors?
What are the bone tumors?
CT tumors:
- osteoid osteoma
- osteosarcoma
Cartilage Tumors:
- enchondromas
- chondromyxoid fibromas
- chondrosarcomes
Bone tumors:
- giant cell (50% benign)
- Chondroblastomas
- Ewings Sarcoma (malignant)
What are red flag sx of bone cancer?
What are red flag sx on XRAY?
night pain, constant pain, unsual sx, no improvement with conservative management, fever, malaise, weakness, night sweats.
Red flag on Xray:
-lytic or blastic bone changes, soft tissue calcification, periosteal rxn.
Tumor Evaluation:
- Imaging
- Labs
- dx test
PE: check for boney tenderness
Xray Bone scan CT MRI CXR/CT for more high risk lesions
Consider labs:
-CBC, calcium, phosphorous, alk phosphate)
Dx: bx
Consult/referral oncologist.
T/F, infection can cross the joint lines but primary tumors do not.
True.
Tx of tumors:
- benign
- possibly malignant
Benign: observation vs excision/curettage
Malignant: referral to CA center. Surgery, often in conjunction with chemo and radiation.
Types of Tumors:
-how do we classify tumors?
Classify:
- bony vs soft tissue
- benign vs malignant
- primary versus metastatic
What are the Malignant Bone tumors?
Osteosarcoma
Ewings
Osteosarcoma:
- MC in what age?
- MC in which gender?
- MC location?
- XRAY findings
- other imaging used.
MC 2nd decade
female = male
MC in appendicular (50% knee)
Xray: mixed lytic/sclerotic with cortical destruction (codmans triangle, star bust, periosteal rxn)
MRI.
Codmans triangle = the triangular area of new subperiosteal bone that is created when a lesion often a tumor raises the periosteum away from the bone.
most lethal?
Ewings:
- MC age
- MC in which bones?
- Xray findings
- survival rates?
MC in 2nd decade of life
MC in long bone diaphyses.
Xray: lytic, moth-eaten, indistinct margins, “Onion skin”**
Survival rate: 80-90% with pre-op chemotherapy.
Soft Tissue Tumors:
- sx
- tx of:
- -small superficial cystic lesion
- -large deep solid tumors
Sx: hx rarely helpful, they just notice a mass.
Small superficial cystic lesion: less than 5cm, usually benign so we observe.
Large deep solid tumor: studies/bx.
May resect: intralesional, marginal, wide, radical
Metastatic Bone Dz:
- what are the MC types of CA to metastasize to the b one?
- MC sites of bone mets
- initial presentation
- tx
Types of CA to metastasize to bone:
-breast, lung, prostate, kidney
MC sites of bone mets:
-spine, ribs, pelvis, proximal limb girdles
Initial presentation: back pain.
Tx:
- assess fracture risk
- maintain function
- palliation
Benign Tumors:
-what are these?
Tumors:
- osteochondroma
- osteoid osteoma
- bone cyst
- nonossifying fibroma
Osteochondroma:
- MC site
- MC in what gender/age
- sx
- course
- dx
- tx
- benign/malignant
MC site is knee or proximal humerus.
MC in males, 2nd and 3rd decade
Sx:
-mechanical problem, compression, space occupying.
Course: stops growing at skeletal maturity
Dx:
-CT or MRI
Tx: completely excise cartilage and perichondrium.
benign
What is the MC benign tumor?
WHat is the MC cause of bone destruction in adults?
Osteochondroma
Metastatic bone dz is the MC cause of bone destruction in adults.
Osteoid Osteoma:
- MC in which age? gender?
- MC location
- describe the lesion
- sx
- dx
- tx
- -benign/malignant
MC in 2nd to 3rd decade
MC in men.
MC location: long bones of lower extremity, cortex, posterior elements of lumbar spine.
Lesion: well demarcated,up to 1cm.
Benign.
Sx:
- dull/sharp pain
- worse at night
- better with aspirin/NSAIDS***
Dx:
-Xray/CT
Tx:
- en bloc resection
- percutaneous radiofrequency ablation
benign
Unicameral bone cyst:
- MC in which age?
- Which gender?
- MC location?
- dx
- tx
- -benign/malignant
this is a fluid filled lesion.
MC in 5-15YO
MC in boys
MC location is proximal humerus
Dx: central radiolucent lesion metaphyseal side of growth plate, long bones.
Tx:
- curettage/graft (20-45% recurrence)
- needle aspiration and several steroid injections. (10% recurrence)
-benign
Fibrous cortical defect/non-ossifying fibroma:
- MC found where?
- tx
- -benign/malignant
Found: metaphysis of long bones (knee)
Tx:
- weakening bone = currettage/graft
- fx = immobilize, observe, sometimes lesions heal.
benign
Enchondromas:
- MC which age
- MC site
- xray findings
- benign or malignant?
MC in young adults
MC site is phalanges and metacarpals
Xray: speckled calcification.
Benign
CHondromyxoid fibroma:
- MC age?
- MC location?
- benign/malignant
Age: adolescents
MC location: tibia, eccentric, metaphyseal
benign
chondrosarcomas:
- MC age
- MC location
- xray findings
- benign/malignant
MC age: greater than 40YO
MC location: central, metaphyseal
xray: calcification
malignant
Giant Cell:
- MC age
- location on bone
- benign/malignant
MC age: young adults
Metaphysis and epiphysis
Benign
Chondroblastoma:
- MC in which age?
- MC where?
- Benign of malignant?
MC 8- skeletal maturity
Epiphysis
Benign
